{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:59:00Z","timestamp":1781816340108,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007812","name":"University of Washington","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007812","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007911","name":"University of California, San Diego","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007911","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>There is broad agreement among the US public, medical community, and policy community on a top priority to expand kidney transplantation to more patients while promoting quality and equity. How to achieve these goals within existing health systems is the key question. Essential to successful kidney transplantation is a proper pretransplant medical evaluation. However, an increasing body of evidence suggests that this process can be burdensome to patients and caregivers, resource\u2010intensive for transplant programs and the healthcare system, and potentially perpetuate inequity in transplant access\u2014all factors running counter to the objectives of improving transplant access. A strategy of systematically reducing the number or intensity of testing procedures\u2014or de\u2010escalation\u2014that is supported by available medical evidence and clinical consensus holds promise as a potential avenue to improve transplant access. In this perspective, we outline the rationale for de\u2010escalation of portions of the pretransplant medical evaluation for kidney transplantation, apply an implementation science framework to systematically examine the barriers and facilitators for de\u2010escalation, and finally lay out a blueprint for how de\u2010escalation may be achieved in an efficacious, safe, and sustainable manner.<\/jats:p>","DOI":"10.1111\/ctr.70494","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T14:35:50Z","timestamp":1773066950000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["De\u2010Escalating Medical Evaluation for Kidney Transplantation: A Potential Avenue to Improve Access to Kidney Transplantation"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0542-8749","authenticated-orcid":false,"given":"Xingxing S.","family":"Cheng","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine Stanford University  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-1517","authenticated-orcid":false,"given":"Larissa","family":"Myaskovsky","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine University of New Mexico School of Medicine  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3814-1920","authenticated-orcid":false,"given":"Neeraj","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine Robert Wood Johnson Medical School  New Brunswick New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9174-8038","authenticated-orcid":false,"given":"Catherine R.","family":"Butler","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine and the Kidney Research Institute University of Washington  Seattle Washington USA"},{"name":"Veteran Affairs Health Systems Research Center of Innovation for Veteran\u2010Centered and Value\u2010Driven Care  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Center for Medicare and Medicaid Services.ESRD Quality Incentive Program: Technical Specifications for ESRD QIP Measures. Accessed September 1 2023 https:\/\/www.cms.gov\/medicare\/quality\/end\u2010stage\u2010renal\u2010disease\u2010esrd\u2010quality\u2010incentive\u2010program\/technical\u2010specifications\u2010esrd\u2010qip\u2010measures."},{"key":"e_1_2_10_3_1","unstructured":"Center for Medicare and Medicaid Services.Increasing Organ Transplant Access (IOTA) Model. Accessed June 24 2024 https:\/\/www.cms.gov\/priorities\/innovation\/innovation\u2010models\/iota."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2024.03.017"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000441"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.37526\/1526-744X.2022.49.5.397"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.04.008"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2016.11.011"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.0043"},{"key":"e_1_2_10_10_1","first-page":"3","article-title":"The Evaluation of Renal Transplant Candidates: Clinical Practice Guidelines","volume":"2001","author":"Kasiske B. L.","year":"2001","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003136"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.08.039"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)93010-K"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.05.033"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915925"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.001"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0005282021"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2020.04.006"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17031"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4852"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6388"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14796"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.6653"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.06.011"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000271"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003002"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.1847"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2017.12.004"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001104"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(08)34030-6"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012\u2010020\u201001041\u20108"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.01.020"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2019.05.008"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182408812"},{"key":"e_1_2_10_35_1","unstructured":"Organ Procurement and Transplantation Network.OPTN Enhanced Transplant Program Performance Metrics. Published Online2022. Accessed June 22 2022 https:\/\/optn.transplant.hrsa.gov\/media\/r5lmmgcl\/mpsc_performancemetrics_3242022b.pdf."},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.2668"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.13383"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.32772"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70494","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70494","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70494","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:34:24Z","timestamp":1781814864000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/ctr.70494"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70494","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70494"}}