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Access to renal transplantation

Access to renal transplantation. Chris Dudley UKRR/UKT Joint analysis. Equity in renal transplantion. Equitable organ allocation (UKT) Equitable access to the waiting list (unit level). Deceased donor kidney programme. Problems. Point prevalence analysis Short-term fluctuation

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Access to renal transplantation

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  1. Access to renal transplantation Chris Dudley UKRR/UKT Joint analysis

  2. Equity in renal transplantion • Equitable organ allocation (UKT) • Equitable access to the waiting list (unit level)

  3. Deceased donor kidney programme

  4. Problems • Point prevalence analysis • Short-term fluctuation • Enrichment with unsuitable patients

  5. Renal Association Clinical Practice Guidelines – Transplant module Guideline 1.4 There must be demonstrable equity of access to deceased donor kidney transplantation irrespective of gender, ethnicity or district of residence.

  6. Renal Association Clinical Practice Guidelines – Transplant module Audit measures • The time to placement on the UK Transplant national transplant list in relation to start date of dialysis • A comparison between renal units of the proportion of dialysis patients placed on the national transplant list corrected for differences in identified unit and patient specific variables including co-morbidity.

  7. Analysis • Access to the waiting list • Prevalent patients • Incident patients • Time to listing

  8. Access to the waiting list • Point prevalence analysis The proportion of patients on dialysis who were also active on the waiting list on 31/12/06 • Incident patient analysis The % of incident dialysis patients between 01/01/03 – 31/12/04 were subsequently activated on the WL within 2 years of commencing dialysis • Only patients <65 years were considered for inclusion

  9. Percentage of all dialysis patients by centre on the active transplant waiting list on 31/12/2006 for patients aged under 65

  10. Point prevalence n = 11,554

  11. Percentage of incident patients aged <65 years active on the transplant waiting list within 2 years of commencement of dialysis

  12. Incident patient n = 4816

  13. Time to wait-listing • Incident patients between 01/01/03 – 31/12/04 used as cohort for consideration and then followed up until 30/09/07 • Time taken to activate on WL = date of first activation – date of start of dialysis • Patients achieving pre-emptive deceased or live donor transplantation were considered to have spent 0 days on the WL

  14. Time to wait-listingn=4804 Significant centre variation [P < 0.0001] persisted even after correcting for age, gender and PRD

  15. Combined unit performance[Incident patients] IDEAL SLOW LOW LOW & SLOW

  16. Conclusions • Several units are significant outliers in % of both prevalent and incident patient wait-listed • Several units are significant outliers in the time taken to activate patients on the waiting list • Some units have both a low % of incident patients on the waiting list and take longer to work patients up for activation • The reason for differences between units needs to be explored

  17. Cautions Need to correct for patient and centre specific factors • Patient • Age • PRD • Graft number • Centre • Size of renal unit • Size of LD programme • Listing practice of LD transplants

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