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Barriers to living donor kidney transplantation in the United Kingdom: A national observational study

Lookup NU author(s): Dr Charlie Tomson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© The Author 2016. 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.

Publication metadata

Author(s): Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, Roderick P, Johnson RJ, Ravanan R, Fogarty D, Bradley C, Gibbons A, Metcalfe W, Draper H, Bradley AJ, Oniscu GC

Publication type: Article

Publication status: Published

Journal: Nephrology Dialysis Transplantation

Year: 2017

Volume: 32

Issue: 5

Pages: 890-900

Online publication date: 31/03/2017

Acceptance date: 09/02/2017

Date deposited: 27/06/2017

ISSN (print): 0931-0509

ISSN (electronic): 1460-2385

Publisher: Oxford University Press


DOI: 10.1093/ndt/gfx036


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