The rates of referral from dialysis facilities to transplant centres are lower than expected and exhibit wide variation across the US state of Georgia, according to new research by Rachel Patzer and colleagues. These researchers previously reported that patients in Georgia have the lowest level of access to kidney transplantation in the USA, but the limiting step to transplant access was unknown.
The study utilized data made available through the Southeastern Kidney Transplant Coalition, in which all three adult transplant centres in Georgia share data on patient referrals from dialysis facilities. The within-facility median rate of referral for transplantation was ∼24%, but some facilities referred no patients within 1 year of starting dialysis, whereas others referred up to 75% of patients within 1 year. Factors that had previously been associated with low rates of wait-listing were not associated with referral for transplantation. For example, black patients were more likely to be referred than white patients, but were less likely to be wait-listed.
“The extreme variability in dialysis facility referral for transplantation suggests that there is an opportunity to intervene in the facilities with the lowest transplant referrals,” says Patzer. “We are looking for more transplant centres across the country to collaborate in sharing patient referral data in a voluntary registry, as no national surveillance data are available. This type of data will help to set national standards for the proportion of patients that should be referred for kidney transplantation—information that is currently unknown.”
Patzer, R. E. et al. Variation in dialysis facility referral for kidney transplantation among patients with end-stage renal disease in Georgia. JAMA 314, 582–594 (2015)
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Edwards, J. Wide variation in rates of dialysis facility referrals to transplant centres. Nat Rev Nephrol 11, 631 (2015). https://doi.org/10.1038/nrneph.2015.146