1. Renal transplantation at University Hospital North Midlands NHS Trust
Kerry Tomlinson
Please feel free to use your own Trust Powerpoint template if you would prefer
Jul 2015

2. Preferred Pathway: Transplant First
Identify LD
Work up
CKD team chase transplant status and document
Transplant status discussed at CKD meeting
Attend seminar, work up clinic and assessment
Discuss transplantation and refer
Pre-emptive transplant
Tests ordered in parallel
RCA for patients not listed at start of RRT
eGFR<20 or 1 year pre RRT
List
Discuss RRT options
Create access
Preparation for access
RRT

3. Key data (1) % of dialysis patients currently listed for transplant
20% (87/432)
26 listed are still pre-dialysis
i.e. total list 113
% of listed patients currently suspended from transplant waiting list
37% (similar in dialysis and pre-dialysis)
23%UHB 50% Manchester
(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

4. 48 76 81
referral , haematology problem
144
crash lander
200
out of country
212
K/P referred to manchester
253
Late referral
289
previous transplant failed 08/13, had to be removed
294
acute start
301
rapid deterioration in transplant
387
late presenter K/P referred to manchester
465
chest problems under chest physicians
486
patient choice
648
aggressive fsgs, plan to wait this period of time. Activated as soon as could
732
BMI too great
806
personal choice
1019
very complex
1040
stoke patient , refused by UHB
Key data (1)
% of listed patients who were pre-emptively listed in 2014
63% (68% UHB, 55 % Manchester)
Median time from dialysis start date to listing (2)
0 (0 UHB, 0 Manchester)
(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

5. Key data (1)
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

6. Time to listing: Historical
Median 170 days
Median 0 days
Median 0 days
Stoke 84 Leighton 347
Stoke 93 Leighton 407 (incomplete data)
Stoke 0 Leighton 89
2014 Stoke 0 Leighton 0
Note post 2012 introduction of separate listing clinic in Leighton to parallel Stoke system, no other change made at same time

7. Unplanned starters 14% (19) listed 74% (14) listed <12 months
Largest group who may have been listsed earlier/at all may be helped by psychology input
(up to October)
135 unplanned (22% known, 78% unknown)
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
86% (116) not listed
2 transferred
33 deceased
53 recovered
22 unsuitable
5 pt choice/1 DNA
In parallel with this project an audit was carried out looking at unplanned 135 starters of which 78% were unknown. 86% not listed due to various reasons but 5 of these were pt choice and 1 DNA
Overall 74% were listed in <12 months in keeping with NICE guidance
>12 months 5 for various reasons
Largest group who may have been listsed earlier/at all may be helped by psychology input

8. Key challenges for timely assessment and listing
Complex patients often have significant delay, not all necessary
Interaction with transplant centre
Financial resource: tariff change will mean workup expected as part of low-clearance clinic?
Process and maintaining good practice (audit and data)
Stick to a limited number of bullet points