Original article
Vol. 151 No. 3132 (2021)
Demographic, psychosocial and health disparities between living and deceased renal allograft recipients in Switzerland
Summary
BACKGROUND
Living donor renal transplantation is widely performed in Switzerland with a superior long-term outcome and lower waiting time compared with deceased renal transplantation. However the chances of receiving a living donor kidney transplant are not the same for all transplant candidates. The current study aimed to identify psychosocial and demographic characteristics that predict lower access to living kidney donation in Switzerland.
METHODS
The study was a nationwide multicentre study nested within the Swiss Transplant Cohort Study. Pre-transplant demographic, psychosocial and health characteristics of 1126 deceased and 859 living renal transplant recipients were compared using logistic regression analysis.
RESULTS
Transplant candidates with higher age (odds ratio [OR] per 10 years 0.67, 95% confidence interval [CI] 0.60–0.74), lower education (OR 0.46, 95% CI 0.36–0.59), a work capacity of less than 50% (OR 0.48, 95% CI 0.35–0.66), single or formerly married (OR 0.38, 95% CI 0.26–0.53 / OR 0.37, 95% CI 0.26–0.53) or with a higher hospital depression score (OR per 5 points 0.61, 95% CI 0.50–0.74) were less likely to receive an allograft from a living donor. In some regions of Switzerland candidates were more likely to undergo living transplantation than in other regions. No association was found with gender or income.
CONCLUSIONS
Interventions to increase access to kidney transplantation from living donors should target transplant candidates of older age, lower education, lower working capacity and not living in a committed relationship. The observed regional differences suggest that additional determinants of living donation may play a role such as population and health professional attitudes toward living donation.
References
- Thiel GT, Nolte C, Tsinalis D. Prospective Swiss cohort study of living-kidney donors: study protocol. BMJ Open. 2011;1(2):e000202–000202. doi:.https://doi.org/10.1136/bmjopen-2011-000202
- Swiss Transplant. Jahresbericht 2018 [Internet]. swiss transplant; 2019. Available from: https://www.swisstransplant.org/fileadmin/user_upload/Swisstransplant/Jahresbericht/Jahresbericht_und_Grafiken_2018/Swisstransplant_Jahresbericht_2018.pdf
- Donation and Transplantation Institut. International registry in organ donation and transplantation [Internet]. 2018. Available from: ttps://www.irodat.org/?p=database
- Baid-Agrawal S, Frei UA. Living donor renal transplantation: recent developments and perspectives. Nat Clin Pract Nephrol. 2007;3(1):31–41. doi:.https://doi.org/10.1038/ncpneph0383
- Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, et al. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant. 2015;15(S2, Suppl 2):1–34. doi:.https://doi.org/10.1111/ajt.13195
- Koller M, Stampf S, Rick J, Bianco S, Achermann R, Steiger J. Swiss Transplant Cohort Report, May 2008 - December 2016. 2017;(June 2017). Available from: https://www.stcs.ch/publications
- Schweizerischer Organ Lebendspender Verein SOLV. Lebendspenderegister [Internet]. Beziehung zwischen Nierenspendenden und -empfangenden in der Schweiz. [cited 2016 Dec 16]. Available from: http://www.lebendspende.ch/de/register_sol_dhr_statistik_nierenspenden.php
- Burkhalter F, Huynh-Do U, Hadaya K, Matter M, Müller T, Binet I, et al. Early complications after living donor nephrectomy: analysis of the Swiss Organ Living Donor Health Registry. Swiss Med Wkly. 2017;147(3334):w14497. doi:.https://doi.org/10.4414/smw.2017.14497
- Krishnan N, Mumford L, Lipkin G, Gill P, Fletcher S, Dasgupta I, et al. Comparison of Medium-term Outcomes of Living Kidney Donors With Longitudinal Healthy Control in the United Kingdom. Transplantation. 2020;104(3):e65–74. doi:.https://doi.org/10.1097/TP.0000000000003082
- Zentrale Ethikkommission Subkommission. Lebendspende von soliden Organen, Richtlinien [Internet]. SAMW; 2008. Available from: https://www.samw.ch/de/Ethik/Themen-A-bis-Z/Organtransplantation/Lebendorganspende.html
- Gore JL, Danovitch GM, Litwin MS, Pham PTT, Singer JS. Disparities in the utilization of live donor renal transplantation. Am J Transplant. 2009;9(5):1124–33. doi:.https://doi.org/10.1111/j.1600-6143.2009.02620.x
- Reese PP, Shea JA, Bloom RD, Berns JS, Grossman R, Joffe M, et al. Predictors of having a potential live donor: a prospective cohort study of kidney transplant candidates. Am J Transplant. 2009;9(12):2792–9. doi:.https://doi.org/10.1111/j.1600-6143.2009.02848.x
- Zimmermann T, Pabst S, Bertram A, Schiffer M, de Zwaan M. Differences in emotional responses in living and deceased donor kidney transplant patients. Clin Kidney J. 2016;9(3):503–9. doi:.https://doi.org/10.1093/ckj/sfw012
- Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, et al. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant. 2017;32(5):890–900. doi:.https://doi.org/10.1093/ndt/gfx036
- de Groot IB, Veen JIE, van der Boog PJM, van Dijk S, Stiggelbout AM, Marang-van de Mheen PJ ; PARTNER-study group. Difference in quality of life, fatigue and societal participation between living and deceased donor kidney transplant recipients. Clin Transplant. 2013;27(4):E415–23. doi:.https://doi.org/10.1111/ctr.12165
- Khattak MW, Sandhu GS, Woodward R, Stoff JS, Goldfarb-Rumyantzev AS. Association of marital status with access to renal transplantation. Am J Transplant. 2010;10(12):2624–31. doi:.https://doi.org/10.1111/j.1600-6143.2010.03318.x
- Zimmermann T, Pabst S, Bertram A, Schiffer M, de Zwaan M. Differences in emotional responses in living and deceased donor kidney transplant patients. Clin Kidney J. 2016;9(3):503–9. doi:.https://doi.org/10.1093/ckj/sfw012
- Koller MT, van Delden C, Müller NJ, Baumann P, Lovis C, Marti HP, et al. Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort. Eur J Epidemiol. 2013;28(4):347–55. doi:.https://doi.org/10.1007/s10654-012-9754-y
- Swiss Transplant Cohort Study. Swiss Transplant Cohort Study description [Internet]. [cited 2018 Feb 17]. Available from: http://www.stcs.ch/about/study-description
- EuroQol Group Association. EQ-5D-3L [Internet]. Available from: https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/
- Snaith RP. Sigmond AS. The Hospital Anxiety and Depression Scale Manual. Nfer-Nelson, Windsor; 1994.
