Eligibility and average waiting time for cadaveric kidney transplantation in the State of Qatar: a national study

Background Kidney transplantation is the most effective treatment for patients with end-stage kidney disease (ESKD), offering significantly improved long-term survival compared to dialysis. However, the limited availability of donor kidneys and the risks associated with immunosuppressive therapy can hinder access to transplantation. In this study, we aim to assess the outcomes of patients referred for kidney transplant evaluation in Qatar, determine the causes and factors associated with patients’ rejection from the waiting list, determine the average waiting time from listing to cadaveric kidney transplantation, and identify factors associated with having a cadaveric kidney transplantation. Methods We retrospectively studied adult patients with ESKD who were referred to Hamad General Hospital for kidney transplant evaluation between January 1, 2003, and December 31, 2017. All data were collected from a national electronic medical record system. Factors associated with undergoing cadaveric transplantation were determined using multivariate analysis. Results A total of 1201 adult patients were referred for kidney transplant evaluation during the study period. Eight-hundred and thirty five patients (69.5%) completed the transplant work-up and were discussed by the transplant committee for suitability to undergo kidney transplantation. Of them, 797 patients (95.4%) were fit for kidney transplantation, while 38 patients (4.6%) were rejected, primarily due to old age or severe cardiovascular disease. Three hundred and sixty one out of the 797 patients (45.3%) fit for kidney transplantation had living kidney transplantation and the remaining 436 were added to the cadaveric kidney transplant waiting list. During the study period, 84 patients (19.3%) had cadaveric kidney transplantation with an average waiting time from listing to transplantation of 1.79 ± 1.71 years, while 59 patients (13.5%) died. Having peritoneal dialysis as the primary dialysis modality was identified as the only independent predictor of cadaveric transplant (p = 0.003). Conclusion This study provides a comprehensive analysis of kidney transplant evaluations and outcomes in Qatar. Most patients were deemed suitable for kidney transplantation; however, older age and cardiovascular disease were the primary barriers to listing. The average waiting time for cadaveric transplantation in Qatar was relatively short compared to global averages with peritoneal dialysis being key predictor of receiving a cadaveric kidney transplant. Assessing the outcomes of kidney transplantation and determining factors contributing to different outcomes is essential to improve access to kidney transplantation and optimize patient outcomes.