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Barriers to living donor kidney transplantation in the United Kingdom: a national observational study.
Nephrol Dial Transplant. 2017 May 01; 32(5):890-900.ND

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.

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Authors+Show Affiliations

Wu DA
Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Robb ML
NHS Blood and Transplant, Bristol, UK.
Watson CJE
Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Forsythe JLR
Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK. NHS Blood and Transplant, Bristol, UK.
Tomson CRV
Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
Cairns J
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Roderick P
Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Johnson RJ
NHS Blood and Transplant, Bristol, UK.
Ravanan R
Department of Renal Medicine, Southmead Hospital, Bristol, UK.
Fogarty D
Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK.
Bradley C
Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK.
Gibbons A
Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK.
Metcalfe W
Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Draper H
Health Sciences, University of Warwick, Conventry, UK (author has moved institutions since acceptance of the article).
Bradley AJ
Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Oniscu GC
Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.

MeSH

AdolescentAdultAfrican AmericansAgedCommunication BarriersDonor SelectionFemaleHealth Knowledge, Attitudes, PracticeHumansKidney TransplantationLiving DonorsMaleMiddle AgedProspective StudiesTissue and Organ ProcurementUnited KingdomWhitesYoung Adult

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28379431

Citation

Wu, Diana A., et al. "Barriers to Living Donor Kidney Transplantation in the United Kingdom: a National Observational Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 32, no. 5, 2017, pp. 890-900.
Wu DA, Robb ML, Watson CJE, et al. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant. 2017;32(5):890-900.
Wu, D. A., Robb, M. L., Watson, C. J. E., Forsythe, J. L. R., Tomson, C. R. V., Cairns, J., Roderick, P., Johnson, R. J., Ravanan, R., Fogarty, D., Bradley, C., Gibbons, A., Metcalfe, W., Draper, H., Bradley, A. J., & Oniscu, G. C. (2017). Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 32(5), 890-900. https://doi.org/10.1093/ndt/gfx036
Wu DA, et al. Barriers to Living Donor Kidney Transplantation in the United Kingdom: a National Observational Study. Nephrol Dial Transplant. 2017 May 1;32(5):890-900. PubMed PMID: 28379431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. AU - Wu,Diana A, AU - Robb,Matthew L, AU - Watson,Christopher J E, AU - Forsythe,John L R, AU - Tomson,Charles R V, AU - Cairns,John, AU - Roderick,Paul, AU - Johnson,Rachel J, AU - Ravanan,Rommel, AU - Fogarty,Damian, AU - Bradley,Clare, AU - Gibbons,Andrea, AU - Metcalfe,Wendy, AU - Draper,Heather, AU - Bradley,Andrew J, AU - Oniscu,Gabriel C, PY - 2016/11/07/received PY - 2017/02/09/accepted PY - 2017/4/6/pubmed PY - 2018/1/5/medline PY - 2017/4/6/entrez KW - inequity KW - kidney transplantation KW - living donor KW - pre-emptive transplantation KW - sociodemographic disparities SP - 890 EP - 900 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 32 IS - 5 N2 - 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. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/28379431/Barriers_to_living_donor_kidney_transplantation_in_the_United_Kingdom:_a_national_observational_study_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfx036 DB - PRIME DP - Unbound Medicine ER -