대한신장학회

논문분류	춘계학술대회 초록집
제목	Roles and Responsibilities of Nephrologists at Pre-transplant Period: Current State in Thailand
저자	Nuttasith Larpparisuth
출판정보	2022; 2022(1):
키워드
초록	Kidney transplantation (KT) significantly prolongs survival and improves quality of life in end-stage kidney disease (ESKD) patients. Transplant outcomes in Thailand are extremely favorable and comparable to western countries. The expenses of KT surgery, rejection treatment and lifelong immunosuppression have been reimbursable for all Thai citizens since 2008. The number of KT in Thailand has gradually increased over the period. However, number of patients on the waitlist is also growing substantially more, especially after implementation of universal coverage for dialysis policy. The policy of our country currently allows only preemptive living donor KT, but not with deceased donor due to unmet needs in number of donors. During pre-transplant period in Thailand, ESKD patients are referred from general nephrologists to transplant centers which located in the capital Bangkok or major cities in each region. The referral process is performed based on personal connection of nephrologists and catchment area of each transplant centers. The transplant nephrologist, in conjunction with transplant team evaluates referred candidates to determine suitability for KT. The transplant nephrologist principally performed medical workup and specialist consultation (if required) to ensure that the candidates are eligible for transplantation. The Thai Transplantation Society provides the Thai guideline for KT candidates evaluation in 2020, however, workup processes are slightly different in details among each center. The decision to put a candidate on waitlist at a transplant center depends on a transplant committee, of which the transplant nephrologist is a key person. After approval, the serum of candidate will be sent monthly to Thai Red Cross Society which is responsible for deceased donor kidney allocation. Wait time begins from the time of dialysis initiation. Mean wait time in our country for deceased donor KT is around 5 years. While on the waitlist, candidates are reevaluated by the transplant team, mainly transplant nephrologist. Several transplant centers in Thailand set up pre-KT clinic to review medical records, request additional laboratory testing, and assess fitness of candidates for transplantation. Even of universal coverage for KT, the ratio of candidates on waitlist to overall ESKD patients below the age of 65 was only 8%. There are still multiple hindrances for pre-transplant evaluation and waitlist process among Thai ESKD patients, such as traveling expense, a negative attitude towards KT, and/or lack of interest in KT due to misunderstanding or the long waiting time. However, the deceased donor campaigns and upcoming policy for promotion of pre-emptive KT collaborated by the Thai Red Cross Society, Thai Transplant Society and The Ministry of Public Health will increase access to KT and better health for Thai ESKD patients.
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