Renal transplantation at Royal Wolverhampton Hospitals Trust Dr J Nicholas Please feel free to use your own Trust Powerpoint template if you would prefer July 2015

Pathway Post Tx Seen in Tx clinic - Nx CKD identification Patients seen in a variety of clinics EPR used to track cases Record all activities Underpinned by CKD/ Tx nurses chasing consultants, patients, Tx centre Counselling Ideally start at least at GFR <18ml/min Work up Test requests + record activity in EPR Referral for Tx Refer + inform patient + CKD / Tx nurses Send all details to UHB/ Oxford Activation on Tx list Await information from UHB/ Oxford / BTS Activation/ Suspension / removal events Inform patient, UHB/ Oxford + CKD / Tx team + record in EPR Surveillance Each consultant is responsible to the care of this detail Arrange tests following review Keep all updated Post Tx Seen in UHB/ Oxford Transfer by 3 mths Seen in Tx clinic - Nx Return to RRT – return to cycle as identified

EPR reports to assist Tx care pathway Reports for HD/ PD/ CKD cases presented, with dashboards and details to identify transplantation issues.

Key data (1) % of dialysis patients currently listed for transplant – 10% % of listed patients currently suspended from transplant waiting list – 10% % of listed patients who were pre-emptively listed in 2014 – 40% Median time from dialysis start date to listing (2) – 10 months Renal Unit performance on the Renal Registry data quality dashboard (3) (1) Please don’t go to great lengths to collect this data; if you don’t routinely collect it that is useful for us to know – we’re anticipating that many units won’t be collecting the majority of this data. (2) Please count a pre-emptive listing as zero so as not to skew the figures (3) Please provide your latest data or a summary of all data received from the UK Renal Registry

Incident RRT details Less than 5% are pre-emptive transplants in a year

Trends in GFR pre RRT – decade data Decline in GFR of all incident RRT patients prior to RRT – by months Data presented by first RRT modality Is there any other relevant data that your unit routinely collects that you would like to share?

Record of transplant listing activity RWHT has used an EPR to track activity for 20 years. Extract from the EPR of all activity associated with transplant planning since 1996. Activity dip noted in 2014 following installation of a new EPR. Further training has led to change in activity in 2015

Time to list around RRT and numbers involved Time to list – median months Numbers newly listed per year Data presented by year of listing Peaked at 40 cases in 2008

Fractions listed pre and post RRT Improved pre dialysis follow up and increased fraction of pre-emptive listing. Numbers listed can be 40/year Data presented by year of listing

RRT Tx status – includes PD and HD Summary A small number have been transplanted and some had failure and status needs resolving A number have no documented plan and needs resolution – Age median 65 years A number removed A number are suspended and some may require removal from the list A number are undergoing tests to promote referral

All cases – RRT + CKD Summary A small number have been transplanted and some had failure and status needs resolving A large number have no documented plan and needs active resolution if GFR <25ml/min (graphic not included) A number removed from the list A number are suspended and some may require removal from the list A number are undergoing tests to promote referral

Age distribution of RRT + CKD cases in pathway

Specialised services Dashboard

Summary of activity Processes identified for RWHT Guidance available for all. Time to listing has fallen over time. A lot of activity is present to support transplantation. Most patients are not fit for renal transplantation. Patients without plans are identified. Patients on the list and those who are suspended are easily identified.

Key challenges for timely assessment and listing Engagement in the process and full utilisation of the resources Several audits have been presented in the past to resolve issues. MDTs need to be focussed to resolve transplant details, to their full measure. Stick to a limited number of bullet points