scholarly journals Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members

2020 ◽  
Vol 9 (11) ◽  
pp. 3751
Author(s):  
Katie Wong ◽  
Amanda Owen-Smith ◽  
Fergus Caskey ◽  
Stephanie MacNeill ◽  
Charles Tomson ◽  
...  
Keyword(s):  
Ethnic Group ◽  
Blood Group ◽  
Living Donor ◽  
Family Members ◽  
Free Text ◽  
Minority Ethnic Group ◽  
Donor Kidney ◽  
The Uk ◽  
Minority Ethnic ◽  
Living Donor Kidney

There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13–31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled ‘Other—please give details’ was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30–4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02–4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18–3.02), were “not the right blood group” (aOR = 1.65, 95% CI 1.35–2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60–5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: ‘Burden of disease within the family’; ‘Differing religious interpretations’; ‘Geographical concerns’; and ‘A culture of silence’. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.

scholarly journals P1635INVESTIGATING REASONS FOR ETHNIC INEQUITY IN LIVING-DONOR KIDNEY TRANSPLANTATION IN THE UK: A MIXED METHODS ANALYSIS OF A MULTICENTRE QUESTIONNAIRE-BASED STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Katie Wong ◽  
Yoav Ben-Shlomo ◽  
Amanda Owen-Smith ◽  
Fergus Caskey ◽  
Stephanie MacNeill ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Blood Group ◽  
Living Donor ◽  
Family Members ◽  
Free Text ◽  
Donor Kidney ◽  
Living Kidney Donors ◽  
The Uk ◽  
The Right ◽  
Living Donor Kidney

Abstract Background and Aims A living-donor kidney transplant (LDKT) is one of the best treatments for kidney failure, yet in the UK there is evidence of ethnic inequity in access. We designed this questionnaire-based mixed-methods study to investigate the patient-reported reasons that family members of Black, Asian and Minority Ethnic group (BAME) individuals were not able to become living kidney donors. Method This questionnaire-based case-control study included 14 UK hospitals. Participants were adults transplanted between 1/4/13-31/3/17. Participants provided data on all relatives aged >18 years who could have been potential living kidney donors. Participants were asked for the reasons why relatives could not donate: individuals were asked to tick all options that applied from a list of reasons (Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation), and a box was provided for free-text entries following the option of ‘Other – please give details’. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s ethnicity (binary variable White versus BAME). 56/171 BAME respondents provided free text responses and all were analysed. Qualitative responses were analysed using thematic analysis. Results 1,240 questionnaires were returned from 3,103 patients (40% response). There was strong evidence that after adjustment for potential confounders sex, age and socioeconomic position, BAME individuals were more likely than White respondents to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) 3.14 [95% CI 2.10-4.70]), were prevented from donating by financial concerns (aOR 2.25 [95% CI 1.49-3.39]), were not able to take time off work (aOR 2.05 [95% CI 1.36-3.09]), and were not the right blood group (aOR 1.47 [95% CI 1.12-1.94]). Four qualitative themes were identified from free-text responses from BAME participants: i) Burden of disease within the family ii) ‘Unorthodox’ religious beliefs iii) Specific geographical concerns (healthcare provision, visa difficulties) iv) Knowledge handling. The theme ‘Knowledge Handling’ incorporated three subthemes: a) Need for more detailed knowledge, b) Protected disclosure of health status, and c) Recipient assumptions about potential donor knowledge. Conclusion We have identified multiple barriers to living kidney donation in the UK BAME population, which should be further investigated and addressed. BAME transplant recipients were more likely to report that potential donors were not the right blood group to donate: work should be undertaken to ascertain if this reflects true ABO-incompatibility or perceived incompatibility. Potential donors living outside the UK is a major barrier, related to difficulties with accessing visa and concerns about a specific country’s healthcare system’s capacity for longer-term post-donation care. The financial barriers reported may disproportionately affect overseas donors who, although entitled to reimbursement for travel, accommodation and visa costs, may incur large “up-front” costs which may be prohibitive. No respondents reported that a major religion’s position on living donation was a barrier to donation. However, there were several references to family members holding beliefs that were described as ‘distorted’ religious beliefs: this highlights the need to understand the beliefs of potential donors who belong to non-mainstream religions, which may be out of the remit of denominational faith leaders.

