MARYAM PAKFETRAT, ALİREZA SHAKER, LEİLA MALEKMAKAN, NAKİSA RASAEİ
Experimental and Clinical Transplantation - 2024;22(10):760-766
Objectives: End-stage renal disease is a health concern around the world. Kidney transplant substantially improves survival compared with dialysis. Although kidney transplant is the better choice for treatment of end-stage renal disease, most patients refuse this option. In this study, we aimed to find the most common reasons why patients did not undergo a kidney transplant. Materials and Methods: We conducted a cross-sectional study involving 263 patients on chronic hemodialysis in hemodialysis centers in Shiraz, Iran, in 2024. We collected data via structured interviews, which had questions on demographics, disease characteristics, dialysis details, and reasons for transplant refusal. P < .05 was considered significant. Results: In our study cohort, mean age was 60.2 ± 16.8 years and 57.8% were male patients. The most prevalent reason for refusing kidney transplant was patient-centric barriers for kidney transplant (47.7%); difficulties with the transplant process included financial concern (33.7%), unacceptability of outcomes (30.2%), and worries about the unpredictability of transplant outcome (24.1%). The mean age of patients on the kidney transplant waiting list was 51.7 ± 16.4 years, and mean age of those who declined a kidney transplant was 60.2 ± 16.8 years (P < .001). Among patients on the waiting list, 68.7% were married compared with 81.7% of patients who declined a kidney transplant (P = .011). Conclusions: Addressing financial concerns by possibly improving insurance coverage, enhancing patient education on transplant benefits and risks, and providing psychological support can potentially increase acceptance rates. Tailored interventions focusing on individual patient concerns and improving communication between health care providers and patients are essential.
