P117
TIMELY LISTING FOR KIDNEY TRANSPLANTATION: IMPROVING ACCESS IN A
NON -TRANSPLANT CENTRE
Ofori-Ansah, S¹, Das, P², Hudson, C¹, Kingdom E¹, Azmy,C¹
¹Sussex Kidney Unit, Brighton &Sussex University Hospitals NHS Trust, ²NHS Kidney
Care
INTRODUCTION: Kidney transplantation is the best form of replacement therapy for patients
with end stage renal disease (ESRD). In the absence of a living donor, patients with ESRD are
expected to be registered on the deceased donor transplant list within six months of their
anticipated start of dialysis. Despite the benefits of kidney transplantation, pre-emptive
transplantation is unusual in the UK with only 2.5% of chronic kidney disease (CKD) patients
undergoing transplantation as their first renal replacement therapy. Numerous challenges and
barriers impede the provision of timely patient education and kidney transplant listing especially
in non-transplanting centres.
AIMS and OBJECTIVES: The Timely Listing for Kidney Transplantation Project was
undertaken in a tertiary hospital over a six month period. The aims were a) to identify barriers to
listing in CKD 5 patients; b) to identify how these obstacles can be overcome; c) increase
patient referrals for transplantation; d) to adopt a cultural change in clinical practice favouring
pre-emptive kidney transplantation.
METHODS: A series of clinical audits and a patient survey were undertaken to identify
problems and barriers to the transplant work-up process and timely listing of patients onto the
transplant register. These identified a) the percentage of CKD 4 and CKD 5 patients with a
documented transplant waiting list status reported by consultant assignment; b) delayed referral
for recipient evaluation +/- listing and c) waiting times for investigations required for recipient
evaluation in preparation for transplant listing. Discussions were held with other
multidisciplinary teams who provide services for patients as part of the transplant work-up
process, with a view to improving access for potential recipients and donors.
RESULTS: The patient survey and audits revealed late referral of CKD 5 and CKD 4 patients
for education and pre-transplant assessment. This was due to variations in estimated glomerular
filtration rate (eGFR) at which patients were referred; variations in senior medical input to
support the work-up process; an imbalance between nursing staffing and work load; deficits in
documenting the transplant work-up process; and long waiting times for performance of and
reporting of transplant work-up investigations. Delays in pre-transplant cardiac investigations
were commonly identified. Strategies were put in place to resolve these problems. This led to
an increase in numbers of patients referred for patient education and transplant assessment - a
25% increase in number of patients with documented transplant waiting-listed status.
Completion of transplant work–up documentation improved. Negotiations with the cardiac
business group led to an allocation of two dedicated appointment slots per week for a recipient
and donor, thus improving the waiting time, transplant work-up process, timely listing of
patients onto the transplant list and patient experience of the listing process.
CONCLUSION: The project has had a number of benefits including the adoption of a
“transplant-first” culture and the promotion pre-emptive transplantation amongst patients and
staff. We hope that these improvements will enable us to continue to provide timely access to
transplantation for our patients with advanced kidney disease.