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Access to transplant in the UK
The ATTOM study
Dr Rommel Ravanan
Rommel.ravanan@nbt.nhs.uk
On behalf of ATTOM investigators
Access to transplant in the UK
• Unexplained between centre variation in access to the
waiting list, time taken for activation and receipt of a
transplant once activated*
• Patient and/or unit specific variables that explain such
variation not clear
* BMJ 2010;341:c3451
Figure 1
Percentage listed prior to start of RRT or within 2yrs of starting dialysis
(Excluding centres with <10 patients on RRT)
90
Tx centre vs not: OR 0.9 (0.82 to 0.99)
80
70
% W a it lis t e d
60
50
40
30
20
R isk-a d ju ste d ce n tre ra te
95% Lo wer CL
9 9 .8 % L o w e r C L
N a tio n a l ra te
95% Upp er CL
9 9 .8 % U p p e r C L
10
0
50
100
150
200
250
300
Number of patients
350
400
450
500
Figure 3
Percentage transplanted (LKD/DCD) within 2yrs of registration
(Excluding centres with <10 patients waitlisted)
60
R isk-a d ju ste d ce n tre ra te
95% Lo wer CL
9 9 .8 % L o w e r C L
N a tio n a l ra te
95% Upp er CL
9 9 .8 % U p p e r C L
50
Tx centre vs not: OR 0.69 (0.60 to 0.79)
% T ra n s p la n t e d
40
30
20
10
0
0
20
40
60
80
100
120
140
160
Number waitlisted
180
200
220
240
260
280
Median time to waitlisting
Figure 4
(Excluding centres with <10 patients waitlisted)
1400
U n a d ju ste d ce n tre ra te
N a tio n a l ra te
95% Upp er CL
9 9 .8 % U p p e r C L
U n a d ju ste d ce n tre ra te
95% Lo wer CL
9 9 .8 % L o w e r C L
M e d ia n t im e t o w a it lis t in g (d a y s )
1200
1000
800
654 days
600
400
200
0
0
20
40
60
80
100
120
140
160
180
200
220
240
260
280
300
320
Number waitlisted
The centre represented by an unfilled symbol has its final event time as the plotting position as the median time could not be estimated
ATTOM
Access to Transplantation
and
Transplant Outcome Measures
The Scottish Renal
Registry
QoL on dialysis and
transplantation
Survival on dialysis
and after
transplantation
Health economics
ATTOM
Access to
transplantation
Organ Allocation
The ATTOM group
Cambridge
Andrew Bradley
Chris Watson
Ms Ruth Summers (NHS manager)
Bristol
Charlie Tomson
Chris Dudley
Rommel Ravanan
Edinburgh
Gabriel Oniscu
John Forsythe
UKRR
Terry Feest / Damian Fogarty
SRR
Wendy Metcalfe
NHSBT
Rachel Johnson
Royal Holloway
Prof Clare Bradley (PROMs expertise)
LSHTM
Prof John Cairns (Health economic expertise)
Southampton University (Epidemiology & Qualitative research expertise)
Prof Paul Roderick,
Dr Gerry Leydon
+ Ethics & patients representatives
ATTOM Cohort 1
ATTOM Cohort 2
Functioning
Transplant
Incident
transplant
patients1 in
the UK
Prevalent
wait-listed
patients in
the UK
n = 2250
n = 2250
Death
Return to
dialysis
Transplant
Death or
removal from
the list
Remain on
the
transplant
list
ATTOM - how
• Embedded research nurses in 20 transplant centres
• Nurses record clinical phenotype from case notes/IT
systems
• Administer/collect PROMs questionnaires
• Parallel qualitative assessment of centre practice
patterns
•
Outcome data by linking ATTOM database to registries
ATTOM – help needed
• Local PIs for R&D approvals (~May 2011)
• Facilitate local nurse recruitment (~August/September
2011)
• Data clarifications (if needed) for nurses
• Participate in semi-structured interviews / answer
questionnaires (for the qualitative work stream)
ATTOM - output
• What’s in it for the units?
Accurate benchmarking of unit level co-morbidity burden / transplant
related resource availability
Share �best practice’
�Free’ near complete data returns to UKRR/SRR
NIHR portfolio income to your NHS trust
• What’s in it for the renal community in the UK?
�Real world’ UK clinical evidence base to drive UK clinical policy
Survival probability model to improve equity of access
Understanding PROMs in renal patients
Permanent complete dataset for many analyses by UKRR/SRR
Contact for information
Rommel.ravanan@nbt.nhs.uk
Charlie.tomson@nbt.nhs.uk
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