Qualitative Research in Nephrology and Other Medical Specialities: State of Evidence and Critique

Database search of qualitative research studies in nephrology in comparison to other medical specialities

Qualitative Research in Nephrology and Other Medical Specialities: State of Evidence and Critique

Systematic search of studies published with qualitative methodology by medical specialities. Comparison of nehphrology to other medical specialities

Box and whisker plot of waiting time by elective liver transplant indication.

Box and whisker plot of waiting time by elective liver transplant indication.</p

Elective liver transplantation (CLD/HCC vs VS) by centre.

Elective liver transplantation (CLD/HCC vs VS) by centre.</p

Patient survival outcomes by transplantation indication and list type.

Patient survival outcomes by transplantation indication and list type.</p

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist.

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist.</p

Kaplan Meier survival curve for allograft survival following elective transplantation.

Kaplan Meier survival curve for allograft survival following elective transplantation.</p

Allograft survival probability by transplantation indication and list type.

Allograft survival probability by transplantation indication and list type.</p

Elective liver transplantation (PLD vs Non-PLD) by centre.

Elective liver transplantation (PLD vs Non-PLD) by centre.</p

Intraoperative death.

IntroductionLiver transplantation is the only curative option for patients with polycystic liver disease (PLD). In the United Kingdom, these patients are listed on the variant syndrome list due to their preserved liver function reflected in the United Kingdom End-stage Liver Disease (UKELD) score. The transplantation and survival rates for this patient group in the UK have not been previously reported.MethodsA retrospective cross-sectional analysis of patients receiving liver transplantation between 2010 and 2017 was performed using the NHS blood and transplantation database. This database contains the demographic, clinical parameters, indication for transplantation and follow-up of all patients in UK-based transplant centres. Basic statistics was performed using SPSS version 27.Results5412 recipients received elective liver allografts in the study period. 1.6% (100) of recipients had PLD as their primary indication for transplantation with 60 receiving liver only allografts and 40 receiving combined liver-kidney allografts. PLD patients had a >3-fold longer mean waiting time for transplantation compared to non-PLD patients, 508 days v 154 days respectively. PLD patients receiving combined liver-kidney allografts had a longer waiting time than those receiving a liver only allograft, 610 days v 438 days respectively. There were comparable patient survival rates for people with PLD and non-PLD primary indications at 30 days (94.0% vs 97.6%) and 1 year (92.0% vs 93.2%) but improved survival rates at 5 years (81.3% vs 76.5%). There were also comparable allograft survival rates for people with PLD and non-PLD primary indications at 30 days (93.9% vs 95.3%) and 1 year (91.9% vs 91.2%) but improved survival rates at 5 years (82.5% vs 77.3%). Transplant centre-level analysis identified variation in the proportion of liver transplantations for people with PLD as their primary listed indication.ConclusionsPatients with PLD wait significantly longer for liver transplantation compared to other indications. However, transplanted PLD patients demonstrate better longer-term patient and liver allograft survival rates compared to transplanted non-PLD patients. The unexpected variation between individual UK centres transplanting for PLD deserves further study.</div