Referral for Kidney Transplantation in Canadian Provinces
CLINICAL EPIDEMIOLOGY www.jasn.org Referral for Kidney Transplantation in Canadian Provinces S. Joseph Kim,1,a John S. Gill,2,3,a Greg Knoll,4,5 Patricia Campbell,6 Marcelo Cantarovich,7 Edward Cole ,1 and Bryce Kiberd8 1University Health Network, University of Toronto, Toronto, Canada; 2University of British Columbia, Vancouver, Canada; 3Division of Nephrology, Center for Health Evaluation and Outcome Sciences, Vancouver, Canada; 4University of Ottawa, Ottawa, Canada; 5Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada; 6University of Alberta, Edmonton, Canada; 7McGill University, Montreal, Canada; and 8Dalhousie University, Halifax, Canada ABSTRACT Background Patient referral to a transplant facility, a prerequisite for dialysis-treated patients to access kidney transplantation in Canada, is a subjective process that is not recorded in national dialysis or trans- plant registries. Patients who may benefit from transplant may not be referred. Methods In this observational study, we prospectively identified referrals for kidney transplant in adult patients between June 2010 and May 2013 in 12 transplant centers, and linked these data to information on incident dialysis patients in a national registry. Results Among 13,184 patients initiating chronic dialysis, the cumulative incidence of referral for trans- plant was 17.3%, 24.0%, and 26.8% at 1, 2, and 3 years after dialysis initiation, respectively; the rate of transplant referral was 15.8 per 100 patient-years (95% confidence interval, 15.1 to 16.4). Transplant re- ferral varied more than three-fold between provinces, but it was not associated with the rate of deceased organ donation or median waiting time for transplant in individual provinces.
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