Manchester Royal Infirmary Renal & Pancreas Transplant Unit / 2010 Activity Annual Report

Transcription

1 Manchester Royal Infirmary Renal & Pancreas Transplant Unit 29 / 21 Activity Annual Report Vicki Bowman Renal Transplant Audit & Data Manager Dr Susan Martin Consultant Clinical Scientist / Transplantation Laboratory Director Mr Titus Augustine Consultant Transplant Surgeon / Clinical Manager June 21

2 Contact Details Central Manchester University Hospitals NHS Foundation Trust Renal and Pancreas Transplant Unit and Transplantation Laboratory Manchester Royal Infirmary Oxford Road Manchester M1 9WL Tel: Fax: Vicki Bowman Renal Transplant Data & Audit Manager victoria.bowman@cmft.nhs.uk Dr Susan Martin Consultant Clinical Scientist / Transplantation Laboratory Director susan.martin@cmft.nhs.uk Mr Titus Augustine Consultant Transplant Surgeon / Clinical Manager titus.augustine@cmft.nhs.uk Copies of this report are freely available on request both in paper and electronic (pdf) format on contacting Vicki Bowman, Renal Transplant Data & Audit Manager, as above. If you wish to make use of charts from this report in a presentation, please contact Vicki, as before. 2

3 Introduction & Acknowledgments Following both the th transplant performed and the th anniversary of kidney and pancreas transplantation in Manchester in 28/9, 29/1 proved to be another historic year during which a record number of transplants were performed. The compilers of this report acknowledge the contributions from each and every member of the transplant team: Medical, Ward, Outpatient, Donor Transplant Coordinators, Specialist Nurses, Secretarial, Clerical and Transplantation Laboratory staff of all grades, and others from associated dialysis centres who have contributed to make this another successful year. Special thanks must also go to living donors and the families of deceased donors, without whom no transplants would have been possible.

4 Table of Contents Page Abbreviations and Definitions 5 All transplants Summary tables 6 Fig 1: All transplants by quarter, by type 2/1 7 Fig 2: All transplants by type 29/1 7 Kidney alone transplants Fig : Adult kidney alone transplants by financial year 8 Pancreas transplants Fig : Adult pancreas transplants by financial year 8 Paediatric Transplants Fig 5: Paediatric transplants by type, by financial year 9 Paediatric recipients - referral origin 9 Fig 6: Paediatric pre-emptive transplantation by financial year 9 Living Donor Transplants Fig 7: Adult living donor transplants by quarter, 27/8-29/1 1 Fig 8: Adult living donor transplants by donor relation, 29/1 1 Deceased Donor Transplants Fig 9: Waiting time to transplant by blood group 11 Fig 1: Kidney transplants 28/9 and 29/1 by donor age 12 Fig 11: Pancreas transplants 28/9 and 29/1 by donor age 12 Fig 12: Decease donor transplants by organ origin, 27/8 29/1 1 Fig 1: Cold ischaemia time 1 The CMFT Kidney and Pancreas Transplant Waiting List Summary table 15 Pancreatic islet transplantation 15 Fig 1: Pancreatic islet waiting list by activation status, 28/9 29/1 16 Fig 15: Waiting list by organ required 16 Fig 16 Waiting list by age 17 Time to enter waiting list 17 Fig 17: Median time to list by referral centre, 27/8 29/1 18 Paediatric patients on the transplant waiting list 18 Fig 18: Annual transplants versus number on waiting list, Fig 19: Waiting time to transplant by organ required 19 Waiting time for transplanted patients 2 Fig 2: Waiting time by transplant chance 2 Fig 21: Waiting time by reaction frequency 21 Fig 22: Waiting time by ABO blood group 21 Fig 2: Access to transplant, 25/6 29/1 22 Source of transplant referrals by referral network sector 2 Transplant list status 2 Fig 2: Activation status by referral network sector 2 Fig 25: CMFT transplant list 29/1 by activation status 2 Transplantation and transplant listing in a population context Fig 26: Transplant listing and deceased donor transplants per million population by area 25 Fig 27: Access to transplant for patients receiving renal replacement therapy (RRT) across 26 referral network sectors Appendix: Referral Network Sectors 27

