Renal Transplant Audit (including liver+kidney) 2010 David Milford Department of Nephrology Birmingham Children’s Hospital

Activity 2009 2010 n= 14 (BCH) 21 3 (non-BCH) Donor type 2009 2010 n= 14 (BCH) 21 3 (non-BCH) Donor type Deceased 12 12 Live 2 9 Kidney alone 11 18 Liver+kidney 3 3 Do ratios ?? Do a table to show results accordingly

Transplant numbers

BCH % of national waiting list

Details 2009 2010 Dialyisis PD 3 4 HD 6 10 PET 2 4 Mean age 9.3 9.1 2009 2010 Dialyisis PD 3 4 HD 6 10 PET 2 4 Mean age 9.3 9.1 Age range 4.5 – 15.75 3 - 16 Ethnicity (all transplants) Caucasian 12 12 (7 LRD) Asian 2 9 (2 LRD)

Dialysis patients and ethnicity Total no patients White Non-white % non-white Month Jan-02 16 10 6 38 Jun-02 Jan-03 Jun-03 17 11 35 Jan-04 29 14 15 52 Jun-04 32 53 Jan-05 31 45 Jun-05 34 19 44 Jan-06 28 12 43 Jun-06 24 13 46 Jan-07 50 Jun-07 26 62 Jan-08 27 56 Jun-08 Jan-09 Jun-09 23 48 Jan-10 22 Jun-10 58

Referral units Unit Number Stafford 2 Russells Hall 1 Birmingham – Children’s Birmingham – Heartlands Birmingham – City Northampton Burton Nuneaton Good Hope Banbury Stoke on Trent

Recipient details Cause renal failure Previous Tx: all 0 Time on W/L Developmental 10/18; cong neph 3/18 Previous Tx: all 0 Time on W/L All: median = 17.5 m (3-39 m) Asian: median = 25 m (3-39 m) Match points All: median = 5 (1-9) Asian: median = 5.5 (2-8)

Donor details Age: median 40 yr (20-54 yr) Sex 11 M: 7 F Cause death ICH 6 RTA 3 CMV D+/R- 7/18

Transplant details CIT Anastamosis time CRF median 64 (0-88) Cad mean 13 h (9-19 h) LRD mean 3.35 h (3-4.3 h) Anastamosis time Cad mean 47 m (30-56 m) LRD mean 39 m (24-49 m) CRF median 64 (0-88)

Mean mismatches

Outcomes Death =0 Delayed graft function = 4/18 Baseline immunosuppression Bas/Tac/MMF 17/18 Tac/Aza/Pred 1/18 CMV viraemia = 2/18 PTLD =1/18 (6/12 post Tx, gut infiltrate) Acute rejection 7/18

Transplant function Median 54 49

Complications Recurrent UTI 8/18 Blocked stent → nephrostomy Blocked stent → replaced LRD : nephrostomy, stent re-insertion, suprapubic catheter, Mitrofanoff fashioned, Tx ureter unkinked Ureterostomy reversed to Mitrofanoff Passenger lymphocyte syndrome LRD: angioplasty for RAS LRD: ureterostomy revision Mitrofanoff fashioned

Rejection rates

Liver+kidney transplant Age (Y) 5 8 4 Sex M F Weight 14 28 15 cause ESRF ARPKD D-HUS on W/L (M) 11 dialysis HD PET donor age 21 31 20 cause death CVA ICH Menin FU PCr 32 66 35

Issues for audit Waiting list proportionately larger Cadavaric transplant rate slightly increased, LRD numbers increasing Very high proportion of Asian patients Rejection rate appears higher with minimal steroid regimen, growth benefit may become evident

American Journal of Transplantation 2010; 10: 828–836