Introduction

Access to Transplantation and Transplant Outcome Measures (ATTOM) is a prospective cohort study involving all 72 UK renal units, investigating factors affecting access to and outcomes from renal transplantation.

Methods

6842 patients 18-75 years were recruited between 2011-2013, including 2621 incident dialysis, 2262 incident transplant and 1959 waitlisted patients (matched to transplant patients for centre, age, time on waiting list and diabetes). Baseline data were collected at recruitment. Factors affecting the likelihood of being in the transplant versus waitlisted group were analysed by multivariate logistic regression. A step-wise Cox proportional hazards model was built to analyse predictors of 1-year mortality on dialysis.

Results

Compared to waitlisted and transplant patients, dialysis patients were significantly older, had lower levels of education, greater social deprivation and higher prevalence of all comorbidities.

The likelihood of being transplanted versus remaining on the waiting-list was significantly reduced by female gender, previous transplantation, O blood group, non-white ethnicity, greater social deprivation, lower education level, smoking and having a Charlson Comorbidity Index (CCI) score ≥1.

There was significant inter-centre variation in the mean CCI scores amongst dialysis, waitlisted and transplant populations.

Survival at 1 year for incident dialysis patients was 93.0% (95% CI: 91.8 – 94.0). The most common causes of death were cardiac disease (20.2%), infection (19.2%) and malignancy (18.2%). Significant predictors of mortality at 1 year included increasing age (per year, hazard ratio (HR) 1.02, p=0.01), congestive heart failure (HR 2.34, p<0.0001), chronic respiratory disease (HR 2.08, p=0.0001), liver disease (HR 3.37, p<0.0001), malignancy (HR 1.82, p=0.002) and unemployment (HR 3.01, p=0.002).

Discussion

There are significant sociodemographic and comorbidity differences between dialysis, waitlisted and transplant patients in the UK. The comorbidity profile of listed as well as transplanted patients varies significantly between centres in the UK, suggesting different selection criteria. Several comorbid conditions affect 1-year survival on dialysis and could assist the selection process for transplantation.

CITATION INFORMATION: Wu D, Robb M, Watson C, Ravanan R, Forsythe J, Bradley A, Oniscu G. Sociodemographic and Comorbidity Differences Between Dialysis, Waitlisted and Transplant Patients in the UK: Findings from the ATTOM Study. Am J Transplant. 2016;16 (suppl 3).

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