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

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

3. Transplant numbers

4. BCH % of national waiting list

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

6. 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

7. 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

8. 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)

9. 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

10. Transplant details CIT Anastamosis time CRF median 64 (0-88)
Cad mean 13 h (9-19 h)
LRD mean 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)

11. Mean mismatches

12. 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

13. Transplant function
Median

14. 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

15. Rejection rates

16. 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

17. 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

18. American Journal of Transplantation 2010; 10: 828–836