Temporary inactive status on renal transplant waiting list: causes, risk factors, and outcomes

Approximately 30% of all patients listed for a kidney transplant in the United States are on inactive status. The consequences of temporary inactivation and rates of transplantation in this group of patients have not been reported. We undertook a retrospective cohort study at our transplant center examining all patients listed between 2001 and 2007. We examined the rate of inactivation, risk factors, duration, and outcomes including transplantation rates and patient survival while on the waiting list and after transplantation. There were 436 patients included in the analysis; 322 (73.9%) were never inactivated and 114 patients (26.1%) were temporarily inactive. The most common causes for inactivation were cardiovascular and suspected malignancy. Time to reactivation was similar among different causes. Waiting times for transplantation (excluding time of inactivation) was 18.7 ± 0.9 versus 39.9 ± 2.3 months for active compared with temporarily inactive patients (log-rank P < .0001). Sixty-five percent of patients were reactivated within 24 months. Approximately one-third of patients were never reactivated. Patient survival was similar among both groups. Temporary inactivation is an independent risk factor for a prolonged waiting time even if time of inactivation is not accounted for. Effective strategies for monitoring patients temporarily inactive on the waiting list should be developed.