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Inequalities in outcomes after kidney transplant failure in the UK.

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Τίτλος: Inequalities in outcomes after kidney transplant failure in the UK.
Συγγραφείς: Westaway S; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; North Bristol NHS Trust, Bristol, United Kingdom., Bailey PK; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; North Bristol NHS Trust, Bristol, United Kingdom., Santhakumaran S; UK Renal Registry, UK Kidney Association, Bristol, United Kingdom., Beresford M; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom., Greenhall G; Barts Health NHS Trust, London, United Kingdom., Griffin S; University Hospital of Wales, Cardiff, United Kingdom.; Wales Kidney Research Unit, Wales, United Kingdom., Hole BD; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; North Bristol NHS Trust, Bristol, United Kingdom., Hilton R; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Masoud S; National Registry of Rare Kidney Diseases, Bristol, United Kingdom.; Centre for Kidney and Bladder Health, University College London, London, United Kingdom., Nitsch D; UK Renal Registry, UK Kidney Association, Bristol, United Kingdom.; The London School of Hygiene and Tropical Medicine, London, United Kingdom., Plumb L; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; Bristol Royal Hospital for Children, Bristol, United Kingdom., Robb M; NHS Blood and Transplant, Bristol, United Kingdom., Pippias M; Population Health Sciences, Bristol Medical School, Bristol, United Kingdom.; North Bristol NHS Trust, Bristol, United Kingdom.
Πηγή: PloS one [PLoS One] 2026 Aug 26; Vol. 21 (8), pp. e0356769. Date of Electronic Publication: 2026 Aug 26 (Print Publication: 2026).
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
Imprint Name(s): Original Publication: San Francisco, CA : Public Library of Science
Ιατρικοί όροι (MeSH): Kidney Transplantation*/adverse effects , Kidney Failure, Chronic*/therapy, United Kingdom/epidemiology ; Humans ; Male ; Retrospective Studies ; Female ; Middle Aged ; Registries ; Treatment Failure ; Adult ; Renal Dialysis ; Glomerular Filtration Rate ; Aged ; Treatment Outcome
Περίληψη: Background: Failing transplant management is an international research priority. The Failing Kidney Transplant Outcomes Registry Analysis (FAKTOR) is investigating management and outcomes of kidney transplant failure in the UK.
Methods: A retrospective cohort analysis using UK Renal Registry data on adults (≥18 years) with kidney transplant failure (eGFR < 15ml/min/1.73m2) between 01/2012-12/2021. Treatment status was determined each year post-failure as the first status recorded of: i) re-transplantation, ii) haemodialysis (HD), iii) peritoneal dialysis (PD), iv) death; those alive without changing Kidney Replacement Therapy (KRT) modality classed as v) alive without new KRT, subclassified as vi) managed conservatively if eGFR < 7.5ml/min/1.73 m2 with no future dialysis. Treatment status was determined by one-year post-failure and reported by: age, sex, ethnicity, socioeconomic group, primary renal disease (PRD) and centre type (transplanting/non-transplanting). When applicable, last eGFR pre-dialysis was recorded. Regression models investigated the relationship between patient characteristics and centre type with outcomes: i) treatment status by one-year and ii) pre-dialysis eGFR.
Results: We included 5447 patients. By one-year, 47.8% first received HD and 5.2% were pre-emptively re-transplanted. Black and Asian people were less likely to be re-transplanted than White people (Black Relative Risk Ratio (RRR) 0.41, 95% CI 0.20-0.87. Asian RRR 0.57, 0.34-0.96). Males were more likely to be re-transplanted (RRR 1.39, 1.06-1.81) and to receive HD (RRR 1.68, 1.47-1.92). Each quintile increase in deprivation was associated with a 22% lower re-transplantation likelihood (RRR 0.78, 0.71-0.86). Diabetic PRD was associated with higher mortality (RRR 1.97, 1.34-2.88) relative to glomerulonephritis. Median pre-dialysis eGFR was 9.6 ml/min/1.73 m2 (IQR 7.7-11.7) and 7.1% higher in non-transplanting compared with transplanting centres (+7.1%, + 2.6% to +11.9%).
Conclusions: This first nationwide description of outcomes following kidney transplant failure in the UK highlights strong evidence of pre-emptive re-transplantation inequalities, favouring White people, those in less deprived areas and males.
