Variations in the assessment practice for renal transplantation across the United Kingdom.
BACKGROUND
To investigate whether there are any variations in the evaluation of adult candidates for cadaveric renal transplantation among transplant centers in the United Kingdom.


METHODS
An online survey of transplant units in the United Kingdom, including nephrologists, surgeons, and transplant coordinators, measured differences in the assessment process and evaluation of patient's age, body mass index (BMI), cardiovascular comorbidity, and viral serology.


RESULTS
A response was received from 20 out of the 23 centers (87%). These centers perform 90% of all renal transplants in the United Kingdom. In 30% of the units, there is no formal transplant assessment clinic. There is no cutoff age limit for assessment across the United Kingdom, but 12 centers (60%) exclude patients with a high BMI, with a median cutoff BMI of 35. Eight out of the 20 centers do not give cytomegalovirus (CMV)-negative patients the option to receive kidneys from a CMV-positive donor. Hepatitis C antibody-positive donors are not used in 50% of the units. There is considerable variation in the investigation of cardiovascular disease and exclusion criteria based on cardiovascular status of the patients. Five units have no consistent policy of re-evaluating patients once they are listed.


CONCLUSIONS
There is evidence, from this study, of significant variations in the assessment of patients for renal transplantation across the United Kingdom. Further research and better-defined guidelines are required for a uniform assessment process and to ensure equity of access to the renal transplant waiting list.
Akolekar
Deepika
D
Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Oniscu
Gabriel C
GC
Forsythe
John L R
JL
D015992:Body Mass Index; D002319:Cardiovascular System; D041981:Gastrointestinal Tract; D006801:Humans; D016030:Kidney Transplantation; D017063:Outcome Assessment, Health Care; D012699:Serology; D006113:United Kingdom; D014850:Waiting Lists