Journal Article

Time trend in access to the waiting list and renal transplantation: a comparison of four European countries

Vianda S. Stel, Reinhard Kramar, Torbjorn Leivestad, Andries J. Hoitsma, Wendy Metcalfe, Jacqueline M. Smits, Pietro Ravani and Kitty J. Jager

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 9, pages 3621-3631
Published in print September 2012 | ISSN: 0931-0509
Published online May 2012 | e-ISSN: 1460-2385 | DOI:
Time trend in access to the waiting list and renal transplantation: a comparison of four European countries

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To examine the time trend and international differences in access to the waiting list and renal transplantation of patients with end-stage kidney disease.


We included all patients (n = 30 961) from Austria, Norway, the Netherlands and Scotland who started renal replacement therapy (RRT) between 1995 and 2003 with their kidney transplant waiting list data (until 31 December 2005) and follow-up data on RRT and mortality (until 31 December 2007). The outcome measure was access to the waiting list within 2 years and to a first renal transplant within 4 years from the start of RRT, expressed as incidence per million age-related population (p.m.a.r.p.) per year. To estimate trends over time, mean percentage annual change (MPAC) and 95% confidence interval (CI) were calculated.


In each country, the number of patients starting RRT > 65 years increased significantly over time, whereas the number of renal transplants did not increase to the same extent. Only in Norway were almost all patients on the waiting list transplanted within 4 years of RRT start if they were < 65 years. In patients who started RRT > 65 years, the access to renal transplantation was high in Norway (49 p.m.a.r.p.) and low in Austria ( < 26 p.m.a.r.p.), the Netherlands and Scotland (both < 10 p.m.a.r.p.) but increased significantly in Austria (MPAC = 9.8%; 95% CI = 3.9–16.9) and the Netherlands (MPAC = 9.0%; 95% CI = 3.2–15.0).


Only in Norway, virtually all patients on the waiting list < 65 years received a transplant within 4 years after the start of RRT and, remarkably, also most of those > 65 years of age.

Keywords: epidemiology; Europe; kidney transplantation; time trend; waiting list

Journal Article.  5878 words.  Illustrated.

Subjects: Nephrology

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