(Copyright: © 2026 Westaway et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Competing Interests: The authors have declared that no competing interests exist.
References: BMJ. 2021 Sep 10;374:n2159. (PMID: 34507980)
Clin J Am Soc Nephrol. 2019 Nov 7;14(11):1616-1625. (PMID: 31649071)
BMJ. 2007 Oct 20;335(7624):806-8. (PMID: 17947786)
Can J Kidney Health Dis. 2020 Apr 14;7:2054358120908677. (PMID: 32313663)
Kidney360. 2021 Oct 20;3(1):144-152. (PMID: 35368561)
Nephrol Dial Transplant. 2023 Aug 31;38(9):2086-2088. (PMID: 37169887)
Adv Kidney Dis Health. 2024 Sep;31(5):476-482. (PMID: 39232618)
Clin J Am Soc Nephrol. 2020 Jun 8;15(6):830-842. (PMID: 32467306)
Transplantation. 2010 Aug 15;90(3):279-85. (PMID: 20523276)
Nephrol Dial Transplant. 2012 Dec;27(12):4464-72. (PMID: 23028105)
Nephrol Dial Transplant. 2017 May 01;32(5):890-900. (PMID: 28379431)
Transpl Int. 2024 Apr 22;37:12605. (PMID: 38711816)
Nephron Clin Pract. 2013;125(1-4):111-25. (PMID: 24662170)
Kidney Int. 2023 Dec;104(6):1076-1091. (PMID: 37236423)
Kidney Int. 2024 Jan;105(1):35-45. (PMID: 38182300)
Am J Transplant. 2020 Mar;20(3):769-778. (PMID: 31599065)
Clin J Am Soc Nephrol. 2022 Mar;17(3):444-451. (PMID: 33692118)
Am J Kidney Dis. 2012 Mar;59(3):419-27. (PMID: 22014401)
Transplantation. 2024 Oct 1;108(10):2144-2152. (PMID: 38771099)
Nephrol Dial Transplant. 2021 Aug 27;36(9):1656-1663. (PMID: 32591814)
Pediatr Nephrol. 2020 Dec;35(12):2191-2200. (PMID: 32809052)
Br Med Bull. 2022 Jul 9;142(1):4-14. (PMID: 35368069)
Pediatr Transplant. 2024 Mar;28(2):e14730. (PMID: 38433601)
Transplantation. 2012 Mar 27;93(6):610-6. (PMID: 22245879)
Am J Nephrol. 2017;46(2):165-175. (PMID: 28787713)
Am J Nephrol. 2019;50(3):161-167. (PMID: 31311008)
Am J Transplant. 2010 Apr;10(4 Pt 2):1090-107. (PMID: 20420655)
Nephrol Dial Transplant. 2009 Dec;24(12):3774-82. (PMID: 19622573)
Transplantation. 2026 Apr 1;110(4):e866-e875. (PMID: 41385712)
Am J Kidney Dis. 2012 Jan;59(1 Suppl 1):A7, e1-420. (PMID: 22177944)
Transpl Int. 2021 Nov;34(11):2329-2340. (PMID: 34339557)
Entry Date(s): Date Created: 20260826 Date Completed: 20260826 Latest Revision: 20260828
Update Code: 20260828
PubMed Central ID: PMC13514003
DOI: 10.1371/journal.pone.0356769
PMID: 42647538
Βάση Δεδομένων: MEDLINE
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  Data: Inequalities in outcomes after kidney transplant failure in the UK.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Kidney+Transplantation%22&quot;&gt;Kidney Transplantation*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Kidney+Transplantation+adverse+effects%22&quot;&gt;adverse effects&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Kidney+Failure%2C+Chronic%22&quot;&gt;Kidney Failure, Chronic*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Kidney+Failure%2C+Chronic+therapy%22&quot;&gt;therapy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22United+Kingdom%22&quot;&gt;United Kingdom&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22United+Kingdom+epidemiology%22&quot;&gt;epidemiology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Retrospective+Studies%22&quot;&gt;Retrospective Studies&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Middle+Aged%22&quot;&gt;Middle Aged&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Registries%22&quot;&gt;Registries&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Treatment+Failure%22&quot;&gt;Treatment Failure&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adult%22&quot;&gt;Adult&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Renal+Dialysis%22&quot;&gt;Renal Dialysis&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Glomerular+Filtration+Rate%22&quot;&gt;Glomerular Filtration Rate&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Aged%22&quot;&gt;Aged&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Treatment+Outcome%22&quot;&gt;Treatment Outcome&lt;/searchLink&gt;
