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Observational Study
. 2017 May 1;32(5):890-900.
doi: 10.1093/ndt/gfx036.

Barriers to living donor kidney transplantation in the United Kingdom: a national observational study

Diana A Wu  1 , Matthew L Robb  2 , Christopher J E Watson  3 , John L R Forsythe  1   2 , Charles R V Tomson  4 , John Cairns  5 , Paul Roderick  6 , Rachel J Johnson  2 , Rommel Ravanan  7 , Damian Fogarty  8 , Clare Bradley  9 , Andrea Gibbons  9 , Wendy Metcalfe  1 , Heather Draper  10 , Andrew J Bradley  3 , Gabriel C Oniscu  1
Affiliations
Observational Study

Barriers to living donor kidney transplantation in the United Kingdom: a national observational study

Diana A Wu et al. Nephrol Dial Transplant. .

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.

Keywords: inequity; kidney transplantation; living donor; pre-emptive transplantation; sociodemographic disparities.

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Figures

FIGURE 1
FIGURE 1
Study population (asterisk refers to recruitment that took place over a 12-month period in each centre between 1 November 2011 and 31 March 2013).
FIGURE 2
FIGURE 2
Multivariable logistic regression analysis of factors associated with LDKT versus DDKT. N. Ireland, Northern Ireland.
See this image and copyright information in PMC

References

    1. Terasaki PI, Cecka JM, Gjertson DW et al.. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med 1995; 333: 333–336 - PubMed
    1. Meier-Kriesche HU, Kaplan B.. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis . Transplantation 2002; 74: 1377–1381 - PubMed
    1. Gjertson DW, Cecka JM.. Living unrelated donor kidney transplantation. Kidney Int 2000; 58: 491–499 - PubMed
    1. Dudley C, Harden P.. Renal Association clinical practice guideline on the assessment of the potential kidney transplant recipient. Nephron Clin Pract 2011; 118(Suppl 1): c209–c224 - PubMed
    1. Kasiske BL, Snyder JJ, Matas AJ. et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 2002; 13: 1358–1364 - PubMed

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