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. 2016 Feb 25;6(2):e010377.
doi: 10.1136/bmjopen-2015-010377.

Access to Transplantation and Transplant Outcome Measures (ATTOM): study protocol of a UK wide, in-depth, prospective cohort analysis

Gabriel C Oniscu  1 , Rommel Ravanan  2 , Diana Wu  1 , Andrea Gibbons  3 , Bernadette Li  4 , Charles Tomson  5 , John L Forsythe  1 , Clare Bradley  3 , John Cairns  4 , Christopher Dudley  2 , Christopher J E Watson  6 , Eleanor M Bolton  6 , Heather Draper  7 , Matthew Robb  8 , Lisa Bradbury  8 , Rishi Pruthi  9 , Wendy Metcalfe  1 , Damian Fogarty  9 , Paul Roderick  10 , J Andrew Bradley  6 ; ATTOM Investigators
Affiliations

Access to Transplantation and Transplant Outcome Measures (ATTOM): study protocol of a UK wide, in-depth, prospective cohort analysis

Gabriel C Oniscu et al. BMJ Open. .

Abstract

Introduction: There is significant intercentre variability in access to renal transplantation in the UK due to poorly understood factors. The overarching aims of this study are to improve equity of access to kidney and kidney-pancreas transplantation across the UK and to optimise organ allocation to maximise the benefit and cost-effectiveness of transplantation.

Methods and analysis: 6844 patients aged 18-75 years starting dialysis and/or receiving a transplant together with matched patients active on the transplant list from all 72 UK renal units were recruited between November 2011 and March 2013 and will be followed for at least 3 years. The outcomes of interest include patient survival, access to the transplant list, receipt of a transplant, patient-reported outcome measures (PROMs) including quality of life, treatment satisfaction, well-being and health status on different forms of renal replacement therapy. Sociodemographic and clinical data were prospectively collected from case notes and from interviews with patients and local clinical teams. Qualitative process exploration with clinical staff will help identify unit-specific factors that influence access to renal transplantation. A health economic analysis will explore costs and outcomes associated with alternative approaches to organ allocation. The study will deliver: (1) an understanding of patient and unit-specific factors influencing access to renal transplantation in the UK, informing potential changes to practices and policies to optimise outcomes and reduce intercentre variability; (2) a patient-survival probability model to standardise access to the renal transplant list and (3) an understanding of PROMs and health economic impact of kidney and kidney-pancreas transplantation to inform the development of a more sophisticated and fairer organ allocation algorithm.

Ethics and dissemination: The protocol has been independently peer reviewed by National Institute for Health Research (NIHR) and approved by the East of England Research Ethics Committee. The results will be published in peer-reviewed journals and presented at conferences.

Keywords: EPIDEMIOLOGY; HEALTH ECONOMICS; QUALITATIVE RESEARCH; TRANSPLANT SURGERY.

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Figures

Figure 1
Figure 1
ATTOM, Access to Transplantation and Transplant Outcome Measures (ATTOM) study patient recruitment and cohort distribution.
Figure 2
Figure 2
Number of patients changing between the study cohorts and the direction of change.
Figure 3
Figure 3
(A and B) Data completeness for each item collected in the study.
Figure 4
Figure 4
Quantitative and qualitative analysis approach for access to transplantation workstream.
Figure 5
Figure 5
Study cohorts for survival analysis comparison.
See this image and copyright information in PMC

References

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