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1. Discuss the state of the science on advance care planning and palliative care consultation in kidney transplant candidates and recipients
2. Describe the prevalence and racial and ethnic disparities of advance care planning and palliative care consultation in kidney transplant candidates and recipients
3. Propose solutions and interventions for the racial disparities and low prevalence of advance care planning and palliative care consultation among kidney transplant candidates and recipients
Among patients listed for kidney transplant (KT), 27% die or are removed from the waitlist. Many KT recipients will need another transplant in their lifetime; therefore, both candidates and recipients experience high mortality and symptom burden. These patients could benefit from palliative care (PC) and advance care planning (ACP), but it is unclear how many and which patients receive ACP and PC.
To estimate prevalence of ACP and PC by age and race among adult KT candidates and recipients.
Among 2,579 KT candidates and 1,234 KT recipients (12/2008-2/2020), we assessed the presence of ACP and PC through chart review. ACP and PC correlates were identified via multivariable logistic regression.
KT candidates’ and recipients’ mean ages were 55 and 53 years, respectively; 46.6% and 40.5% were Black. 21.4% of candidates had ACP; prevalence was higher in older (18-64 years = 19.9%, 65+ = 25.7%) and White candidates (White = 24.4%, Black = 19.1%, Hispanic = 15.0%, other race = 21.0%). 34.9% of recipients had ACP; similarly, older (18-64 years = 31.7%, 65+ = 47.1%) and White (White = 39.5%, Black = 31.2%, Hispanic = 26.3%, other = 26.6%) patients had higher prevalence. After adjustment, older age (OR = 1.85, 95% CI 1.35-2.53) and Black race (OR = 0.68, 95% CI 0.51-0.91) were associated with ACP only among KT recipients. PC prevalence was 4.3% in candidates and 5.1% in recipients and higher in older candidates (18-64 years = 3.8%, 65+ = 5.6%, p = 0.046) and recipients (18-64 years = 3.8%, 65+ = 10.0%, p < 0.001). After adjustment, only Black race (OR = 0.65, 95% CI 0.42-0.99) was associated with PC in candidates, while only older age (OR = 2.47, 95% CI 1.38-4.41) was associated with PC in recipients.
KT candidates and recipients experience a lower prevalence of ACP and PC compared to patients with chronic illness in the United States. Importantly, significant racial and ethnic disparities exist in ACP.
PC remains underutilized among KT candidates and recipients, more so for Black and Hispanic patients, and may improve symptom burden and ACP.
© 2022 Published by Elsevier Inc.