1. 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

2. 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

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

4. 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

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

6. 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?

7. 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

8. 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

9. 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

10. 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

11. 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

12. Age distribution of RRT + CKD cases in pathway

13. Specialised services Dashboard

14. 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.

15. 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