5 Abbreviations Abbreviation Full Explanation DBD Heartbeating Donor Referring to a donor with confirmed brain stem death. DCD Non Heartbeating Donor Referring to a donor with confirmed cardiac death DBD Kidney Donation after brain stem Kidney transplant from a donor with death kidney confirmed brain stem death DCD Kidney Donation after cardiac Kidney transplant from a donor with death kidney confirmed cardiac death Living Donor Living donor Kidney transplant from a living donor. Donation after brain stem Simultaneous pancreas and kidney DBD SPK death simultaneous transplant from a donor with pancreas & kidney confirmed brain stem death DCD SPK DBD PAK DCD PAK DBD PAT DCD PAT DBD SHK Islets Donation after cardiac death simultaneous pancreas & kidney Donation after brain stem death pancreas after kidney Donation after cardiac death pancreas after kidney Donation after brain stem death pancreas alone Donation after cardiac death pancreas alone Donation after brain stem death simultaneous heart & kidney Pancreatic islet transplantation Definitions Simultaneous pancreas and kidney transplant from a donor with confirmed cardiac death Pancreas transplant from a donor with confirmed brain stem death with the recipient having previously received a kidney transplant Pancreas transplant from a donor with confirmed cardiac death with the recipient having previously received a kidney transplant Pancreas alone transplant from a donor with confirmed brain stem death Pancreas Alone transplant from a donor with confirmed cardiac death Simultaneous heart and kidney transplant from a donor with confirmed brain stem death Transplantation of insulin-producing Islets of Langerhans extracted from deceased donor pancreata Adult recipient Paediatric recipient A person receiving a transplant who is aged 19 years or over on the date of transplant. A person receiving a transplant who is aged under 19 years on the date of transplant. 5

6 All Transplants, 29/1 Summary Table by Financial Year, 25/6 29/1 25/6 26/7 27/8 28/9 29/1 All transplants [+26.1%] 159 [-19.7%] 178 [+ 11.9%] 21 [+18.%] Paediatric recipient 18 (11.5%) 16 (8.1%) 9 (5.7%) 17 (9.6%) 15 (7.1%) transplants (>19 years) All kidney alone 16 (86.6%) 166 (8.8%) 12 (77.%) 17 (82.6%) 182 (86.7%) transplants Pancreas alone or 21 (1.%) 1 (15.7%) 6 (22.6%) 1 (17.%) 27 (12.9%) pancreas and kidney transplants All DBD transplants 111 (7.7%) 11 (71.2%) 7 (6.5%) 11 (56.7%) 86 (1.1%) All DCD transplants 16 (1.2%) 2 (1.1%) 1 (19.5% 2 (12.9%) 5 (25.6%) Living donor transplants (19.1%) 7 (18.7%) 5 (.9% 5 (.% 7 (.%) Islet cell transplantation 1 (.5%) Summary Table by Calendar Year, All transplants [+1.%] 165 [-12.2%] 18 [+11.5%] 17 [-6.%] Paediatric recipient 2 (12.%) 1 (7.%) 12 (7.%) 16 (8.7%) 1 (7.5%) transplants (>19 years) All kidney alone 1 (86.7%) 158 (8.%) 128 (77.6%) 151 (82.1%) 16 (8.%) transplants Pancreas alone or 22 (1.%) (16.%) 7 (22.%) (17.9%) 27 (15.6%) pancreas and kidney transplants All DBD transplants 119 (71.7%) 17 (72.9%) 8 (5.%) 15 (57.1%) 77 (.5%) All DCD transplants 17 (1.2%) 18 (9.6%) 29 (17.6%) 25 (1.6%) 8 (22.%) Living donor transplants (18.1%) (17.6%) 5 (2.1%) 5 (29.%) 58 (.5%) Islet cell transplantation () indicates % of total [ ] indicates % change from previous year There were a total of 21 recipients transplanted during 29/1, which represents an increase of 18.% on the 28/9 total. Figures 1- further illustrate this data. 6

7 All transplants 29/1 by quarter, by type 7 6 Number of transplants April/May/June July/August/Sept Oct/Nov/Dec Jan/Feb/March Islets 1 DBD PAT 2 1 DCD PAK 1 DCD SPK 1 DCD Kidney DBD PAK 1 2 DBD SPK DBD kidney Living donor Fig 1: A summary of the year s activity by transplant type. Kidney and Pancreas Transplants 29/1 by Type DBD SPK 22.9% DCD Kidney 9.% All Pancreas 1.% DCD PAK 1.% DBD PAT.5% Living donor DBD kidney DBD kidney.5% Living donor.% DCD SPK 1.% Islets.5% DBD PAK.5% DBD SPK DBD PAK DCD Kidney DCD SPK DCD PAK DBD PAT Islets Fig 2: Kidney and pancreas transplant activity 29/1 showing relative proportion of activity by transplant type. The magnified part of the pie chart details pancreas transplant activity. 7

