Royal Free London NHS Foundation Trust, London, United Kingdom.
Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Transplantation. 2018 Jun;102(6):961-968. doi: 10.1097/TP.0000000000002046.
Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether center variation exists in the assessment of patients for renal transplantation in the United Kingdom.
An online survey, informed by qualitative interviews, was distributed to all UK renal centers. This survey examined center approaches to chronic kidney disease service provision, transplant recipient assessment, education provision, and waitlisting decision making processes. Center reevaluation policies for patients already listed and priorities for future development were also examined.
All 71 renal centers responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of the centers, transplantation was not discussed as a treatment option with all patients. Fourteen centers reported having a dedicated transplant assessment clinic, whereas 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cutoff at 75 years. Eighty-three percent of the centers excluded patients with a high body mass index. Cardiac investigations were risk-stratified in 90% of centers. Surgical involvement varied with 11% of centers listing patients without formal surgical review. There was no formal protocol in place to reevaluate listed patients in 62% of centers.
There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which center-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients.
尽管有评估肾移植候选人的指南，但在移植的可及性方面存在差异。这项全国性调查研究了英国在评估肾移植患者方面是否存在中心差异。
一项基于定性访谈的在线调查分发给所有英国肾脏中心。该调查考察了中心在慢性肾脏病服务提供、移植受者评估、教育提供以及等待名单决策过程方面的方法。还考察了中心对已列入名单的患者的重新评估政策和未来发展的优先事项。
所有 71 个肾脏中心都做出了回应。其中，83%的中心在低清除率诊所中对透析前患者进行了评估。在 26%的中心中，并非所有患者都讨论了将移植作为一种治疗选择。14 个中心报告说有专门的移植评估诊所，而 28%的中心没有正式的评估方案。有 3 个中心将年龄作为列入名单的排除标准，这 3 个中心的截止年龄均为 75 岁。83%的中心排除了身体质量指数高的患者。90%的中心对心脏检查进行风险分层。外科手术的参与情况因中心而异，有 11%的中心没有正式的外科审查就对患者进行了登记。在 62%的中心中，没有正式的方案来重新评估列入名单的患者。
尽管英国对患者进行肾移植的列入名单的实践模式存在广泛差异，但它对移植的可及性的影响尚不清楚。需要对前瞻性的患者队列进行进一步分析，以确定中心特定和患者特定因素在多大程度上影响了对移植的获得。
