10.17863/CAM.15753
Wu, Diana A
Robb, Matthew L
Watson, Christopher JE
Forsythe, John LR
Tomson, Charles RV
Cairns, John
Roderick, Paul
Johnson, Rachel J
Ravanan, Rommel
Fogarty, Damian
Bradley, Clare
Gibbons, Andrea
Metcalfe, Wendy
Draper, Heather
Bradley, Andrew J
Oniscu, Gabriel C
Barriers to living donor kidney transplantation in the United Kingdom: a national observational study.
Oxford University Press (OUP)
2017
inequity
kidney transplantation
living donor
pre-emptive transplantation
sociodemographic disparities
Adolescent
Adult
Black or African American
Aged
Communication Barriers
Donor Selection
Female
Health Knowledge, Attitudes, Practice
Humans
Kidney Transplantation
Living Donors
Male
Middle Aged
Prospective Studies
Tissue and Organ Procurement
United Kingdom
White People
Young Adult
Apollo - University of Cambridge Repository
University of Cambridge
013meh722
2017-11-21
2017-11-21
2017-05-01
eng
Article
https://www.repository.cam.ac.uk/handle/1810/269516
10.1093/ndt/gfx036
Attribution-NonCommercial 4.0 International
Attribution-NonCommercial 4.0 International
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
http://creativecommons.org/licenses/by-nc/4.0/
http://creativecommons.org/licenses/by-nc/4.0/
open.access
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.
National Institute for Health and Care Research
RP-PG-0109-10116