1. Renal Transplantation at UHB
Mark Jesky
Please feel free to use your own Trust Powerpoint template if you would prefer
16th July 2015

2. A brief description of our pathway
Low clearance clinic is a vital time in renal journey
Not so long ago….(2012)
<50% individuals in LCC had a documented transplant decision
Very few pre-emptive transplants (either live or deceased donors)
Lack of transparency along transplant work up process
Reconfiguration of LCC/ CKD service at UHB
Key to this was introduction of MDT
Clarification of work up and referral process for transplantation

3. A brief description of our pathway
MDT Comprises
Vascular access team
Deceased and Live donor teams
Dietician
CKD nurses
Doctors
We discuss
All patients with an eGFR <15 or an accelerated decline seen in LCC that week and
All patients with an eGFR <15 due to attend the following week

4. A brief description of our pathway
Aims to ensure each patient has documented transplant decision
Letter format
Documented on renal IT systems
Prospective review identifies any missing information (transplantation, VA etc.) which can be targeted in clinic
Format also provides an update on where people are up to in transplant (inc. pre-emptive work up)

5. A brief description of our pathway
These changes have
Reduced number without transplant status listed
Improved pre-emptive transplantation (~15 last year)
Enabled timely (early) listing
Driven a change to patients being referred early
(patients suspended without gaining days waiting but are all prepared to be activated when the time comes) – good practice & promotes pre-emptive listing/ transplantation.

6. Transplant List Data
Is there any other relevant data that your unit routinely collects that you would like to share?

7. Key data (1) CKD G5 (non dialysis) patients*
32/141 (22.7%) patients currently listed for transplant
46.9% currently suspended
29/141 (20.6%) undergoing assessment or in a holding pattern
19/141 (13.5%) have no status documented
(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

8. Key data (1) Dialysis patients
236/1129 (20.9%) patients currently listed for transplant
119/236 (50.4%) of listed patients currently suspended from transplant waiting list
282/1129 (25.0%) have no status documented
(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

9. Key challenges for timely assessment and listing
Large, diverse catchment area
~ 50% of those starting dialysis are not known to LCC
both internal and external to UHB
unable to benefit from MDT structure
Aiming for a uniform pathway for ALL patients who are likely to progress to ESRD within 6-12 months
Varying waiting time for surgical assessment (improving)
What to do with patients with high BMIs?
Stick to a limited number of bullet points