8 Kidney alone transplants Adult recipient kidney alone transplants by type, 27/8-29/1 Number of transplants /8 28/9 29/1 DCD kidney DBD kidney Living donor Financial Year Fig : A summary of adult kidney alone transplant activity over the last financial years. Pancreas transplants Adult pancreas/kidney and pancreas alone transplants, 27/8-29/1 Number of Transplants /8 28/9 29/1 DCD PAT 1 DBD PAT 1 1 DCD PAK 2 1 DBD PAK 6 DCD SPK 1 DBD SPK Fig : A summary of pancreas transplant activity over the last financial years. 8

9 Paediatric Transplants Paediatric Transplants by Type, 27/8-29/1 Number of Transplants /8 28/9 29/1 Financial Year DBD kidney Living donor Fig 5: Paediatric kidney transplants over the last financial years by type, Paediatric Recipients - Referral Origin The majority of paediatric recipients are referred for transplant from Alder Hey and Royal Manchester Childrens Hospital. The exceptions during 29/1 were a child referred from Solihull and a teenager referred from adult services at Salford Royal. 27/8 28/9 29/1 RMCH (%) 8 (7%) 8 (5%) Alder Hey 5 (56%) 9 (5% 5 (%) Adult services (7%) Out of region (7%) TOTAL Pre-transplant renal replacement therapy in paediatric patients transplanted 28/9 and 29/ % Number of recipients % 6.% 5.% Pre emptive Haemodialysis Peritoneal dialysis % 17.6% 28/9 29/1 Renal replacement therapy type Fig 6: This figure illustrates the growing number of paediatric patients transplanted pre-emptively, prior to requiring dialysis. 9

10 Adult Living Donor Transplantation Adult living donor transplants by quarter, 27/8-29/1 No. of transplants April/May/June July/August/Sept Oct/Nov/Dec Jan/Feb/March Living donor 7/ Living donor 8/ Living donor 9/ Living donor 7/8 Living donor 8/9 Living donor 9/1 Fig 7: Adult living donor transplantation by quarter. Donor Relation Living donor transplants 29/1 by relation of donor to recipient Not biologically related 25% Offspring 12% Other Relation 5% Paired/pooled 9% Sibling 25% Parent 2% Fig 8: An illustration of relationship of living donors to recipients, 29/1 1

11 Deceased Donor Transplants Waiting times to deceased donor transplants carried out in 29/1 by blood group Information regarding waiting time to transplant is shown for patients transplanted during the 29/1 time period, and also those on the waiting list at the end of 29/1. Median waiting time to transplant by blood group for adults transplanted during 29/ Median waiting time to transplant (months); patients transplanted 29/1 A B O Median waiting time in months Fig 9: The incidence of each blood type in both groups of patients can be seen in the table below. Blood Group Awaiting transplant April 21 Transplanted 29/1 A 281 (1.2%) 9 (6.%) B 12 (15.8%) 1 (1.1%) AB (.7%) O (9.%) 5 (5.5%) Total:

12 Deceased Donors 29/1 Adult deceased donor kidney transplants by donor age, 28/9 and 29/1 7 5 Number of transplants /9 29/ >7 Donor age range Fig 1: This graph illustrates the age of kidney donors for transplants taking place during 28/9 and 29/1. Adult SPK and pancreas transplants by donor age, 28/9 and 29/ mb er o f t ran splants /9 29/1 Nu >7 Donor age range Fig 11: This graph illustrates the age of pancreas and kidney/pancreas donors during 28/9 and 29/1 Deceased Donors 29/1 The median age for kidney alone donors was 5 in 29/1, slightly higher than the median of 5 the previous year. For pancreas and kidney/pancreas donors the median age was 1 which is similar to the median value in 28/9. 12

