Practice variations in the evaluation of adult candidates for cadaveric kidney transplantation - A survey of the European transplant centers

Background. This survey was conducted to investigate similarities and diffe rences in the diagnostic evaluation of adult candidates for cadaveric renal transplantation and the criteria for acceptance to the cadaveric renal tra nsplant waiting-list in the European transplant centers. Methods. A questionnaire listing 45 diagnostic procedures (consultations of 9 specialties, 18 imaging techniques and 18 laboratory investigations), 45 medical conditions constituting possible reasons for exclusion from renal transplantation, and 10 properties characterizing the responding transplant center was sent to 214 European transplant centers. Results. A completed questionnaire was returned by 154 of 214 centers (72%) . Significant disagreement (P<0.001) exists about the necessity of 28 of th e 45 surveyed diagnostic procedures and about the acceptability of transpla nt candidates for 15 of the 45 surveyed medical conditions. The influence of center characteristics on the observed practice variations was examined by multinomial logistic regression (factors: Center size, wai ting list pressure, responsibility for organizing the diagnostic work-up, s tatus of transplant center, responsibility for decision about acceptance of candidates and geographic location of center): In 13 of 28 controversial d iagnostic procedures, geographic location of the centers turned out to be t he only significant determining factor (P<0.001), whereas the dissent about medical conditions is not influenced significantly by the analyzed factors . Conclusion. The detected significant practice variations in the evaluation of renal transplant candidates may either indicate where scientific evidenc e is missing and more clinical research is needed or where the existing evi dence has not been adequately disseminated and convincing guidelines should be established.