1. Kidney transplantation: why should I care? Staff Wellbeing Week Queen’s University Belfast 28 Jan 2015 Dr Aisling Courtney

3. Kidney failure Dialysis Transplantation

4. Q1 How many people in Northern Ireland have kidney failure? (end-stage kidney disease) – 500 – 750 – 1000 – 1500 – 2000

5. Who gets kidney failure? Anyone and everyone Dialysis: 2 month – 94 years

6. Why do kidneys fail? Diabetes Hypertension Plumbing problems Kidney inflammation Polycystic kidney disease Other rarer disorders doctors spend years and years learning about

7. What can be done? Reduce your risk of: Diabetes Hypertension

8. Obesity – 100 calorie rule Exercise – sustainable Reducing your risk

9. What’s so bad about kidney failure?

10. Kidney failure Dialysis Transplantation

11. Q2 If you commence dialysis aged 40 yr., what chance is there that you’ll reach your 50 th birthday? – 25% – 50% – 66% – 75% – 90%

12. UK Renal Registry 10th Annual Report Kaplan–Meier survival of incident patients starting dialysis in the UK: 1997–2009 cohort

13. How long can you live on dialysis? Susan C Born 1969 Commenced dialysis 1991 Unsuitable for transplantation Died 2011

14. Quality as well as quantity Food Fluid intake Time Travel

15. 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Haemodialysis Peritoneal dialysis Number of people in NI on regular dialysis treatment

16. Location of NI Renal Units 1989 1995 1999 2003 2005 When? 1968 >105,000 dialysis treatments in 2014

17. Kidney failure Dialysis Transplantation

18. How long can you live with a transplant? 1997-06 2006-14 All Belfast recipients 1967-76 1977-86 1987-96 1997-06 2007-14

19. Why transplantation? Live better Live longer Live cheaper

20. Cost-effectiveness £35,000 per year: hospital haemodialysis £17,000 for a transplant in first year £5,000 per year thereafter £30,000 per year cost saving in second and subsequent years If there are 50 more transplants than previously then after the first year there is a saving in excess of £1.5 million per year

21. What would you want? So why doesn’t everyone get a transplant?

24. NHSBT showing DCD use

25. Transplantation in Belfast

26. 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Haemodialysis Peritoneal dialysis Number of people in NI on regular dialysis treatment

27. NI transplant numbers

28. Living donor transplant programme

29. 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Haemodialysis Peritoneal dialysis Number of people in NI on regular dialysis treatment

31. Kidney failure Dialysis Transplantation Living donor

32. Do you have to be perfect to be a donor? Need to be suitable: 1.for GA / surgery 2.to be left with a single kidney 3.of kidney for donation to recipient

33. Current pathway Expression of interest after receipt of information Completion & return of health questionnaire

34. For hospital use Date received: Date reviewed: Person requiring transplant: Relationship to you: Name: Date of birth: Address: Telephone number: GP name: Have you ever been hospital?YesNo If yes, please give details Have you had any operations?YesNo If yes, please give details Do you attend your GP regularly?YesNo If yes, please give details Are you on any regular medication?YesNo If yes, please give details Have you been diagnosed with any of the following? High blood pressureYesNo DiabetesYesNo Angina / heart diseaseYesNo StrokeYesNo Kidney stonesYesNo CancerYesNo Blood clotYesNo Do you smoke?YesNo What is your height?_____ What is your weight?_____ Did / do any of your parents or siblings have any of the following? High blood pressureYesNo DiabetesYesNo Females If you have been pregnant, were there any complications with: High blood pressureYesNo Protein in the urineYesNo Pre-eclampsiaYesNo Have any of your family already donated a kidney to the potential recipient? YesNo Are you willing to consider paired donation?YesNo

35. Pathway Expression of interest after receipt of information Completion & return of health questionnaire Review of health questionnaire SuitableUnsuitable Enter work-up Exit

