P143
LISTING FOR TRANSPLANTATION – TIMELY OR NOT?
Brand, S¹, Arsalanizadeh, B¹, Stopper, K¹, Bowen, R¹, Byrne, C¹, Das, P², McHaffie, G¹
¹Nottingham Renal & Transplant Unit, Nottingham City Hospital, ²NHS Kidney Care
BACKGROUND: Our transplant unit has a catchment population of 1.3 million, servicing two
renal units. Previous audit data from the unit has suggested that the rate of pre-emptive
transplantation was lower than expected. This prompted a number of changes to the assessment
pathway including reduced waits for cardiac testing and efforts to reduce the time from surgical
assessment to activation on the transplant list. In 2011 NHS Kidney Care launched a project to
improve the time to transplant listing. This has provided an opportunity to assess our progress to
date and provided further impetus to maximise the benefits of timely transplant listing.
METHODS: A series of eight key metrics were developed to enable baseline data to be
obtained and by which progress could be assessed. These metrics covered all elements of the
transplant listing process from the timing of preliminary discussion with a nephrologist, through
to time between surgical assessment and transplant listing. Our unit Proton system was used to
extract patient data and a case note review was also undertaken to assess performance against
these metrics.
FINDINGS:
 9% of all prevalent pre-End Stage Renal Disease patients with GFR 15 (n=231) had
no documented decision regarding transplantation. For patients with GFR 16-21 (n=82)
this rose to 32%.
 Of suitable prevalent patients with GFR 15 only 41% (n=23) were active on the
transplant list.
 Of prevalent dialysis patients who were active on the transplant list, 39% (n=14)
peritoneal dialysis patients had been listed pre-dialysis, but only 15% (n=10)
haemodialysis patients had been listed pre-dialysis.
 In 2010 22 % of transplants were from live donors. Only 9% of all transplants were
pre-emptive.
CONCLUSIONS: Issues were identified much earlier in the transplant assessment process than
had previously been appreciated. There appears to be undue delay in the time taken to initiate
discussions about kidney transplantation, insufficient emphasis on live donor options and a lack
of consistency of practice between nephrologists. A cultural change will be required to embed a
‘Transplant First’ mentality across the unit. Innovations in the care pathway for patients with
advanced kidney disease are being developed and implemented. Strategies to ensure patients
receive appropriate educational material are also being reviewed and updated. Finally the
established metrics will be monitored regularly to ensure continued improvement in
performance. Monthly reporting of progress to NHS Kidney Care will allow dissemination of
learning experiences nationally to the wider renal community. It is hoped that these, and other
changes, will empower patients to make a more informed choice about transplantation and when
this is undertaken at an early stage more patients should benefit from a timely renal transplant.