13 Deceased Donors 29/1 Deaceased donor transplants by organ origin, 27/8-29/1 9 8 N umber of transpl ants /8 28/9 29/1 Local 1 67 Import Fig 12: Donor organ origin by financial year. During 29/1 a higher percentage of deceased donor organs were from local donors than previous years 7.9%, compared to 9.% in 27/8 and.7% in 28/9. This reflects the increased proportion of DCD donors for whom organs are generally transplanted locally. 1

14 Cold Ischaemia Time Cold Ischaemia Time, Deceased Donor Kidney Transplants 25/6 to 29/1 by crossmatch method 8:2: :6: 26/7 27/8 28/9 29/1 28:8: CIT time 2:: 19:12: 1:2: XM Test Virtual XM 9:6: :8: Me dian CIT = 15: Median CIT = 17:57 Median CIT = 18:6 Median CIT = 17:22 M edian CIT = 15:7 :: 2//26 2/7/26 1/1/26 18/1/27 28//27 6/8/27 1/11/27 22/2/28 1/6/28 Date 9/9/28 18/12/28 28//29 6/7/29 1/1/29 22/1/21 2/5/21 Fig 1: Cold ischaemia time for adult DBD and DCD kidney alone transplants, April 26 March 21. The median CIT time is shown for each financial year, as well as since the introduction of virtual crossmatching in December 28. The scatter plot shows a strong trend toward shorter CIT times with virtual crossmatching, with lower median CIT times since this method was introduced. CIT time and Virtual Crossmatching Virtual crossmatching was introduced for on 1/12/28; The purpose of this approach is to reduce the cold ischaemia time without compromising the safety of transplantation. 1

15 CMFT Kidney and Pancreas Transplant Waiting List Demographics and Summary Table Data is based on all patients on the CMFT kidney and pancreas transplant waiting list at the end of each financial year. 27/8 28/9 29/1 Patients on list at end of year 797[+1.%] 878 [+1.2%] 919 [+.7%] Male 5 (56.8%) 5 (57. % ) 5 (5.%) Age Range (in years) Time On Transplant List Range (months) Median t ime on transplant list (in months) Patients active 555 (69.6%) 572 (65.1%) 6 (65.6%) Patients suspended 22 (.%) 6 (.9%) 16 (.%) () indicates % of total [ ] indicates % change from previous year Pancreatic Islet Cell Waiting List The pancreatic islet transplantation programme began in 28, but it was not until February 21 that the unit s first transplant was performed. The table below details some key data about the programme. There has been a reduction in referral activity since the initial influx of patients at the start of the programme, and this is also reflected by the reduction in number of patients on the waiting list (see Fig 1, overleaf). 28/9 29/1 First referrals for islet transplantation 22 Number of islet transplant offers # 6 Number of islet transplants 1 Age range of patients on the waiting list Mean age of patients on the waiting list 5 55 Ratio of male: female patients on islet waiting list 6: :1 15

16 Pancreatic islet waiting list 28/9 and 29/1 with activation status 12 1 ents 8 er of pati Numb 6 1 Suspended patients Active patients 2 28/9 29/1 Financial Year 2 Fig 1 : The pancreatic islet waiting list showing number of patients with activation status for the last 2 financial years. CMFT Kidney and Pancreas Transplant List by Organ Required CMFT Kidney and Pancreas Transplant List by Organ Required, April 21 Kidney alone 91.9% Kidney and heart.1% Kidney after liver.2% Pancreas after kidney.5% Other 7.% Pancreas alone.% Pancreas after islets.% Kidney and pancreas F ig 15: Organs required by adult patients listed on the CMFT kidney and pancreas transplant list. 16

17 CMFT Kidney & Pancreas Transplant list, April 21 by age CMFT Kidney and Pancreas Transplant List by age range, April Patients of Number Kidney Pancreas Age Range Fig 16: This graph illustrates the age distribution among potential recipients listed for kidney and pancreas transplantation. The median age for adult kidney patients was 5. years and for pancreas patients 1.8 years. Time to enter CMFT Kidney and Pancreas Transplant Waiting list The time taken to complete the transplant listing process is audited on an annual basis. This time period is measured by calculating the number of days elapsed between the date of the referring Nephrologist s signature on each patient s Request to List Form and the date they enter the transplant list. The table below and the accompanying graph illustrate median listing times for patients from each referral centre over the last years. 27/8 28/9 29/1 Median time to list in days; all centres GM East GM West Cumbria & Lancashire ECR Childrens

