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Variation in Access to Kidney Transplantation across Renal Programs in Ontario, Canada

In the United States kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a healthcare system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to United States ESRD networks). We also assessed the cumulative incidence of kidney transplant for healthier dialysis patients (age 18 to 50 years without diabetes, coronary disease or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23,022 chronic dialysis patients the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI], 4.8-10.7) to 31.4% (95% CI, 16.5-47.5) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI, 0.2-0.5) to 1.5 (95% CI, 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly-funded healthcare system.