Factors That Influence Access to the National Renal Transplant Waiting List

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Abstract
Registry data can be used to examine whether there are differences between individual renal units in the proportion of dialysis patients listed for renal transplantation, to investigate possible reasons for any differences observed, and to discover whether highlighting these anomalies can influence practice. A cross-sectional study of 12, 401 prevalent adult dialysis patients from 41 renal units across England and Wales was performed. The proportion of patients registered on the deceased donor transplant waiting list was determined for each renal unit. Patient- and center-specific factors that influence the probability of being listed for transplantation were identified and used to adjust for differences observed between units. The annual change in the size of the transplant waiting list was examined before and after presentation of these data. A total of 23.3% of patients were active on the transplant waiting list. Specific variables significantly associated with listing were age, primary renal disease, graft number, social deprivation, and ethnicity but not gender. Centre-specific variables included size of renal unit, size of living donor program, and listing practice for living donor transplantation. Whether the renal unit was also a transplant unit was not significant. After adjusting for these variables, there remained unexplained variation between renal units in the proportion of dialysis patients on the waiting list. An increase in the number of patients listed for transplantation has been observed since presenting these data. Differences in listing practice exist between centers that cannot be explained by the patient case mix or center characteristics examined.