title: Barriers to living donor kidney transplantation in the United Kingdom: a national observational study.
abstract: BACKGROUND
  Living donor kidney transplantation (LDKT) provides more timely access to transplantation and better clinical outcomes than deceased donor kidney transplantation (DDKT). This study investigated disparities in the utilization of LDKT in the UK.
  
  
  METHODS
  A total of 2055 adults undergoing kidney transplantation between November 2011 and March 2013 were prospectively recruited from all 23 UK transplant centres as part of the Access to Transplantation and Transplant Outcome Measures (ATTOM) study. Recipient variables independently associated with receipt of LDKT versus DDKT were identified.
  
  
  RESULTS
  Of the 2055 patients, 807 (39.3%) received LDKT and 1248 (60.7%) received DDKT. Multivariable modelling demonstrated a significant reduction in the likelihood of LDKT for older age {odds ratio [OR] 0.11 [95% confidence interval (CI) 0.08-0.17], P < 0.0001 for 65-75 years versus 18-34 years}; Asian ethnicity [OR 0.55 (95% CI 0.39-0.77), P = 0.0006 versus White]; Black ethnicity [OR 0.64 (95% CI 0.42-0.99), P = 0.047 versus White]; divorced, separated or widowed [OR 0.63 (95% CI 0.46-0.88), P = 0.030 versus married]; no qualifications [OR 0.55 (95% CI 0.42-0.74), P < 0.0001 versus higher education qualifications]; no car ownership [OR 0.51 (95% CI 0.37-0.72), P = 0.0001] and no home ownership [OR 0.65 (95% CI 0.85-0.79), P = 0.002]. The odds of LDKT varied significantly between countries in the UK.
  
  
  CONCLUSIONS
  Among patients undergoing kidney transplantation in the UK, there are significant age, ethnic, socio-economic and geographic disparities in the utilization of LDKT. Further work is needed to explore the potential for targeted interventions to improve equity in living donor transplantation.
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Diana A
authors.initials: DA
authors.lastname: Wu
authors.affiliation: NHS Blood and Transplant, Bristol, UK.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Robb
authors.affiliation: Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: Christopher J E
authors.initials: CJE
authors.lastname: Watson
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.|NHS Blood and Transplant, Bristol, UK.
authors.forename: John L R
authors.initials: JLR
authors.lastname: Forsythe
authors.affiliation: Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Charles R V
authors.initials: CRV
authors.lastname: Tomson
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Cairns
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.affiliation: NHS Blood and Transplant, Bristol, UK.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: Department of Renal Medicine, Southmead Hospital, Bristol, UK.
authors.forename: Rommel
authors.initials: R
authors.lastname: Ravanan
authors.affiliation: Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK.
authors.forename: Damian
authors.initials: D
authors.lastname: Fogarty
authors.affiliation: Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Bradley
authors.affiliation: Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gibbons
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Metcalfe
authors.affiliation: Health Sciences, University of Warwick, Conventry, UK (author has moved institutions since acceptance of the article).
authors.forename: Heather
authors.initials: H
authors.lastname: Draper
authors.affiliation: Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bradley
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Oniscu
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D003144:Communication Barriers; D046148:Donor Selection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D009927:Tissue and Organ Procurement; D006113:United Kingdom; D044465:White People; D055815:Young Adult
keywords: inequity; kidney transplantation; living donor; pre-emptive transplantation; sociodemographic disparities