{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:10:01Z","timestamp":1780459801837,"version":"3.54.1"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ontario Health Ontario Renal Network"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Previous studies conducted in publicly and privately funded health care systems suggest that access to kidney transplants may vary depending on where a patient receives their kidney care. It is poorly understood whether variability exists across the key steps required to receive a kidney transplant in a publicly funded health care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine whether there is variation across Ontario\u2019s regional renal programs (RRPs) in key steps completed toward receiving a kidney transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Population-based cohort study from November 1, 2017, to December 31, 2021, using linked administrative health care databases with a maximum follow-up of March 31, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>This study includes 27 RRPs and independent health facilities in Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Patients approaching the need for dialysis and patients receiving maintenance dialysis with no recorded contraindication to kidney transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Key steps toward receiving a kidney transplant, including (1) referred to a transplant center for an evaluation; (2) had a potential living donor contact a transplant center to be evaluated; (3) deceased donor waitlist activation; and (4) received a transplant from a living or deceased donor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>For each step toward receiving a kidney transplant, we reported a unique incidence rate per 100 person-years with a 95% confidence interval (95% CI), presented by Ontario\u2019s RRPs, including the 27 RRPs and independent health facilities. We also presented results by 5 Ontario geographic regions. In an additional analysis, we examined the time to complete specific transplant steps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 8319 individuals approaching the need for dialysis and 4869 individuals receiving maintenance dialysis. During follow-up, 2870 (34.5%) individuals approaching the need for dialysis initiated maintenance dialysis. In individuals approaching the need for dialysis, we found the rate of a potential living kidney donor contacting a transplant center to be evaluated varied more than 17-fold across RRPs from 0.67 (95% CI = 0.1, 4.8) to 11.7 (95% CI = 9.2, 14.9). In the dialysis cohort, the average number of steps completed toward receiving a kidney transplant varied almost 4-fold across RRPs from 11.7 (95% CI = 9.3, 14.8) to 44.0 (95% CI = 38.6, 50.1) steps per 100 person-years. The average rate of each step measured separately also varied widely, with the rate of referral to a transplant center for an evaluation (per 100 person-years) varying across RRPs from 6.0 (95% CI = 4.2, 8.5) to 47.9 (95% CI = 42.6, 53.8), the rate of a potential living kidney donor contacting a transplant center to be evaluated from 1.5 (95% CI = 0.78, 2.9) to 10.7 (95% CI = 7.9, 14.5), the rate of deceased donor waitlisting from 2.9 (95% CI = 1.9, 4.4) to 13.2 (95% CI = 11.0, 15.8), and the rate of kidney transplant from 2.0 (95% CI = 1.1, 3.4) to 12.6 (95% CI = 10.8, 14.8). When examining the results by 5 Ontario geographic regions, we found patients receiving maintenance dialysis in Northern Ontario had substantially lower rates of completing key steps toward receiving a kidney transplant. For example, the rate of transplant referral (per 100 person-years) was almost 3-fold lower in Northern Ontario (10.0, 95% CI = 8.3, 12.0) compared to Toronto (28.7, 95% CI = 25.7, 32.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>We did not examine the reason for differences in access to kidney transplant across RRPs (eg, differences in physician practices and staff-to-patient ratio).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Despite operating in a publicly funded health care system, there is substantial variability across the 4 key steps required to receive a kidney transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>Not registered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20543581251346048","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T05:43:21Z","timestamp":1750916601000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Variation in Kidney Transplant Referral, Living Donor Contacts, Waitlisting, and Kidney Transplant Across Regional Renal Programs in Ontario, Canada: A Population-Based Cohort Study"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5304-8038","authenticated-orcid":false,"given":"Kyla L.","family":"Naylor","sequence":"first","affiliation":[{"name":"ICES Western, London Health Sciences Centre Research Institute, London, Ontario, Canada"},{"name":"Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0404-7319","authenticated-orcid":false,"given":"Seychelle","family":"Yohanna","sequence":"additional","affiliation":[{"name":"Provincial Medical Lead, Access to Kidney Transplantation, Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada"},{"name":"Division of Nephrology, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Smith","sequence":"additional","affiliation":[{"name":"ICES Western, London Health Sciences Centre Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-3114","authenticated-orcid":false,"given":"Amit X.","family":"Garg","sequence":"additional","affiliation":[{"name":"ICES Western, London Health Sciences Centre Research Institute, London, Ontario, Canada"},{"name":"Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Elliott","sequence":"additional","affiliation":[{"name":"Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Knoll","sequence":"additional","affiliation":[{"name":"Department of Medicine (Nephrology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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