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  Data: Background: Failing transplant management is an international research priority. The Failing Kidney Transplant Outcomes Registry Analysis (FAKTOR) is investigating management and outcomes of kidney transplant failure in the UK.&lt;br /&gt;Methods: A retrospective cohort analysis using UK Renal Registry data on adults (≥18 years) with kidney transplant failure (eGFR &amp;lt; 15ml/min/1.73m2) between 01/2012-12/2021. Treatment status was determined each year post-failure as the first status recorded of: i) re-transplantation, ii) haemodialysis (HD), iii) peritoneal dialysis (PD), iv) death; those alive without changing Kidney Replacement Therapy (KRT) modality classed as v) alive without new KRT, subclassified as vi) managed conservatively if eGFR &amp;lt; 7.5ml/min/1.73 m2 with no future dialysis. Treatment status was determined by one-year post-failure and reported by: age, sex, ethnicity, socioeconomic group, primary renal disease (PRD) and centre type (transplanting/non-transplanting). When applicable, last eGFR pre-dialysis was recorded. Regression models investigated the relationship between patient characteristics and centre type with outcomes: i) treatment status by one-year and ii) pre-dialysis eGFR.&lt;br /&gt;Results: We included 5447 patients. By one-year, 47.8% first received HD and 5.2% were pre-emptively re-transplanted. Black and Asian people were less likely to be re-transplanted than White people (Black Relative Risk Ratio (RRR) 0.41, 95% CI 0.20-0.87. Asian RRR 0.57, 0.34-0.96). Males were more likely to be re-transplanted (RRR 1.39, 1.06-1.81) and to receive HD (RRR 1.68, 1.47-1.92). Each quintile increase in deprivation was associated with a 22% lower re-transplantation likelihood (RRR 0.78, 0.71-0.86). Diabetic PRD was associated with higher mortality (RRR 1.97, 1.34-2.88) relative to glomerulonephritis. Median pre-dialysis eGFR was 9.6 ml/min/1.73 m2 (IQR 7.7-11.7) and 7.1% higher in non-transplanting compared with transplanting centres (+7.1%, + 2.6% to +11.9%).&lt;br /&gt;Conclusions: This first nationwide description of outcomes following kidney transplant failure in the UK highlights strong evidence of pre-emptive re-transplantation inequalities, favouring White people, those in less deprived areas and males.&lt;br /&gt; (Copyright: &#169; 2026 Westaway et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
– Name: Abstract
  Label: Competing Interests
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  Data: The authors have declared that no competing interests exist.
– Name: Ref
  Label: References
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(PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237169887%22&quot;&gt;37169887)&lt;/searchLink&gt;&lt;br /&gt;Adv Kidney Dis Health. 2024 Sep;31(5):476-482. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239232618%22&quot;&gt;39232618)&lt;/searchLink&gt;&lt;br /&gt;Clin J Am Soc Nephrol. 2020 Jun 8;15(6):830-842. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232467306%22&quot;&gt;32467306)&lt;/searchLink&gt;&lt;br /&gt;Transplantation. 2010 Aug 15;90(3):279-85. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2220523276%22&quot;&gt;20523276)&lt;/searchLink&gt;&lt;br /&gt;Nephrol Dial Transplant. 2012 Dec;27(12):4464-72. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2223028105%22&quot;&gt;23028105)&lt;/searchLink&gt;&lt;br /&gt;Nephrol Dial Transplant. 2017 May 01;32(5):890-900. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228379431%22&quot;&gt;28379431)&lt;/searchLink&gt;&lt;br /&gt;Transpl Int. 2024 Apr 22;37:12605. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238711816%22&quot;&gt;38711816)&lt;/searchLink&gt;&lt;br /&gt;Nephron Clin Pract. 2013;125(1-4):111-25. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2224662170%22&quot;&gt;24662170)&lt;/searchLink&gt;&lt;br /&gt;Kidney Int. 2023 Dec;104(6):1076-1091. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2237236423%22&quot;&gt;37236423)&lt;/searchLink&gt;&lt;br /&gt;Kidney Int. 2024 Jan;105(1):35-45. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238182300%22&quot;&gt;38182300)&lt;/searchLink&gt;&lt;br /&gt;Am J Transplant. 2020 Mar;20(3):769-778. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231599065%22&quot;&gt;31599065)&lt;/searchLink&gt;&lt;br /&gt;Clin J Am Soc Nephrol. 2022 Mar;17(3):444-451. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2233692118%22&quot;&gt;33692118)&lt;/searchLink&gt;&lt;br /&gt;Am J Kidney Dis. 2012 Mar;59(3):419-27. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222014401%22&quot;&gt;22014401)&lt;/searchLink&gt;&lt;br /&gt;Transplantation. 2024 Oct 1;108(10):2144-2152. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238771099%22&quot;&gt;38771099)&lt;/searchLink&gt;&lt;br /&gt;Nephrol Dial Transplant. 