- De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, et al.; Psychosocial Interest Group, Swiss Transplant Cohort Study. The Swiss Transplant Cohort Study’s framework for assessing lifelong psychosocial factors in solid-organ transplants. Prog Transplant. 2013;23(3):235–46. doi:.https://doi.org/10.7182/pit2013250
- Fox J, Monette G. Generalized Collinearity Diagnostics. J Am Stat Assoc. 1992;87(417):178–83. doi:.https://doi.org/10.1080/01621459.1992.10475190
- R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria; 2016. Available from: https://www.r-project.org/
- Gordon EJ. “They don’t have to suffer for me”: why dialysis patients refuse offers of living donor kidneys. Med Anthropol Q. 2001;15(2):245–67. doi:.https://doi.org/10.1525/maq.2001.15.2.245
- Hanson CS, Chadban SJ, Chapman JR, Craig JC, Wong G, Ralph AF, et al. The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation: A Thematic Synthesis of Qualitative Studies. Transplantation. 2015;99(3):540–54. doi:.https://doi.org/10.1097/TP.0000000000000433
- Garonzik-Wang JM, Berger JC, Ros RL, Kucirka LM, Deshpande NA, Boyarsky BJ, et al. Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation. 2012;93(11):1147–50. doi:.https://doi.org/10.1097/TP.0b013e31824e75a5
- Kranenburg LW, Richards M, Zuidema WC, Weimar W, Hilhorst MT, IJzermans JNM, et al. Avoiding the issue: patients’ (non)communication with potential living kidney donors. Patient Educ Couns. 2009;74(1):39–44. doi:.https://doi.org/10.1016/j.pec.2008.07.028
- Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Hemmelgarn BR ; Alberta Kidney Disease Network. Barriers to living kidney donation identified by eligible candidates with end-stage renal disease. Nephrol Dial Transplant. 2011;26(2):732–8. doi:.https://doi.org/10.1093/ndt/gfq388
- Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol. 2001;40(4):429–34. doi:.https://doi.org/10.1348/014466501163904
- Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27(2):363–70. doi:.https://doi.org/10.1017/S0033291796004382
- Hinz A, Brähler E. Normative values for the hospital anxiety and depression scale (HADS) in the general German population. J Psychosom Res. 2011;71(2):74–8. doi:.https://doi.org/10.1016/j.jpsychores.2011.01.005
- Hagren B, Pettersen I-M, Severinsson E, Lützén K, Clyne N. The haemodialysis machine as a lifeline: experiences of suffering from end-stage renal disease. J Adv Nurs. 2001;34(2):196–202. doi:.https://doi.org/10.1046/j.1365-2648.2001.01745.x
- Moran A, Scott A, Darbyshire P. Waiting for a kidney transplant: patients’ experiences of haemodialysis therapy. J Adv Nurs. 2011;67(3):501–9. doi:.https://doi.org/10.1111/j.1365-2648.2010.05460.x
- Bundesversammlung der Schweizerischen Eidgenossenschaft. Transplantationsgesetz [Internet]. [cited 2017 Aug 7]. Available from: https://www.admin.ch/opc/de/classified-compilation/20010918/index.html
- Gill J, Dong J, Gill J. Population income and longitudinal trends in living kidney donation in the United States. J Am Soc Nephrol. 2015;26(1):201–7. doi:.https://doi.org/10.1681/ASN.2014010113
- Swiss Transplant (Institution/Organisation). Eine repräsentative Umfrage zeigt: Die Schweizer haben eine äusserst positive Einstellung zur Organspende. Swiss Transplantant Magazin. 2015;28:8–11.
- Fox J. Effect Displays in R for Generalised Linear Models. J Stat Softw. 2003;8(15):1–27. doi:.https://doi.org/10.18637/jss.v008.i15