Pruthi, Rishi, Tonkin-Crine, Sarah, Calestani, Melania, Leydon, Geraldine, Eyles, Caroline, Oniscu, Gabriel C., Tomson, Charles, Bradley, Andrew, Forsythe, John L., Bradley, Clare, Cairns, John, Dudley, Christopher, Watson, Christopher, Draper, Heather, Johnson, Rachel, Metcalfe, Wendy, Fogarty, Damian, Ravanan, Rommel and Roderick, Paul J. (2018) Variation in practice patterns for listing patients for renal transplantation in the United Kingdom : a National Survey. Transplantation, 102 (6). pp. 961-968. doi:10.1097/TP.0000000000002046 ISSN 1534-6080.

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Abstract

Introduction

Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether centre variation exists in the assessment of patients for renal transplantation in the UK.

Methods

An online survey, informed by qualitative interviews, was distributed to all UK renal centres. This survey examined centre approaches to chronic kidney disease service provision, transplant recipient assessment, education provision and wait-listing decision making processes. Centre re-evaluation policies for patients already listed and priorities for future development were also examined.

Results

All 71 renal centres responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of centres transplantation was not discussed as a treatment option with all patients. Fourteen centres reported having a dedicated transplant assessment clinic whilst 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cut off at 75 years. 83% of centres excluded patients with a high BMI. Cardiac investigations were risk-stratified in 90% of centres. Surgical involvement varied with 11% of centres listing patients without formal surgical review. There was no formal protocol in place to re-evaluate listed patients in 62% of centres.

Conclusions

There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which centre-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Kidneys -- Transplantation -- Patients -- Interviews -- Great Britain, Kidneys -- Transplantation -- Regional disparities -- Great Britain
Journal or Publication Title:	Transplantation
Publisher:	Lippincott Williams & Wilkins
ISSN:	1534-6080
Official Date:	1 June 2018
Dates:	Date Event 1 June 2018 Published 5 December 2017 Available 1 November 2017 Accepted
Volume:	102
Number:	6
Page Range:	pp. 961-968
DOI:	10.1097/TP.0000000000002046
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	6 February 2018
Date of first compliant Open Access:	1 June 2019
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID RP-PG-0109-10116 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272
Contributors:	Contribution Name Contributor ID Research Group ATTOM Investigators, UNSPECIFIED

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