2021 Aug 27;36(9):1656-1663. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232591814%22&quot;&gt;32591814)&lt;/searchLink&gt;&lt;br /&gt;Pediatr Nephrol. 2020 Dec;35(12):2191-2200. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232809052%22&quot;&gt;32809052)&lt;/searchLink&gt;&lt;br /&gt;Br Med Bull. 2022 Jul 9;142(1):4-14. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235368069%22&quot;&gt;35368069)&lt;/searchLink&gt;&lt;br /&gt;Pediatr Transplant. 2024 Mar;28(2):e14730. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238433601%22&quot;&gt;38433601)&lt;/searchLink&gt;&lt;br /&gt;Transplantation. 2012 Mar 27;93(6):610-6. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222245879%22&quot;&gt;22245879)&lt;/searchLink&gt;&lt;br /&gt;Am J Nephrol. 2017;46(2):165-175. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228787713%22&quot;&gt;28787713)&lt;/searchLink&gt;&lt;br /&gt;Am J Nephrol. 2019;50(3):161-167. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2231311008%22&quot;&gt;31311008)&lt;/searchLink&gt;&lt;br /&gt;Am J Transplant. 2010 Apr;10(4 Pt 2):1090-107. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2220420655%22&quot;&gt;20420655)&lt;/searchLink&gt;&lt;br /&gt;Nephrol Dial Transplant. 2009 Dec;24(12):3774-82. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2219622573%22&quot;&gt;19622573)&lt;/searchLink&gt;&lt;br /&gt;Transplantation. 2026 Apr 1;110(4):e866-e875. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2241385712%22&quot;&gt;41385712)&lt;/searchLink&gt;&lt;br /&gt;Am J Kidney Dis. 2012 Jan;59(1 Suppl 1):A7, e1-420. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222177944%22&quot;&gt;22177944)&lt;/searchLink&gt;&lt;br /&gt;Transpl Int. 2021 Nov;34(11):2329-2340. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234339557%22&quot;&gt;34339557)&lt;/searchLink&gt;
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  Data: 10.1371/journal.pone.0356769
– Name: AN
  Label: PMID
  Group: ID
  Data: 42647538
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42647538
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1371/journal.pone.0356769
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: e0356769
    Subjects:
      – SubjectFull: United Kingdom epidemiology
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Retrospective Studies
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Registries
        Type: general
      – SubjectFull: Treatment Failure
        Type: general
      – SubjectFull: Adult
        Type: general
      – SubjectFull: Renal Dialysis
        Type: general
      – SubjectFull: Glomerular Filtration Rate
        Type: general
      – SubjectFull: Aged
        Type: general
      – SubjectFull: Treatment Outcome
        Type: general
      – SubjectFull: Kidney Transplantation adverse effects
        Type: general
      – SubjectFull: Kidney Failure, Chronic therapy
        Type: general
    Titles:
      – TitleFull: Inequalities in outcomes after kidney transplant failure in the UK.
        Type: main
  BibRelationships:
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      – PersonEntity:
          Name:
            NameFull: Westaway S
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            NameFull: Santhakumaran S
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            NameFull: Greenhall G
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            NameFull: Griffin S
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            NameFull: Hole BD
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            NameFull: Masoud S
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            NameFull: Nitsch D
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            NameFull: Plumb L
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            NameFull: Robb M
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          Name:
            NameFull: Pippias M
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      – BibEntity:
          Dates:
            – D: 26
              M: 08
              Text: 2026 Aug 26
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1932-6203
          Numbering:
            – Type: volume
              Value: 21
            – Type: issue
              Value: 8
          Titles:
            – TitleFull: PloS one
              Type: main
ResultId 1