A patient’s chance of getting a kidney transplant in the UK depends more on which hospital they attend than on their medical need. The project will recruit every new dialysis and transplant patient across the UK, along with matched controls from the active transplant list, to identify why some centres list far more patients than others. Researchers will collect patient-level data through nurses embedded in transplant centres, conduct qualitative interviews to uncover unit-specific barriers, and measure quality of life for patients on dialysis versus those who receive a transplant. A parallel health economic analysis will calculate the costs and benefits of transplantation for different patient groups. If successful, the work will produce a survival probability model—similar to tools used for liver transplant or cardiac surgery—to standardise access to the transplant list across the UK. It will also generate evidence to overhaul the national kidney allocation algorithm, which currently prioritises tissue matching but ignores differences in quality of life, treatment satisfaction, and cost-effectiveness between patient categories.
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AIMS AND OBJECTIVES: The over arching aims of the project are (1) to improve equity of access to kidney and pancreas transplantation across the UK (2) to optimise organ allocation to maximise the benefit, including cost effectiveness, from kidney and pancreas transplantation.BACKGROUND: Preliminary work has identified the presence of significant inter-centre variability in access to renal transplantation in the UK. However, it is not clear whether patient or unit specific factors, or both, are responsible for inter-centre variability. Further, unit specific factors are yet to be identified by qualitative methods. The absence of an effective tool to guide risk versus benefit assessment in individual patients will perpetuate this inter-centre variability. Development of a survival probability tool, similar to those used to estimate mortality risk in patients awaiting liver transplantation or cardiac bypass surgery, may enable standardisation of access to renal transplantation. Current national kidney allocation algorithms are heavily weighted towards variables such as tissue type but do not take into account possible differences in quality of life, well being, treatment satisfaction or costs associated with transplantation in different patient categories. RESEARCH PLANS: Over a 12 month period, we plan to recruit all incident dialysis and renal transplant patients across the UK as well as matched controls from patients who are currently active on the transplant list. Patient level information will be collected by research nurses embedded in the transplant centres at the time of recruitment. The outcomes of interest would be patient survival, access to the transplant list and achieving transplantation once activated on the list. Qualitative exploration of the processes that shape renal transplantation in each unit will help identify unit specific factors that influence access to renal transplantation. Quality of Life (QoL) analysis of patients on renal replacement therapy as well as comparison of QoL between patients undergoing transplantation versus those remaining on dialysis will be undertaken. A comprehensive health economic analysis of the renal transplantation will also be undertaken in parallel. All patients will be followed for a minimum of three years, with analysis and reporting in the final year of a five year project. RESEARCH TEAM: The research team comprises opinion leaders in the fields of transplant surgery, nephrology, methodology/epidemiology, qualitative research, quality of life assessment, health economics and statistics. This provides the team with sufficient influence to ensure participation from every renal unit across the UK whilst at the same time ensuring the necessary expertise for appropriate data analysis and reporting of findings. RESEARCH ENVIRONMENT: The expertise of the co-applicants in addition to the experience and existing infrastructure of the three national registries maximises the potential for successful outcomes whilst at the same time minimising costs without compromising data quality and security. The UK Renal Registry [UKRR], Scottish Renal Registry [SRR] and NHS Blood and Transplant [NHSBT] are leading national registries with more than 10 years experience in reporting on case mix adjusted centre specific outcomes for patients with end stage renal failure. ANTICIPATED OUTPUTS, OUTCOMES AND IMPACT OF RESEARCH: [1] An understanding of patient and unit specific factors that influence access to renal transplantation in the UK enabling changes to unit practices and policies to reduce inter-centre variability. [2] A patient survival probability model to enable standardisation of access to the renal transplant list within the UK. [3] An understanding of QoL and health economic gains from renal transplantation to inform development of a more sophisticated organ allocation algorithm. PUBLIC INVOLVEMENT: The National Kidney Federation [which is a confederation of regional kidney patients associ
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