Expedited Main Obstacles of Prekidney Transplant Workup: A Quality Improvement Study
Bibliographic record
Abstract
Background: Failure to complete a comprehensive pre-kidney transplant workup in a timely fashion results in increased dialysis exposure, poorer post-transplant survival, and higher resource demands. Candidates undergo workup by our transplant program post-referral rather than by their dialysis programs. We aimed to assess quality metrics at our program, focusing on variability in the duration of pre-transplant workup after adopting a more frequent and scheduled chart review process by our newer coordinator to expedite pre-transplant workup. Methods: This is a retrospective study evaluating the duration and obstacles of the pre-kidney transplant workup of all candidates evaluated at our transplant program between January 1, 2021, and December 31, 2022, after adopting a more regular chart review process by our coordinator, with a follow up until March 1, 2024. Data were also compared with historical candidates’ workup evaluated at our program before January 1, 2021. Results: 101 candidate’s files were reviewed [Mean age 55.4±13.1 years, female (42.6%), Caucasian (76.2%)]. By March 1, 2024, 86.1% of candidates were on dialysis, with 79.3% of those on dialysis by the time of assessment. 78 (77.2%) candidates received a transplant decision while 23 patients stayed in workup, including 5 candidates who were referred, after completing their workup, to another center for combined organ transplantation. Median time from assessment to transplant decision was significantly shorter with more regular pre-transplant chart review at 12.8 (7.2-20.4) months, compared with historical candidates’ workup of 23.3 (14.3-37.1) months (P <0.001). At the time of transplant decision, 64 (63.4%) patients were on dialysis (12 on dialysis <1 year). Median time from dialysis to transplant decision was 24.1 (12.3-43.2) months, compared with historical candidates’ time of 31.6 (5.9-52.4) months (P 0.89). Dialysis vintage can be reduced further with earlier referral to transplant since median time from dialysis to initial assessment was longer in our cohort, 7.9 (2.9-32.1) months, compared with historical candidates’ time of 5.6 (-7.0-20.8) months (P 0.12). Conclusion: Frequent and scheduled chart review of pre-transplant candidates results in shorter workup and dialysis vintage.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.032 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".