Access to Transplantation and Transplant Outcome Measures (ATTOM): study protocol of a UK wide, in-depth, prospective cohort analysis

Abstract

IntroductionThere is significant intercentre variability in access to renal transplantation in the UK due to poorly understood factors. The overarching aims of this study are to improve equity of access to kidney and kidney–pancreas transplantation across the UK and to optimise organ allocation to maximise the benefit and cost-effectiveness of transplantation.Methods and analysis6844 patients aged 18–75 years starting dialysis and/or receiving a transplant together with matched patients active on the transplant list from all 72 UK renal units were recruited between November 2011 and March 2013 and will be followed for at least 3 years. The outcomes of interest include patient survival, access to the transplant list, receipt of a transplant, patient-reported outcome measures (PROMs) including quality of life, treatment satisfaction, well-being and health status on different forms of renal replacement therapy. Sociodemographic and clinical data were prospectively collected from case notes and from interviews with patients and local clinical teams. Qualitative process exploration with clinical staff will help identify unit-specific factors that influence access to renal transplantation. A health economic analysis will explore costs and outcomes associated with alternative approaches to organ allocation. The study will deliver: (1) an understanding of patient and unit-specific factors influencing access to renal transplantation in the UK, informing potential changes to practices and policies to optimise outcomes and reduce intercentre variability; (2) a patient-survival probability model to standardise access to the renal transplant list and (3) an understanding of PROMs and health economic impact of kidney and kidney–pancreas transplantation to inform the development of a more sophisticated and fairer organ allocation algorithm.Ethics and disseminationThe protocol has been independently peer reviewed by National Institute for Health Research (NIHR) and approved by the East of England Research Ethics Committee. The results will be published in peer-reviewed journals and presented at conferences.

Barriers to living donor kidney transplantation in the United Kingdom: a national observational study

“…A full description of the ATTOM study methods and protocol has been reported previously [10]. As part of the ATTOM study, incident kidney transplant recipients were recruited at the time of transplantation from all 23 UK renal transplant centres.…”

Chapter 3 Demographic and Biochemistry Profile of Kidney Transplant Recipients in the UK in 2016:

“…Centre differences in outcomes of transplantation are explored later in this chapter. A large national study (access to Transplant and Transplant Outcome Measures (ATTOM)) is currently investigating differences in access to and outcomes of renal transplantation [11]. The work has already identified significant age, ethnicity, socio-economic and geographic disparities in the utilisation of living kidney donor transplants in the UK [12].…”

UK Renal Registry 19th Annual Report: Chapter 3 Demographic and Biochemistry Profile of Kidney Transplant Recipients in the UK in 2015: National and Centre-specific Analyses

“…There are a number of potential explanations for these inconsistencies, including geographical differences in access to renal transplantation in the UK. This has previously been analysed in detail by the UKRR [2] and is currently the focus of a large national study (access to Transplant and Transplant Outcome Measures (ATTOM)) [3].…”