Variation between centres in access to renal transplantation in UK: longitudinal cohort study.
OBJECTIVE
To assess whether equity exists in access to renal transplantation in the UK after adjustment for case mix in incident patients with end stage renal disease.


METHODS
Longitudinal cohort study.


METHODS
UK Renal Registry and UK Transplant Registry.


METHODS
All incident renal replacement treatment patients (n=16 202) from 65 renal centres submitting data to the UK Renal Registry between 1 January 2003 and 31 December 2005, followed until 31 December 2008 (or until transplantation or death, whichever was earliest).


METHODS
Proportion of incident dialysis patients at each renal centre who were registered on the national transplant list; time taken to achieve registration; and proportion of patients subsequently transplanted.


RESULTS
We found that recipients' age, ethnicity, and primary renal diagnosis were associated with the likelihood of accessing the waiting list or receiving a transplant. After adjustment for case mix, significant inter-centre variability existed in access to the transplant list (change in -2LogL=89.9, df=1, P<0.001), in the time taken to register patients on the waiting list (change in -2LogL=247.4, df=64, P<0.001), in receipt of a renal transplant from a donor after brain stem death (change in -2LogL=15.1, df=1, P=0.001), and in receipt of a renal transplant from a living donor or a donor after cardiac death (change in -2LogL=46.1, df=1, P<0.001).


CONCLUSIONS
Significant variation in access to renal transplantation exists between centres within the UK that cannot be explained by differences in case mix.
Ravanan
R
R
Richard Bright Renal Unit, Southmead Hospital, Bristol BS10 5NB. Rommel.Ravanan@nbt.nhs.uk
Udayaraj
U
U
Ansell
D
D
Collett
D
D
Johnson
R
R
O'Neill
J
J
Tomson
C R V
CR
Dudley
C R K
CR
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D018570:Risk Assessment; D006113:United Kingdom; D014850:Waiting Lists; D055815:Young Adult