Variation in Practice Patterns for Listing Patients for Renal Transplantation in the United Kingdom: a National Survey

Introduction Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether centre variation exists in the assessment of patients for renal transplantation in the UK. Methods An online survey, informed by qualitative interviews, was distributed to all UK renal centres. This survey examined centre approaches to chronic kidney disease service provision, transplant recipient assessment, education provision and wait-listing decision making processes. Centre re-evaluation policies for patients already listed and priorities for future development were also examined. Results All 71 renal centres responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of centres transplantation was not discussed as a treatment option with all patients. Fourteen centres reported having a dedicated transplant assessment clinic whilst 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cut off at 75 years. 83% of centres excluded patients with a high BMI. Cardiac investigations were risk-stratified in 90% of centres. Surgical involvement varied with 11% of centres listing patients without formal surgical review. There was no formal protocol in place to re-evaluate listed patients in 62% of centres. 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 centre-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients. Rommel Ravanan PhD, Paul J. Roderick MD, denotes joint final author Corresponding author: Rishi Pruthi, Consultant Nephrologist, Royal Free Hospital, London NW3 2QG, UK, Tel: 020 7794 0500, Email: rishi.pruthi@nhs.net Authorship The authors declare no conflicts of interest. This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research scheme (RP-PG-0109-10116). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analyses. Presented (as an abstract) at the Joint British Transplantation Society and Nederlandse Transplantatie Vereniging Congress, Bournemouth, 2015; and at the American Society of Nephrology Kidney Week, Philadelphia, 2014 Research idea and study design: RP, GL, CE, CT, AB, JLF, CB, JC, CD, CW, HD, RJ, WM, DF, RR, PJR; data acquisition: RP, STC, MC; data analysis/interpretation: RP, STC, GCO, RR, PJR; statistical analysis: RP; supervision or mentorship: RR, CE, GL, RR, PJR. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. RP takes responsibility that this study has been reported honestly, accurately, and transparently; and that no important aspects of the study have been omitted. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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