The Impact of Cold Ischaemia Time On Outcomes of Living Donor Kidney Transplantation in the UK Living Kidney Sharing Scheme

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Stijn C. van de Laar ◽  
Matthew Robb ◽  
Rachel Hogg ◽  
Lisa Burnapp ◽  
Vassilios E. Papalois ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Donor Kidney ◽  
Sharing Scheme ◽  
Ischaemia Time ◽  
Cold Ischaemia Time ◽  
The Uk ◽  
The Impact ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

scholarly journals Effect of Donor and Recipient ABH-Secretor Status on ABO-Incompatible Living Donor Kidney Transplantation

2021 ◽  
Vol 12 ◽  
Author(s):  
Fan Zhang ◽  
Saifu Yin ◽  
Yu Fan ◽  
Turun Song ◽  
Zhongli Huang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Blood Group ◽  
Graft Rejection ◽  
Living Donor ◽  
Blood Group Antigens ◽  
Post Transplantation ◽  
Donor Kidney ◽  
Secretor Status ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

IntroductionABO blood group antigens within grafts are continuously exposed to anti-A/B antibodies in the serum of recipients after ABO-incompatible (ABOi) kidney transplantation and are instrumental in antibody-mediated rejection. Some individuals secrete soluble blood group antigens into body fluids. In this study, we investigated the effect of donor and recipient secretor status on the outcomes of ABOi kidney transplantation.MethodsData of a total of 32 patients with ABOi living donor kidney transplantation were retrospectively collected between 2014 and 2020 in West China Hospital. The genotype and phenotype of both donors and recipients were examined and evaluated with post-transplantation anti-A/B titer changes, graft function, and rejection.ResultsOf the 32 recipients and 32 donors, 23 (71.9%) recipients and 27 (84.4%) donors had secretor genotypes, whereas 9 (28.1%) recipients and 5 (15.6%) donors did not. Anti-A/B titers after ABOi kidney transplantation were not significantly influenced by the secretor status of either donors or recipients. The post-transplantation serum creatinine (Scr) levels and estimated glomerular filtration rate (eGFR) was better in weak- or non-secretor recipients at day 30 (Scr P = 0.047, eGFR P = 0.008), day 90 (Scr P = 0.010, eGFR P = 0.005), and month 9 (eGFR P = 0.008), and recipients from secretor donors had a lower incidence of graft rejection in the first year after ABOi transplantation (P = 0.004).ConclusionsA weak secretor status phenotype was found in both genotypes, i.e., individuals who secreted soluble antigens as well as those who did not. The recipient ABH-secretor status may have an influence on early posttransplant renal function, and the donor ABH-secretor status might affect the incidence of graft rejection.

scholarly journals P1660ACCESS TO KIDNEY TRANSPLANTATION IN THE UK CHINESE POPULATION: A UK RENAL REGISTRY ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Katie Wong ◽  
Fergus Caskey ◽  
Yoav Ben-Shlomo ◽  
Anna Casula ◽  
Pippa Bailey
Keyword(s):  
Logistic Regression ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Chinese Population ◽  
Living Donor ◽  
Donor Kidney ◽  
Chinese Ethnicity ◽  
The Uk ◽  
To Receive ◽  
Living Donor Kidney

