Renal Transplantation at Shrewsbury and Telford NHS Trust.

Transcription

1 Renal Transplantation at Shrewsbury and Telford NHS Trust. Sue Dean Transplant Nurse. Suresh Ramadoss Nephrologist and Transplant Lead. 9/7/15

2 Key data correct at 9/7/ patients are on a form of dialysis 137 are aged 70 or over. 197 haemodialysis in Centre 18 on home haemodialysis 28 on CAPD

3 Transplant waiting list 54 patients are on kidney waiting list-19 currently suspended (35%). 2 on kidney/pancreas list both currently suspended. 45 patients on dialysis are listed (18%). 11 (19%) listed are pre dialysis. Currently pre dialysis egfr of 20 and below we have 70 patients, which consist of : 39 are in assessment phase. 11 already listed. 20 new patients to look at, bringing the total to 126 patients at Sath being looked at for transplant. CV means no one will miss out on transplant as an option.

4 Referrals Upto March 2014 Referrals 17 Successful listed waiting as high BMI. 11 listed pre dialysis Upto March referrals 12 successfully listed-2 transplanted. 3 on going issues. 3 unsuccessful. 1 moved area. 8 waiting for OPA. 2 listed due to improved BMI and another new drug available- Not new referrals. 6 waiting to be referred-this needs to be improved as 6 pre dialysis. Audit proved this. 6 listed pre dialysis

5 Key Challenges for timely listing. 56% of our patients on dialysis are aged 70 or over. We do look at them for transplant. We are in the process of documenting all patients if suitable or not. New computer system which identifies all patients pre dialysis and on dialysis. This is improving all our MDTs on all aspects of CRF, and will identify patients earlier. CV will mean all patients will be identified more efficiently and make sure no patient misses out on transplant as an option, as well as improve communication with whole team at Sath. Plan this year-assess every patient we can for transplant and if not document so everybody aware of this and discuss with patient. CV will play a big part in helping us do this. We are looking at more patients already for transplant than we ever havenow transplant post permanent, however we will need more staff otherwise we will take a backwards step.

6 Transplant open to everyone at Sath We are very patient focused and always work closely with the patient. Recently a patient has had a successful living donor kidney transplant extremely challenging. This was only possible through excellent planning, perseverance, time and communication with Sath and UHB, and all other teams who dealt with this patient, both previously and currently. This will continue to be on going. Other challenging patients are in this process.

7 Transplant pathway at Sath-developed from kidney care project 2012, and updated. Cadaveric Transplant listing pathway 24/03/2014 Starts at pre dialysis stage, GFR<20 or predicted 1 year away from RRT Cardiac Screening Final Medical Assessment Education Information given in written & verbal form Invited to 2 monthly Transplant seminar Decision made by patient to go ahead with Transplant work up (or continue work up if medical assessment process started) Low risk -< 50 yrs -Non DM -No CAD -Normal LV -Normal ECG -Non smoker -Normal CXR Follow Up 3yrly ECG & Echo. 2yrly CXR * Medium risk ->50 yrs -Diabetic - No Sx CAD/CCF -Normal/mild LV impairment Myocardial perfusion scan Follow Up 2yrly ECG& CXR 3yrly Echo 5yrly Myocardial Perfusion Scan Iliac Doppler * ** High Risk -Angina -Previous MI -Moderate or severe LV impairment -DM + > 50yrs Referral to cardiologist for angiogram Follow Up 2yrly ECG, Echo, CXR 5yrly Myocardial Perfusion Scan Iliac Doppler * Normal test results Refer for transplant Follow up as per Protocol Yearly review for all listed patients Abnormal coronary angiogram Successful Refer for transplant Revascularisation Unsuccessful Not suitable for transplantation Hep B vaccination via G.P. ABO grouping * or earlier if required ** Note change in risk status if > 50 y

8 Number of transplants Cadaveric Live Donor