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Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: A national survey

Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: A national survey
Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: A national survey

Background Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether center variation exists in the assessment of patients for renal transplantation in the United Kingdom. Methods An online survey, informed by qualitative interviews, was distributed to all UK renal centers. This survey examined center approaches to chronic kidney disease service provision, transplant recipient assessment, education provision, and waitlisting decision making processes. Center reevaluation policies for patients already listed and priorities for future development were also examined. Results All 71 renal centers responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of the centers, transplantation was not discussed as a treatment option with all patients. Fourteen centers reported having a dedicated transplant assessment clinic, whereas 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cutoff at 75 years. Eighty-three percent of the centers excluded patients with a high body mass index. Cardiac investigations were risk-stratified in 90% of centers. Surgical involvement varied with 11% of centers listing patients without formal surgical review. There was no formal protocol in place to reevaluate listed patients in 62% of centers. Conclusions There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which center-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients.

0041-1337
961-968
Pruthi, Rishi
efff732d-99ca-48db-9e13-5348cf03ad05
Tonkin-Crine, Sarah
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Calestani, Melania
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Leydon, Geraldine
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Eyles, Caroline
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Oniscu, Gabriel C.
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Tomson, Charles
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Bradley, Andrew
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Forsythe, John L.
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Bradley, Clare
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Cairns, John
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Dudley, Christopher
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Watson, Christopher
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Draper, Heather
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Johnson, Rachel
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Metcalfe, Wendy
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Fogarty, Damian
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Ravanan, Rommel
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Roderick, Paul J.
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Pruthi, Rishi
efff732d-99ca-48db-9e13-5348cf03ad05
Tonkin-Crine, Sarah
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Calestani, Melania
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Leydon, Geraldine
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Eyles, Caroline
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Oniscu, Gabriel C.
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Tomson, Charles
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Bradley, Andrew
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Forsythe, John L.
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Bradley, Clare
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Cairns, John
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Dudley, Christopher
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Watson, Christopher
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Draper, Heather
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Johnson, Rachel
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Metcalfe, Wendy
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Fogarty, Damian
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Ravanan, Rommel
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Roderick, Paul J.
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Pruthi, Rishi, Tonkin-Crine, Sarah, Calestani, Melania, Leydon, Geraldine, Eyles, Caroline, Oniscu, Gabriel C., Tomson, Charles, Bradley, Andrew, Forsythe, John L., Bradley, Clare, Cairns, John, Dudley, Christopher, Watson, Christopher, Draper, Heather, Johnson, Rachel, Metcalfe, Wendy, Fogarty, Damian, Ravanan, Rommel and Roderick, Paul J. (2018) Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: A national survey. Transplantation, 102 (6), 961-968. (doi:10.1097/TP.0000000000002046).

Record type: Article

Abstract

Background Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether center variation exists in the assessment of patients for renal transplantation in the United Kingdom. Methods An online survey, informed by qualitative interviews, was distributed to all UK renal centers. This survey examined center approaches to chronic kidney disease service provision, transplant recipient assessment, education provision, and waitlisting decision making processes. Center reevaluation policies for patients already listed and priorities for future development were also examined. Results All 71 renal centers responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of the centers, transplantation was not discussed as a treatment option with all patients. Fourteen centers reported having a dedicated transplant assessment clinic, whereas 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cutoff at 75 years. Eighty-three percent of the centers excluded patients with a high body mass index. Cardiac investigations were risk-stratified in 90% of centers. Surgical involvement varied with 11% of centers listing patients without formal surgical review. There was no formal protocol in place to reevaluate listed patients in 62% of centers. Conclusions There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which center-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients.

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More information

Accepted/In Press date: 1 November 2017
Published date: 1 June 2018

Identifiers

Local EPrints ID: 424843
URI: http://eprints.soton.ac.uk/id/eprint/424843
ISSN: 0041-1337
PURE UUID: e54aca6a-c572-46a0-8eb3-616cbcbc1d7b
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 05 Oct 2018 11:49
Last modified: 27 Jan 2020 13:40

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Contributors

Author: Rishi Pruthi
Author: Sarah Tonkin-Crine
Author: Melania Calestani
Author: Caroline Eyles
Author: Gabriel C. Oniscu
Author: Charles Tomson
Author: Andrew Bradley
Author: John L. Forsythe
Author: Clare Bradley
Author: John Cairns
Author: Christopher Dudley
Author: Christopher Watson
Author: Heather Draper
Author: Rachel Johnson
Author: Wendy Metcalfe
Author: Damian Fogarty
Author: Rommel Ravanan

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