1. LEARNING FROM AUDIT OF TRANSPLANT LISTING WM Transplant Audit Kerry Tomlinson Sep 2014

2. Preferred Pathway: Transplant First eGFR<20 or 1 year pre RRT Discuss transplantation and refer Attend seminar, work up and assessment Identify LD Work up Discuss RRT options Preparation for access Pre-emptive transplant Create access RRT List

3. Wmids Transplant Access Rates: How do we compare?

4. UHNS data current dialysis patients 2004 mean UHNS

5. Transplant incident numbers

6. Pre-emptive rate 16%- could do better Donor audit 133 contacts lead to 19 donors

7. Stoke- time to listing

8. Time to listing: Historical 2007-8 Median 170 days 2008-9 Median 0 days 2009-10 Median 0 days 2010-11 Stoke 84 Leighton 347 2011-12 Stoke 93 Leighton 407 (incomplete data)

9. Time for work up (mean days) StokeLeighton Time from referral to seminar to referral to transplant centre 287563 As above for late listed patients with no medical problems 90181 (n=1) As above for late listed patients with medical problems or DNA 617628 Time from referral to transplant centre to seen at transplant centre 5966

10. Workup: we’ve come a long way since 2004! Referral to seeing KT: 104 days Awaiting tests: 159 days and rising Referral to UHB to seeing surgeon: 107days Total: 363 days

11. Tests in parallel 2004 159 days 2006 187 days 2009-

12. eGFR at referral to seminar 2012 Listed within 90 days of RRT Listed > 90 days post RRT Stoke198 Leighton179 Approximately 50% late referral avoidable

13. Time to listing: Historical 2007-8 Median 170 days 2008-9 Median 0 days 2009-10 Median 0 days 2010-11 Stoke 84 Leighton 347 2011-12 Stoke 93 Leighton 407 (incomplete data) 2012-13 Stoke 0 Leighton 89 (same for 2012-now)

14. eGFR at referral to seminar 2012-now Listed within 90 days of RRT Listed > 90 days post RRT All187 Approximately 57% late referral avoidable

15. % of cyberren CKD5 patients not displaying transplant status

16. Unplanned starters 86% (116) not listed 2 transferred 33 deceased 53 recovered 22 unsuitable 5 pt choice/1 DNA 86% (116) not listed 2 transferred 33 deceased 53 recovered 22 unsuitable 5 pt choice/1 DNA 14% (19) listed 74% (14) listed <12 months 26% (5)>12 months 3 - clinical reasons 1 - referral not received by centre (how since recovered function) 1- needed time to settle 2010-2011 (up to October) 135 unplanned (22% known, 78% unknown)

17. Timeline-real life ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ● ● J J A S O N D J F M A M J J A S O N D J F M A M J J 1 st discussion LD & RRT Ref RRT chat Mum comes forward Ref trans assess RRT counselling decided PD Blood group Transplant assessment US abdo Echo Gastro all clear Ref UHB Seen UHB and listed Waiting list clinic Ref VNEP VNEPUrgent tube insertion Tube removed Reinsertion LDtransplantLDtransplant X matchUS Donor assessment GFR & split function CTHTA and UHB referral ●=dietician ●=epo/iron●=pharmacist

18. A cautionary tale…

19. Discussion