Impact of Victorian Quality Indicator (QI) on kidney transplant wait-lists for Indigenous and non-Indigenous Australians.

Abstract

Background: In 2012, Victoria introduced a 6monthly reportable renal QI for proportion of patients waitlisted or pre-emptively transplanted by set time points following start of dialysis. In 2019, renal QI was modified to include patients aged 18-70 at 6 and 12 months after commencing dialysis. We aimed to determine if QI influenced timeliness of placement on kidney transplant waiting list for Victorians, including Indigenous (ATSI; Aboriginal and Torres Strait Islander People) Victorians. Method(s): Dialysis start date, date of waitlisting or pre-emptive transplantation, medical co-morbidities, type of kidney replacement therapy (KRT) for patients aged 18-70 commencing KRT between 2007-2020 was extracted from ANZDATA. Data was divided into three eras and four sub-cohorts. Primary outcome was percentage of patients waitlisted or transplanted at 6, 12 and 24 months from starting dialysis. Result(s): Of 25,836 (14.7% ATSI) patients on dialysis, 8,587 (5.7% ATSI) were listed for transplant and 1,103 had pre-emptive transplants by December 2021. A higher proportion of non-ATSI (49%) and ATSI Victorian (31%) patients were waitlisted or had pre-emptive transplants compared to Australians (non-Victorian) (44% and 13% respectively). The proportion of Victorian patients waitlisted or had pre-emptive transplants at all timepoints improved substantially in 2017-2020, compared to 2007-2012. The proportion of Victorian patients waitlisted by 6months improved significantly (aOR 1.85 (1.55-2.21), P<0.001) following QI implementation, but there was no significant change in Australians (non-Victorian). Victorian ATSI patients were three times more likely to be waitlisted or transplanted than ATSI patients in rest of Australia (aOR 3.59 (1.45, 8.87), P = 0.006). Conclusion(s): Following introduction of the Victorian QI, the percentage of dialysis patients on waitlist or had pre-emptive transplants at 6 and 12 months increased. Victorian ATSI patients were more likely to be waitlisted than Australian ATSI patients.