3 April 2025

New Research Letter in Nephrology Dialysis Transplantation Reinforces UKRR Findings on Inequities in Kidney Transplant Waitlisting

A research letter by Esther Wong, Senior Statistician at the UK Renal Registry (UKRR) and PhD candidate at the University of Bristol, titled “Inequity of Access to the UK Kidney Transplant Waiting List”, has been published in the April 2025 issue of Nephrology Dialysis Transplantation (NDT). The letter builds on the UKRR’s landmark 2024 report, Inequity of Access to the UK Kidney Transplant Waiting List, for which Esther was lead author.

The UK Renal Registry (UKRR) plays an important role in reporting and assessing the quality of care and outcomes for all patients eligible for dialysis and kidney transplantation. These publications highlight persistent inequities in access to transplant waitlisting - an issue of clinical significance and considerable public interest - while emphasising the importance of early transplant waitlisting in increasing the likelihood of receiving a kidney transplant from a deceased donor. Under the UK’s allocation system, earlier listing directly improves a patient’s chances of transplantation.

Advancing Equity in Kidney Care

Esther Wong, a Senior Statistician at the UKRR and PhD candidate at the University of Bristol, has led groundbreaking work on healthcare disparities. Her recent research focuses on:

  • Access to transplantation waitlists, including this study and the 2024 UKRR report
  • Acute Kidney Injury (AKI) outcomes, including her work on "Seasonal mortality trends for hospitalised patients with acute kidney injury across England"

Her analyses provide critical evidence to guide policy and clinical practice toward more equitable kidney care. On transplant waitlisting Esther says, "I am struck by how factors like ethnicity and socioeconomic status are associated with differences in the chances of being listed or receiving a kidney transplant. By describing the differences, I hope this reporting identifies opportunities for improving access to kidney transplant listing in ways that are equitable and inclusive."

Key Findings: Systemic Disparities

Both the research letter and the original report reveal significant differences driven by:

  • Age: Younger patients (18-29) had 3.9-fold higher odds of being listed within 2 years compared to those aged 50-59, while patients aged 70-75 faced 81% lower odds.
  • Ethnicity: Patients of Asian ethnicity were 66% more likely to be listed than White patients, while Black patients were 14% less likely.
  • Socioeconomic status: Patients in the most affluent areas had 47% higher odds of listing than those in mid-deprivation areas, while the most deprived had 44% lower odds.
  • Centre-level variation: Transplant centres had 50% higher adjusted odds of listing patients than non-transplant centres, highlighting potential logistical challenges in referral pathways

COVID-19 and the Urgency of Equity

The pandemic reduced waitlisting odds by 10% for patients starting KRT in 2019-2020, pre-existing differences in access remained evident across all groups. The findings highlight the importance of targeted interventions to promote more equitable access, particularly for older, ethnically diverse, and socioeconomically disadvantaged patients.

Why This Matters

These findings align with prior studies, including the ATTOM investigation, and highlight the need for targeted interventions to address inequities. The UKRR continues to monitor these trends through work led by researchers like Esther, with future analyses planned as more data (e.g., transplant assessment records) become available.

Explore Further

Contact: Esther Wong | UKRR Research Team