Dr Lachlan Mcmichael1, Dr Nick Cross2, Professor Kate Wyburn3, Associate Professor Philip Clayton1, Dr Melanie Wyld4
1Royal Adelaide Hospital, , Australia, 2Canterbury District Health Board, Cantaury, New Zealand, 3Royal Prince Alfred Hospital, Sydney, Australia, 4Westmead Hospital, Sydney, Australia
Biography:
Dr Lachlan McMichael is a kidney specialist & early career clinician-researcher. His clinical work is based at Royal Adelaide Hospital as a consultant kidney specialist and transplant physician. He is a PhD candidate at the South Australian Health and Medical Research Institute/Australia & New Zealand Dialysis & Transplant Registry.
His research program is focused on measuring healthcare system performance with a focus on patient access to kidney transplantation and international system comparisons. Dr McMichael hopes his research will inform contemporary kidney transplant practice by reducing the current variation in approaches to kidney transplant evaluation and optimising resource utilisation.
Background:
Living donor kidney transplantation (LDKT) is the gold standard treatment for kidney failure. Rates of LDKT have been declining over time.
Aim:
We sought to identify and quantify the degree of variation in access to living donor kidney transplantation for patients commencing kidney replacement therapy (KRT) by their transplant referral region.
Methods:
Incident adult patients (18-75) commencing KRT registered in the ANZDATA Registry between 2002-2022 were included. All patients were mapped to a transplant referral region. A standardised living donor transplant ratio (SLDTR) was calculated to compare the observed number of LDKT within 12 months of KRT start to the expected number of LDKT based on a patient being transplanted at an average hospital. The expected number of LDKT for each centre were obtained using multivariate Poisson regression including a random effect for each transplant referral region. The SLDTR is presented with 95% & 98% false discovery rate confidence intervals that account for multiple comparisons made between centres.
Results:
There were 54,371 patients included for analysis. Male gender, younger age and lower BMI were associated with receiving a LDKT. The ratio of observed versus expected living donor transplants ranged from 0.3 to 2.23, figure 1. Of 21 transplant centres, 12 (57%) had observed LDKT rates as expected. 4 sites (19%) had a higher ratio than expected and 5 sites (24%) had a lower ratio than expected.
Conclusion:
Accessing living donor kidney transplantation varies across transplant centres in Australia & New Zealand. Further analysis of over and underperforming centres may assist in implementing strategies to improve rates of LDKT.
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