It is well recognized that there is significant variation between centers in access to kidney transplantation. In the absence of high-grade evidence, it is unclear whether variation is due to patient case mix, other center factors, or individual clinician decisions. This study sought consensus between UK clinicians on factors that should influence access to kidney transplantation.
As part of the Access to Transplantation and Transplant Outcome Measures project, consultant nephrologists and transplant surgeons in 71 centers were invited to participate in a Delphi study involving 2 rounds. During rounds 1 and 2, participants rated their agreement to 29 statements covering 8 topics regarding kidney transplantation. A stakeholder meeting was used to discuss statements of interest after the 2 rounds.
In total, 122 nephrologists and 16 transplant surgeons from 45 units participated in rounds 1 and 2. After 2 rounds, 12 of 29 statements reached consensus. Fifty people participated in the stakeholder meeting. After the stakeholder meeting, a further 4 statements reached agreement. Of the 8 topics covered, consensus was reached in 6: use of a transplant protocol, patient age, body mass index, patient compliance with treatment, cardiac workup, and use of multidisciplinary meetings. Consensus was not reached on screening for malignancy and use of peripheral Doppler studies.
The Delphi process identified factors upon which clinicians agreed and areas where consensus could not be achieved. The findings should inform national guidelines to support decision making in the absence of high quality evidence and to guide areas that warrant future research.
1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
2 Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
3 Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom.
4 Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, United Kingdom.
5 Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
6 Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom.
7 Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
8 Health Psychology Research Unit, Royal Holloway, University of London, London, United Kingdom.
9 Department of Social Science and Systems in Health, University of Warwick, Coventry, United Kingdom.
10 NHS Blood and Transplant, Bristol, United Kingdom.
11 Scottish Renal Registry, Glasgow, United Kingdom.
12 Nephrology Unit, Belfast Health and Social Care Trust & UK Renal Registry, Bristol, United Kingdom.
Published online 17 April, 2018.
Received 23 November 2017.
Accepted 12 January 2018.
R.R. and P.R. are joint senior authors/contributed equally.
The ATTOM study was funded by a grant from the Programme Grants for Applied Research (PGfAR) funding stream, from the National Institute of Health Research (NIHR), United Kingdom (ref: RP-PG-0109-10116). This publication presents independent research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
The authors declare no conflicts of interest.
P.R., R.R., G.O., S.T.C., R.P., G.L., and M.C. led the design of the study. The ATTOM project and larger programme of work was developed by J.A.B., R.R., P.R., G.O., G.L., C.T., C.B., C.D., C.W., H.D., R.J., W.M., and D.F. S.T.-C. carried out data collection and analysis with input from P.R., R.R., R.P., G.O., G.L., and M.C. S.T.-C. drafted the article. D.T. made final edits to the article and figures. All authors read and approved the final article.
Correspondence: Sarah Tonkin-Crine, PhD, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom. (firstname.lastname@example.org).
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