LEARNING FROM AUDIT OF TRANSPLANT LISTING WM Transplant Audit Kerry Tomlinson Sep 2014

Preferred Pathway: Transplant First eGFR<20 or 1 year pre RRT Discuss transplantation and refer Attend seminar, work up and assessment Identify LD Work up Discuss RRT options Preparation for access Pre-emptive transplant Create access RRT List

Wmids Transplant Access Rates: How do we compare?

UHNS data current dialysis patients 2004 mean UHNS

Transplant incident numbers

Pre-emptive rate 16%- could do better Donor audit 133 contacts lead to 19 donors

Stoke- time to listing

Time to listing: Historical Median 170 days Median 0 days Median 0 days Stoke 84 Leighton Stoke 93 Leighton 407 (incomplete data)

Time for work up (mean days) StokeLeighton Time from referral to seminar to referral to transplant centre As above for late listed patients with no medical problems (n=1) As above for late listed patients with medical problems or DNA Time from referral to transplant centre to seen at transplant centre 5966

Workup: we’ve come a long way since 2004! Referral to seeing KT: 104 days Awaiting tests: 159 days and rising Referral to UHB to seeing surgeon: 107days Total: 363 days

Tests in parallel days days 2009-

eGFR at referral to seminar 2012 Listed within 90 days of RRT Listed > 90 days post RRT Stoke198 Leighton179 Approximately 50% late referral avoidable

Time to listing: Historical Median 170 days Median 0 days Median 0 days Stoke 84 Leighton Stoke 93 Leighton 407 (incomplete data) Stoke 0 Leighton 89 (same for 2012-now)

eGFR at referral to seminar 2012-now Listed within 90 days of RRT Listed > 90 days post RRT All187 Approximately 57% late referral avoidable

% of cyberren CKD5 patients not displaying transplant status

Unplanned starters 86% (116) not listed 2 transferred 33 deceased 53 recovered 22 unsuitable 5 pt choice/1 DNA 86% (116) not listed 2 transferred 33 deceased 53 recovered 22 unsuitable 5 pt choice/1 DNA 14% (19) listed 74% (14) listed <12 months 26% (5)>12 months 3 - clinical reasons 1 - referral not received by centre (how since recovered function) 1- needed time to settle (up to October) 135 unplanned (22% known, 78% unknown)

Timeline-real life ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ● ● J J A S O N D J F M A M J J A S O N D J F M A M J J 1 st discussion LD & RRT Ref RRT chat Mum comes forward Ref trans assess RRT counselling decided PD Blood group Transplant assessment US abdo Echo Gastro all clear Ref UHB Seen UHB and listed Waiting list clinic Ref VNEP VNEPUrgent tube insertion Tube removed Reinsertion LDtransplantLDtransplant X matchUS Donor assessment GFR & split function CTHTA and UHB referral ●=dietician ●=epo/iron●=pharmacist

A cautionary tale…

Discussion