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Access to transplant in the UK The ATTOM study

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.

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Access to transplant in the UK The ATTOM study

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  1. Access to transplant in the UKThe ATTOM study Dr Rommel Ravanan Rommel.ravanan@nbt.nhs.uk On behalf of ATTOM investigators

  2. 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

  3. Figure 1 Percentage listed prior to start of RRT or within 2yrs of starting dialysis (Excluding centres with <10 patients on RRT) Tx centre vs not: OR 0.9 (0.82 to 0.99)

  4. Figure 3 Percentage transplanted (LKD/DCD) within 2yrs of registration (Excluding centres with <10 patients waitlisted) Tx centre vs not: OR 0.69 (0.60 to 0.79)

  5. Median time to waitlisting (Excluding centres with <10 patients waitlisted) Figure 4 654 days The centre represented by an unfilled symbol has its final event time as the plotting position as the median time could not be estimated

  6. A T T O M Access to Transplantation and Transplant Outcome Measures The Scottish Renal Registry

  7. QoL on dialysis and transplantation Survival on dialysis and after transplantation Health economics ATTOM Organ Allocation Access to transplantation

  8. The ATTOM group CambridgeBristol Andrew Bradley Charlie Tomson Chris Watson Chris Dudley Ms Ruth Summers (NHS manager) Rommel Ravanan EdinburghUKRR Gabriel Oniscu Terry Feest / Damian Fogarty John Forsythe SRRNHSBT Wendy Metcalfe Rachel Johnson Royal HollowayLSHTM Prof Clare Bradley (PROMs expertise) Prof John Cairns (Health economic expertise) Southampton University (Epidemiology & Qualitative research expertise) Prof Paul Roderick, Dr Gerry Leydon + Ethics & patients representatives

  9. ATTOM Cohort 1

  10. ATTOM Cohort 2 Prevalent wait-listed patients in the UK n = 2250 Incident transplant patients1 in the UK n = 2250 Functioning Transplant Death Return to dialysis Transplant Death or removal from the list Remain on the transplant list

  11. 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

  12. 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)

  13. 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

  14. Contact for information Rommel.ravanan@nbt.nhs.uk Charlie.tomson@nbt.nhs.uk

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