18 Median time to list in days by refer ral centre, 27/8-29/ Nu mber of da ys Cumbria & All centres GM East GM West Lancashire ECR Childrens 27/ / / Referral centre Fig 17: Median time to list in days by referral cen tre, illustrating a reduction in median time to list over the past years. Paediatric patients on CMFT Kidney and Pancreas Transplan t Waiting list. In April 21 there we re 19 patients aged <19 on the transplant list awaitin g first kidney transplants. 8 of these patients were su spended at the time of this report; 5 of whom had been suspended since initial listing. Further de tails of these patients can be fo und in the table below. Demographics 28/9 29/1 No. of paediatric patients l isted Active on list 9 11 Suspended on list 8 8 Male 1 12 Female 7 Age range (years) Time on list range (months) Median time on list (months)

19 Transplants by year versus transplant waiting list Transplants by year with waiting list totals, 2-21 Nu mber of tr anspla nts/patie nts / 2/1 21/2 22/ 2/ 2/5 25/6 26/7 Financial Year 27/8 28/9 29/1 Transplants Performed Patients on list at end of financial year Fig 18: A graphical representation of the increase in patients awaiting deceased donor transplant relative to transplants carried out each year over the last 1 years. The number of patients on the waiting list has almost doubled over the last 1 years whereas the number of transplants carried out has not increased to mirror this. Waiting Time To Transplant CMFT Kidney and Pancreas Transplant List April 21 by organ awaited and time on list 5.%.% 25.% f patients % o 2.% 15.% 1.% 5.%.% -5 months 6-12 months 1-2 months 25-6 months 7-6 months 61-8 months Kidney alone 1.9% 1.2% 22.% 1.7% 19.% 7.%.1% 2.8% 1.1%.5%.1% All pancreas 19.% 22.9% 1.% 9.5% 1.%.8%.%.%.%.%.% Time on list months months months 21- months months+ Fig 19: The median waiting time for kidney patients on the list is 2. months (slightly shorter than last year s median of 2. months), and for pancreas patients the median time on the list is 15.5 months (slightly longer than last year s median of 11.5 months). 19

20 Waiting time for transplanted patients by HLA antibody reaction frequency, transplant chance and ABO blood group HLA antibody reaction frequency denotes whether a potential recipient is sensitised (and to what degree). HLA antigens against which a potential recipient is sensitised are considered unacceptable in a donor; the more antigens considered unacceptable the higher the reaction frequency. This makes it more likely that the recipient will wait longer to fi nd a suitable match. Previously transplanted patients are likely to have higher reaction frequencies due to exposure to antigens from donor organs, therefore the more transplants a potential recipie nt has undergone, the more likely they are to wait longer for a suitable match for subsequent transplants. Transplant Chance gives a measure of the chance of a suitably HL A matched donor becoming available for the patient - the higher the value, the better the chance. It is calculated on the basis of the patient s ABO blood group, HLA type and unacceptable antigens with reference to the ABO blood groups and HLA types of all organ donors on record ( over 2). The following Figures illustrate the relationship between Transplant Chance, HLA antibody reaction frequency, ABO blood group and waiting times for tran splant. Median waiting time to transplant by transplant chance % range, patients transplanted 26/7-29/1 6 Median w aitin g time in year s Transplant chance range, in % Fig 2: Median waiting time on transplant list by transplant chance range, showing an inverse relationship between transplant chance and waiting time to transplant for transplanted patients. 2

21 Waiting time for transplanted patients Median waiting time to transplant by HLA antibody reaction frequency, patients transplanted 26/7-29/1 Median waiting time in years >85 HLA antibody reaction frequency range Fig 21: Median waiting time on transplant list by HLA antibody reaction frequency range, demonstrating that more sensitised patients are likely to wait longer for a suitable match. Median waiting time to transplant by blood group for adults transplanted during 29/ Median waiting time to transplant (months); patients transplanted 29/1 A B O Median waiting time in months Fig 22: Median waiting time on transplant list by recipient blood group for transplants 29/1. There were no recipients with blood group AB transplanted during this period. 21

