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Inequalities in outcomes after kidney transplant failure in the UK.

Westaway S, Bailey PK, Santhakumaran S, Beresford M, Greenhall G, Griffin S, Hole BD, Hilton R et al.

PloS one, 2026

5,447 participants

Abstract

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…

How strong is the evidence?

Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 5,447 participants or records.

How the five levels of evidence work. The level is assigned automatically from the abstract and can be wrong, so check the paper.

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