Chapter 13: Centre variation in access to renal transplantation in the UK (2004-2006)

Abstract

Background: Renal transplantation is recognised as being the optimal treatment modality for many patients with end stage renal disease. This analysis aimed to explore the equity of access to renal transplantation in the UK. Methods: Transplant activity and waiting list data were obtained from NHS Blood and Transplant, demographic and laboratory data were obtained from the UK Renal Registry. All incident RRT patients starting treatment between 1st January 2004 and 31st December 2006 from 65 renal centres were considered for inclusion. The cohort was followed until 31st December 2008 (or until transplantation or death, whichever was earliest). Results: Age, ethnicity and primary renal diagnosis were associated with both accessing the kidney transplant waiting list and receiving an organ. A patient starting dialysis in a non-transplanting renal centre was less likely to be registered for transplantation (OR 0.90, 95% CI 0.82-0.99) or receive a transplant from a donor after cardiac death or a living kidney donor (OR 0.69, 95% CI 0.60-0.79) compared with patients cared for in transplanting renal centres. Once registered for kidney transplantation, patients in both transplanting and nontransplanting renal centres had an equal chance of receiving a transplant from a donor after brain stem death (OR 0.92, 95% CI 0.78-1.08). Conclusion: There is wide variation in access to kidney transplantation between UK renal centres which cannot be explained by differences in case mix. Copyright © 2011 S. Karger AG, Basel.