22 Access to transplant 25/6 29/1 Scatter plot showing adult recipient DBD kidney transplants 25/6-29/1 with median times to transplant 25 April 5 - March 6 Median = 1.1 April 6 - March 7 Median =.95 April 7 - March 8 Median =. April 8 - March 9 April 9 - March 1 Median =.71 years Time since entering transplant list in years Transplant No. 1 Transplant No. 2 Transplant No. Transplant No. 17/2/25 5/9/25 2//26 1/1/26 28//27 1/11/27 1/6/28 18/12/28 6/7/29 22/1/21 Transplant Date Fig 2: This scatter plot illustrates the effect on of the change to the NHSBT (then UK Transplant) allocation scheme in April 26 on waiting time to transplant, and the effects since that time up until the present. The new allocation scheme was intended to bring about fairer access to transplantation and reduce wide variability in waiting times by allocating organs on a national basis, prioritising rarer HLA types and patients who had waited a long time. Prior to the introduction of the new allocation scheme, between April 25 and March 26, it is clearly seen at the bottom of the plot that there appears to be a dense concentration of transplants taking place within a short time of entering the transplant list, with some isolated long waits. At that point median time to transplant was 1.1 years. During the year following introduction of the new allocation scheme, the median time to transplant increased to.95 years. On the plot the distribution of transplants is seen to be far more homogenous after April 6. Over the next 2 years the median time to transplant is seen to fall, which may be due to long waiting patients from before implementation of the new allocation scheme having received transplants. During the 29/1 the median time to transplant is seen to have risen to.71 years, but this may be due in part to several patients who had been on the waiting list for many years before finally receiving transplants during this period. 22

23 Source of Transplant Referrals Patients are referred to the CMFT Renal Transplant Unit from network sectors, each encompassing a group of hospitals in the North West region. The Unit also receives Extra Contractual Referrals (ECRs) from outside these referral sectors. Paediatric patients aged 18 or under are referred from Alder Hey or Central Manchester Children s Hospitals. Full lists of hospitals covered by each network sector are given in the appendix. The tables below detail the referral network origin of patients receiving kidney alone deceased donor transplants during 29/1 and also those on the transplant list as of April 21 for purposes of comparison. The bottom rows of the table express the number of patients from each area transplanted during 29/1 as a percentage of the number listed from each area, and again as a percentage of the number active on the transplant list from each area. Referral Network Sector GM East GM West Cumbria and Lancashire ECR All Areas Adults transplanted* 29/1 (28/9) 28(25) 5(8) 2(2) 7(6) 19(89) Adults transplanted as % of total, 29/1 25.7% (28.1%) 5.9% (2.7%) 22.% (22.5%) 6.% (6.7%) (28/9) Adults listed, April 21 (% of total) 251 (2.9%) 298 (9.%) 19 (2.9%) 25 (.%) 76 Adults transplanted 29/1 as percentage of 1.% (1.%) 17.% (12.8%) 11.% (1.5%) 26.9% (2%) 1.7% (11.6%) number listed (28/9) Adults transplanted 29/1 as percentage of number active (28/9) 1.8% (15.2%) 28.6% (17.9%) 16.8% (17.%).8% (.%) 2.8% (17.6%) *Kidney alone deceased donor transplant recipients Transplant list status At any one time a proportion of patients on a transplant list will be temporarily suspended. On the CMFT Kidney and Pancreas Transplant list as of April 21 this proportion was.%,.9% for adults awaiting kidney alone transplantation, with 16.1% of all patients on the list having been suspended for over 12 months. In 28/9 these figures were.9% and 1.8% respectively. The proportion of suspended patients, although the differences are not great, did vary by referral network sector, with GM East having the highest percentage of long term suspensions (16.%) and out of region hospitals having the highest overall percentage of overall suspensions (.%), but the lowest proportion of long term suspensions (12%). GM West had the lowest overall percentage of suspended patients with 28.9%. Referral Network Sector GM East GM West Cumbria & Lancashire ECR Patients active on list (% of total listed for sector)) 189 (7.5%) 175 (6.6%) 1 (67.1%) 16 (61.5%) Length of suspension under 12 months (% of total listed for sector) 2 (11.9%) 6 (22.1%) 2 (19.7%) 7 (26.9%) Length of suspension over 12 months (% of total listed for sector) 7 (17.5%) 5 (17.%) 28 (1.1%) (11.5%) All suspended patients (% of total listed for sector) 79 (1.8%) 11 (9.%) 7 (2.9%) 1 (8.%) 2 Total 52 (65.1%) 15 (18.2%) 128 (16.1%) 27 (.%)

