Table 1.

Thematic Analysis of Individual Responses on Perceived Barriers to Coordinate Approach to Cardiovascular Screening of Kidney Transplant Candidates

Theme	Responders	Volume ≤ 100 Responders	Volume > 100 Responders	Representative Quotes
Unclear goal of screening	8	3 (38%)	5 (62%)	-“The absence of a common language and presence of common goals for a collaborative effort between cardiology and transplant nephrology teams.” -“Surgeon preference: if the patient doesn’t have a negative stress test in the past year, the patient is passed over.” -“The outcome of interest needs to shift toward 5-year survival after transplantation, as death with functioning graft remains the #1 reason for graft loss.”
Challenge in clinical decision making	9	5 (56%)	4 (44%)	-“High pretest probability of CAD in many of our patients and the lack of reliability with noninvasive CAD testing.” -“Predictive values of current modalities are limited.” -“Previous studies on optimal medical management have not included patients with advanced CKD.”
Contrast and kidney function preservation	8	3 (38%)	5 (62%)	-“Concern for contrast-induced nephropathy.” -“Effect of contrast and its toxicity are overestimated.”
Health care delivery systems factors	10	2 (20%)	8 (80%)	-“Evaluations are not always done at the transplant center, but by outside cardiology groups.” -“[Patients are] managed by multiple nephrologists/dialysis units over a wide area with different practice patterns.” -“Distance and insurance.”
Transplant program and provider variability	9	5 (56%)	4 (44%)	-“Ingrained local practices of care.” -“Within-center variability among providers.”
Regulatory restraints	5	2 (40%)	3 (60%)	-“Close monitoring of outcomes data by various agencies (UNOS/CMS) that discourage risk taking.” -“Risk aversion of transplant programs in the current environment.”
Logistic challenges of a clinical trial	7	4 (57%)	3 (43%)	-“Need funding for multicollaborative trials in this field.” -“Need long follow-up to see if interventions prior to transplant make a difference.” -“Dual antiplatelet therapy precludes transplantation for at least 6-12 months.”

Note: Each respondent (N = 40) may have responses that touch on multiple themes and the numbers therefore add up to more than 40.

Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease; CMS, Centers for Medicare & Medicaid Services; UNOS, United Network for Organ Sharing.