Factors influencing kidney transplantation rates: a study from the ERA Registry

Abstract

Background: Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates over the last decade.

Methods: KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010.

Results: Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type-specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the healthcare system.

Conclusions: Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.

Keywords: Europe; barrier; kidney transplantation; measure.

Graphical Abstract

Figure 1:

Resources sufficiently available in 2010 (left panel) and measures put into force (right panel) to increase total KT rates between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries for which a measure was in force in 2010 (#P-value 2010), a measure was put into force after 2010 (*P-value taken) and a measure in force was rated as successful (^P-value success). KTR: Kidney Transplantation Rate.

Figure 2:

Measures in force in 2010 (left panel) and measures put into force (right panel) on the donation level to increase the deceased donor KT rate between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries for which a measure was in force in 2010 (^#P-value 2010), a measure was taken during the study period (*P-value taken) and a measure in force was rated as successful (^P-value success). KDPI: Kidney Donor Profile Index, KTR: Kidney Transplantation Rate.

Figure 3:

Measures in force in 2010 (left panel) and measures put into force (right panel) on the allocation and transplantation level to increase the deceased donor KT rate between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries for which a measure was in force in 2010 (^#P-value 2010), a measure was taken during the study period (*P-value taken) and a measure in force was rated as successful (^P-value success).

Figure 4:

Potential barriers for deceased donor (left panel) and living donor (right panel) KT between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries experiencing a barrier for KT.

Figure 5:

Measures in force in 2010 (left panel) and measures put into force (right panel) on the donation level to increase the living donor KT rate between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries for which a measure was in force in 2010 (^#P-value 2010), a measure was taken during the study period (*P-value taken) and a measure in force was rated as successful (^P-value success).

Figure 6:

Measures in force in 2010 (left panel) and measures put into force (right panel) on the allocation and transplantation level to increase the living donor KT rate between 2010 and 2018, by KT rate group. The Pearson's chi-squared test was used to test for differences between KT rate groups in the percentage of countries for which a measure was in force in 2010 (^#P-value 2010), a measure was taken during the study period (*P-value taken) and a measure in force was rated as successful (^P-value success).