24 Activation status of adults awaiting deceased donor kidney transplantation, CMFT Kidney and Pancreas Transplant list, April Number of patients Suspended on list for more than 12 months Suspended on list for less than 12 months Active on list GM East Sector GM West Sector Cumbria & Lancashire 7 16 ECR Referral sector Fig 2: An overview of the CMFT Renal and Pancreas Transplant list May 29 by transplant list status. Adult patients on CMFT Kidney and Pancreas Transplant list awaiting kidney alone transplantation by status on list, April 21 Suspended on list for more than 12 months 16.1 (15%) Suspended on list for less than 12 months 18.2% (19%) Active 65.7% (66%) Fig 25: A breakdown of adults awaiting kidney only transplantation as of April 21 by status on list. The numbers in brackets denote figures from 28/9. 2

25 Transplants and listings by referral network sector in a population context The figures below detail the numbers of adults listed for kidney alone transplantation and those transplanted during 29/1 relative to each referral network sector s total population. There is considerable variation between the areas, with the highest proportion of people both listed and and transplanted in the GM West sector, and the lowest in Cumbria and Lancashire. These differences may be due to a number of factors; demographic differences, epidemiological factors and referral patterns for transplantation. Figures in brackets denote the previous year s figures. Estimated area population, 28* Patients listed for transplant per million population, 29/1 Patients transplanted per million population, 29/1 GM East GM West Referral Network Sector Cumbria & Lancashire Overall (16) 27 (25) 18 (96) 168 (162) (16) 1 (1) 12 (1) 18 (2).2 *Sources: Strategic Framework for Kidney Care in Greater Manchester Strategic Framework for Kidney Care in Cumbria and Lancashire ONS 2 based population projections ONS mid-26 population estimates ONS mid-29 population estimates UK Renal Registry 12 th Annual Report, December 29 UK Transplant listings and deceased donor kidney transplants per million population by area, 29/ Patients per million population Patients listed per million population Patients transplanted per million population GM East GM West Cumbria & Lancashire Referral network sector/area UK Fig 26: Adult kidney transplant listings and transplants undertaken relative to local population in three referral network sectors, showing UK figures for comparison 25

26 Access to transplant for patients receiving renal replacement therapy (RRT) across referral network sectors These figures are a guide to the number of patients on the kidney transplant list and the number receiving deceased donor kidney alone transplants relative to the number of patients receiving renal replacement therapy (RRT) from each referral network sector, as of January 28. The term renal replacement therapy as used here refers to both hospital and home haemodialysis and peritoneal dialysis. The numbers shown cannot translate directly to the numbers of patients receiving RRT either being listed for transplant or receiving transplants as they do not account for pre-emptive transplants (transplants taking place before RRT is commenced) or listing prior to RRT being commenced. The variations seen, as before, may be due to epidemiological and demographic factors, and referral patterns for transplantation. Patients receiving RRT as of January 28* Patients receiving RRT per million population Patients on kidney transplant list as % of those receiving RRT by area Patients transplanted 29/1 as % of those receiving RRT by area *Source: As previous table. GM East GM West Referral Network Sector Cumbria & Lancashire All Areas % 68.% 1.6% 9.5% UK 8.1% 5.% 8.7%.% 5.% 9.8% Patients receiving renal replacement therapy by area; with numbers on kidney transplant waiting list and numbers transplanted Number of patients Patients receiving RRT Patients listed for transplant Patients transplanted GM East GM West Cumbria & Lancashire Referral network sector Fig 27: Patients receiving RRT by referral network sector 29/1, showing numbers awaiting deceased donor kidney alone transplant and numbers transplanted during this period. 26

27 Appendix: Referral Network Sectors (Adults only) This is a division of patients by grouping of referring hospital and satellite units. Referral Network Main Hospital Satellite Hospitals GM East Sector Manchester Royal Infirmary North Manchester General Hospital Wythenshawe Hospital Tameside Hospital Macclesfield General Hospital GM West Sector Cumbria & Lancashire Hope Hospital Royal Preston Hospital Birch Hill Hospital Rochdale Infirmary Wigan Infirmary Royal Bolton Hospital Chorley and South Ribble Hospital Royal Blackburn Hospital Burnley General Hospital Westmorland General Hospital Blackpool Victoria Hospital Furness General Hospital Royal Lancaster Infirmary ECR - Extra Contractual Referrals All other hospitals/trusts outside these areas 27