Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Am J Transplant. 2017 Jun;17(6):1585-1593. doi: 10.1111/ajt.14133. Epub 2017 Jan 9.
In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system.
在美国，终末期肾病（ESRD）网络中的肾脏移植率存在显著差异。我们进行了一项基于人群的队列研究，以确定在一个与美国不同的医疗保健系统中，肾脏计划之间的肾脏移植率是否存在差异。我们纳入了 2003 年至 2013 年加拿大安大略省的新发慢性透析患者，并确定了 27 个区域肾脏计划（类似于美国 ESRD 网络）中 1、5 和 10 年的累积肾脏移植发生率。我们还评估了“健康”透析患者（年龄在 18-50 岁，无糖尿病、冠心病或恶性肿瘤）的肾脏移植累积发生率。我们使用 Cox 比例风险模型计算了标准化移植比（STR），并根据患者特征进行了调整（最大随访时间为 11 年）。在 23022 名慢性透析患者中，肾脏计划之间的 10 年累积肾脏移植发生率从 7.4%（95%置信区间 4.8-10.7%）到 31.4%（95%置信区间 16.5-47.5%）不等。在我们的健康队列中也观察到了类似的变异性。STR 从肾脏计划的 0.3（95%置信区间 0.2-0.5）到 1.5（95%置信区间 1.4-1.7）不等。尽管患者可以获得相同的公共资助医疗保健系统，但安大略省肾脏计划之间的肾脏移植率存在显著差异。
