UK Renal Registry 15th annual report: Chapter 9 centre variation in access to renal transplantation in the UK (2006-2008).

Background: Renal transplantation is recognised as being the optimal treatment modality for many patients with established renal failure. This analysis aimed to explore inter-centre variation in access to renal transplantation in the UK. Methods: Transplant activity and waiting list data were obtained from NHS Blood and Transplant, demographic and laboratory data were obtained from the UK Renal Registry. All incident RRT patients starting treatment between 1st January 2006 and 31st December 2008 from 72 renal centres were considered for inclusion. The cohort was followed until 31st December 2010 (or until transplantation or death, whichever was earliest). Results: Age, ethnicity and primary renal diagnosis were associated with both accessing the kidney transplant waiting list and receiving a kidney transplant. A patient starting dialysis in a non-transplanting renal centre was less likely to be registered for transplantation (OR 0.80, 95% CI 0.74-0.87) or receive a transplant from a donor after cardiac death or a living kidney donor (OR 0.69, 95% CI 0.61-0.77) compared with patients cared for in transplanting renal centres. Once registered for kidney transplantation, patients in both transplanting and non-transplanting renal centres had an equal chance of receiving a transplant from a donor after brainstem death (OR 0.92, 95% CI 0.79-1.08). Conclusion: There was wide variation in access to kidney transplantation between UK renal centres which cannot be explained by differences in case mix.