Abstract Background and Aims Previous UK Renal Registry (UKRR) analyses and the Access to Transplantation and Transplant Outcome Measures (ATTOM) study have shown ethnic disparity in access to kidney transplants in the UK, but access to transplantation for the UK Chinese population has not been investigated In this UKRR analysis, we compared the likelihood of kidney transplantation between the UK White and UK Chinese renal populations, aiming to investigate whether there was evidence of ethnic disparity in access to kidney transplantation for this specific ethnic group. Method Data on all adult patients >=18 years who started renal replacement therapy (RRT) between 1/1/97 and 31/12/16 were extracted from the UKRR. Patients with ethnicity recorded as anything other than “Chinese” or “White” were excluded from analysis. Patients with ethnicity data missing were also excluded. Patients aged >= 75 years at the start of RRT were excluded because of the high prevalence of comorbidity which decreases the likelihood of transplantation and the very small proportion of patients receiving a kidney transplant in the UK in this age group. Socioeconomic status (SES) was measured using country-specific Index of Multiple Deprivation (IMD) quintiles derived from patient postcodes (1= most deprived, 5= least deprived). The independent variable of interest was Chinese ethnicity (Chinese vs White). Multivariable logistic regression models were used to investigate the relationship between Chinese ethnicity and being listed on the deceased donor transplant waiting list i) at start of RRT ii) 2 years after start of RRT iii) pre-emptive kidney transplantation, iv) kidney transplantation at 3 years after start of RRT, and v) living-donor kidney transplantation. The models were run unadjusted and then adjusted for the confounders, specified a priori, age, sex, primary renal disease and SES. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using robust standard errors to account for clustering by renal centre. Results The dataset comprised of 92,857 incident RRT patients. 0.5% (n=501) were of Chinese ethnicity, 76% (n=70,575) were White. The findings of the multivariable logistic regression analyses are presented in Table 1. Even after adjustment for potential confounders UK Chinese patients had lower odds of being waitlisted at the start of RRT (OR 0.71, [95% CI 0.54-0.94]) but were more likely to be waitlisted at 2 years (OR 1.28, [95% CI 1.02-1.61]) compared to White patients. UK Chinese individuals were also less likely to receive a pre-emptive kidney transplant (OR 0.47, [95% CI 0.29-0.78]), less likely to be transplanted within 3 years of starting RRT (OR 0.69, [95% CI 0.52-0.92]) or have a living-donor kidney transplant(LDKT) (OR 0.39, [95% CI 0.26-0.59]) compared to White patients. Conclusion This is the first study that has shown that UK Chinese renal patients are less likely to have the opportunity to receive a living or deceased kidney transplant. Future research needs to test whether later presentation or more rapid progression of renal disease could explain these observations. The higher odds of transplant listing at 2 years suggests fitness for transplantation is not a significant barrier. The reasons why this ethnic group are less likely to receive a LDKT is also not well understood. Understanding whether these disparities reflect modifiable policy, health system or donor/recipient level barriers will help ensure equitable access to transplantation.

scholarly journals Receipt and Sharing of Information to Improve Knowledge About Living Donor Kidney Transplant Among Individuals With Advanced CKD

2021 ◽  
Author(s):  
Dinushika Mohottige ◽  
Clemontina Davenport ◽  
Hui-Jie Lee ◽  
Patti Ephraim ◽  
Nicole DePasquale ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Health Professionals ◽  
Living Donor ◽  
Family Members ◽  
Donor Kidney ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Shared Information ◽  
Living Donor Kidney Transplant ◽  
Living Donor Kidney

Abstract Background: Knowledge about living donor kidney transplant (LDKT) is associated with greater LDKT access. Yet, little is known about factors associated with high LDKT knowledge.Methods: As part of a clinical trial, we conducted a cross-sectional analysis of data obtained from individuals seen in nephrology clinics who were deemed candidates for pre-emptive LDKT. We assessed participants’ LDKT knowledge [10-point scale based on correct answers to questions about prognosis, donation, and financial aspects of LDKT; (high knowledge ≥8)], self-reported receipt of information about LDKT from various health professionals, and self-reported history of having shared information about LDKT with family members or friends. In multivariable logistic regression models adjusting for participants’ age, race, and total household income, we quantified the association of participants’ high LDKT knowledge with their receipt of LDKT information from health professionals and their sharing of LDKT information with family/friends. Results: Among 130 participants, the median (IQR) age was 59.5 (52.0-65.0) years, 60% were female, 47.7% were Black or African American, and 49.2% had a high school education or less. Participants had seen their nephrologists for a median (IQR) of 2.0 (1.0-4.0) years. Over half (55.4%) had high LDKT knowledge. Nearly one third reported having received LDKT information (33.1%) or sharing LDKT information with family/friends (28.5%). After adjustment, those who received (versus did not receive information) and shared information with family/friends had 3-fold higher odds of high LDKT knowledge (3.05 [1.24, 8.08]). Individuals who received LDKT information (versus did not receive information) from health professionals had 4-fold higher odds of high LDKT knowledge (adjusted OR [95% CI]: 4.01 [1.49, 12.18]. Conclusions: Both the receipt of LDKT information from health professionals and sharing of LDKT information with family members/friends were associated with high LDKT knowledge. Improved provision of LDKT information to patients with advanced CKD and encouragement to share information with family members or friends could aid efforts to improve LDKT rates.Trial registration: ClinicalTrials.gov number, NCT00932334.

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