Rishi Pruthi1,2,3, Sarah Tonkin-Crine4, Melania Calestani2, Geraldine Leydon2, Caroline Eyles2, Gabriel C Oniscu5, Charles Tomson6, Andrew Bradley7, John L Forsythe5, Clare Bradley8, John Cairns9, Christopher Dudley4, Christopher Watson7, Heather Draper10, Rachel Johnson11, Wendy Metcalfe5, Damian Fogarty3,12, Rommel Ravanan13, Paul J Roderick2. 1. Royal Free London NHS Foundation Trust, London, United Kingdom. 2. Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 3. UK Renal Registry, Bristol, United Kingdom. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. 5. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 6. Renal Unit, Freeman Hospital, Newcastle, United Kingdom. 7. Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom. 8. Health Psychology Research Unit, Royal Holloway, University of London, Egham, United Kingdom. 9. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. 10. Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom. 11. NHS Blood and Transplant, Bristol, United Kingdom. 12. Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom. 13. Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom.
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.
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.
Authors: Babak J Orandi; Joshua W Purvis; Robert M Cannon; A Blair Smith; Cora E Lewis; Norah A Terrault; Jayme E Locke Journal: Am J Surg Date: 2020-06-13 Impact factor: 2.565
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Authors: Rishi Pruthi; Matthew L Robb; Gabriel C Oniscu; Charles Tomson; Andrew Bradley; John L Forsythe; Wendy Metcalfe; Clare Bradley; Christopher Dudley; Rachel J Johnson; Christopher Watson; Heather Draper; Damian Fogarty; Rommel Ravanan; Paul J Roderick Journal: Clin J Am Soc Nephrol Date: 2020-05-28 Impact factor: 8.237
Authors: Sarah Tonkin-Crine; Rishi Pruthi; Dominic M Taylor; Geraldine M Leydon; Melania Calestani; Gabriel C Oniscu; J Andrew Bradley; Charles R Tomson; Clare Bradley; Christopher Dudley; Christopher J E Watson; Heather Draper; Rachel J Johnson; Wendy Metcalfe; Damian G Fogarty; Rommel Ravanan; Paul Roderick Journal: Transplant Direct Date: 2018-04-18
Authors: Babak J Orandi; Cora E Lewis; Paul A MacLennan; Haiyan Qu; Shikha Mehta; Vineeta Kumar; Saulat S Sheikh; Robert M Cannon; Douglas J Anderson; Michael J Hanaway; Rhiannon D Reed; A Cozette Killian; Joshua W Purvis; Norah A Terrault; Jayme E Locke Journal: Obesity (Silver Spring) Date: 2021-08-02 Impact factor: 9.298