• Diana A Wu, Matthew L Robb, Watson Christopher J E CJE Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK., Forsythe John L R JLR Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK. NHS Blood and Transp, Tomson Charles R V CRV Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK., John Cairns, Paul Roderick, Rachel J Johnson, Rommel Ravanan, Damian Fogarty, Clare Bradley, Andrea Gibbons, Wendy Metcalfe, Heather Draper, Andrew J Bradley, and Gabriel C Oniscu.
• Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
• Nephrol. Dial. Transplant. 2017 May 1; 32 (5): 890-900.

BackgroundLiving donor kidney transplantation (LDKT) provides more timely access to transplantation and better clinical outcomes than deceased donor kidney transplantation (DDKT). This study investigated disparities in the utilization of LDKT in the UK.MethodsA total of 2055 adults undergoing kidney transplantation between November 2011 and March 2013 were prospectively recruited from all 23 UK transplant centres as part of the Access to Transplantation and Transplant Outcome Measures (ATTOM) study. Recipient variables independently associated with receipt of LDKT versus DDKT were identified.ResultsOf the 2055 patients, 807 (39.3%) received LDKT and 1248 (60.7%) received DDKT. Multivariable modelling demonstrated a significant reduction in the likelihood of LDKT for older age {odds ratio [OR] 0.11 [95% confidence interval (CI) 0.08-0.17], P < 0.0001 for 65-75 years versus 18-34 years}; Asian ethnicity [OR 0.55 (95% CI 0.39-0.77), P = 0.0006 versus White]; Black ethnicity [OR 0.64 (95% CI 0.42-0.99), P = 0.047 versus White]; divorced, separated or widowed [OR 0.63 (95% CI 0.46-0.88), P = 0.030 versus married]; no qualifications [OR 0.55 (95% CI 0.42-0.74), P < 0.0001 versus higher education qualifications]; no car ownership [OR 0.51 (95% CI 0.37-0.72), P = 0.0001] and no home ownership [OR 0.65 (95% CI 0.85-0.79), P = 0.002]. The odds of LDKT varied significantly between countries in the UK.ConclusionsAmong patients undergoing kidney transplantation in the UK, there are significant age, ethnic, socio-economic and geographic disparities in the utilization of LDKT. Further work is needed to explore the potential for targeted interventions to improve equity in living donor transplantation.© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

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