36. One-day assessment Assessment with LD transplant co-ordinator – Urine tests – Blood tests (fasting) – MRSA swabs Radiological investigations – CXR – US scan – DMSA scan – CT scan Cardiac investigations – ECG EDTA GFR Assessment with Consultant Nephrologist

37. Pathway One-day assessment Multidisciplinary team meeting Surgical assessment SurgeryListed for pooled donation

38. Donor age 2012-20142010-2012 Mean: 46 yr. Range: 23-75 Mean: 46 yr. Range: 22-73

39. Donor gender 2012-142010-12 Male 74 Female 105Male 75 Female 103

41. Relationship 2012-2014

42. Kidney failure Dialysis Transplantation Fancy stuff

43. Incompatible transplantation ABO incompatible HLA incompatible 1. Removal of preformed circulating antibodies 2. Reduction of antibody production

44. Pool: indirect donation Mr B Miss AMrs A Mrs B

45. 27 Jan 2010 Mrs C Mrs B Mr B Mr C Mrs PMr P

48. NAMEDATE OF BIRTHBLOOD GROUPCRFAGEWAITING TIME NR23/03/1989A+100237744 (22 yr) HC01/10/1950O+98625231 (15 yr) SM08/11/1981A+98315133 (15 yr) JS05/03/1947O+100655119 (15 yr) WJ15/10/1966A+99465111 (15 yr) MC11/06/1956A+99564850 (13 yr) CB21/07/1980B-100324832 (13 yr) SO18/05/1946A+98663898 (11 yr) JD14/02/1958O+100543729 (11 yr) SD20/10/1976O+98363432 (9 yr) EW04/07/1948O+99643206 TL15/06/1947O+0653171 IB10/02/1942A+0702693 LH09/09/1963O+99492549 NM14/12/1948O-81642530 DL05/01/1961O+0522449 HH16/11/1966O-85462444 AF12/02/1966O+66462386 CM24/11/1949A+100632282 EH05/11/1947B+0652212 KM03/04/1940A+97722162 LB27/07/1979O+100332047 VQ07/05/1980O+91322016 AH21/04/1966A+0461938 DS22/06/1943O+11691938 MM30/03/1944A-9681926 HL18/08/1945O-57671926 GR28/12/1960O+57521925 MM02/07/1940O+96721884 NM06/08/1981O+91311854

49. NAMEDATE OF BIRTHBLOOD GROUPCRFAGEWAITING TIME NR23/03/1989A+100237744 (22 yr) HC01/10/1950O+98625231 (15 yr) SM08/11/1981A+98315133 (15 yr) JS05/03/1947O+100655119 (15 yr) WJ15/10/1966A+99465111 (15 yr) MC11/06/1956A+99564850 (13 yr) CB21/07/1980B-100324832 (13 yr) SO18/05/1946A+98663898 (11 yr) JD14/02/1958O+100543729 (11 yr) SD20/10/1976O+98363432 (9 yr) EW04/07/1948O+99643206 TL15/06/1947O+0653171 IB10/02/1942A+0702693 LH09/09/1963O+99492549 NM14/12/1948O-81642530 DL05/01/1961O+0522449 HH16/11/1966O-85462444 AF12/02/1966O+66462386 CM24/11/1949A+100632282 EH05/11/1947B+0652212 KM03/04/1940A+97722162 LB27/07/1979O+100332047 VQ07/05/1980O+91322016 AH21/04/1966A+0461938 DS22/06/1943O+11691938 MM30/03/1944A-9681926 HL18/08/1945O-57671926 GR28/12/1960O+57521925 MM02/07/1940O+96721884 NM06/08/1981O+91311854

50. Kidney donation Deceased donor – Are you on the organ donor register? – Do your family know? Living donor – Would you consider this?

51. Kidney donation / transplantation www.donatelife.co.uk

52. Kidney transplantation: why should you care? Kidney failure is: – relatively common – can affect anyone – you can reduce your risk Dialysis: – isn't great… Transplantation = transformation you could make a difference

53. www.donatelife.co.uk