INTRODUCTION: National transplant registries routinely focus on centre-specific patient and graft survival rates following renal transplantation. However other outcomes such as graft function (as measured by eGFR), haemoglobin and blood pressure are also important quality of care indicators. METHODS: Renal transplant activity, incident graft survival data and donor information were obtained from NHS Blood and Transplant. Laboratory and clinical variables and prevalent survival data were obtained from the UK Renal Registry. Data were analysed separately for prevalent and one year post-transplant patients. RESULTS: The main increase in transplant activity in 2012 was the use of donors after circulatory death. The death-censored graft failure rate was similar to previous years at 2.2% and the transplant patient death rates remained stable at 2.3 per 100 patient years. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year posttransplant patients. Analysis of prevalent transplants by chronic kidney disease stage showed 13.7% with an eGFR <30 ml/min/1.73 m(2) and 1.7% with an eGFR <15 ml/min/1.73 m(2). Of those with CKD stage 5T, 33% had haemoglobin concentrations <100 g/L, 27.6% phosphate concentrations 1.7 mmol/L and 20.5% adjusted calcium concentrations 2.5 mmol/L. Infection (23%) and malignancy (20%) remained amongst the commonest causes of death in patients with a functioning renal transplant. CONCLUSIONS: Significant variations in clinical outcomes (unadjusted for patient specific variables) amongst kidney transplant recipients continued to exist in the UK and may reflect differences in healthcare delivery between renal centres.
INTRODUCTION: National transplant registries routinely focus on centre-specific patient and graft survival rates following renal transplantation. However other outcomes such as graft function (as measured by eGFR), haemoglobin and blood pressure are also important quality of care indicators. METHODS: Renal transplant activity, incident graft survival data and donor information were obtained from NHS Blood and Transplant. Laboratory and clinical variables and prevalent survival data were obtained from the UK Renal Registry. Data were analysed separately for prevalent and one year post-transplant patients. RESULTS: The main increase in transplant activity in 2012 was the use of donors after circulatory death. The death-censored graft failure rate was similar to previous years at 2.2% and the transplant patient death rates remained stable at 2.3 per 100 patient years. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year posttransplant patients. Analysis of prevalent transplants by chronic kidney disease stage showed 13.7% with an eGFR <30 ml/min/1.73 m(2) and 1.7% with an eGFR <15 ml/min/1.73 m(2). Of those with CKD stage 5T, 33% had haemoglobin concentrations <100 g/L, 27.6% phosphate concentrations 1.7 mmol/L and 20.5% adjusted calcium concentrations 2.5 mmol/L. Infection (23%) and malignancy (20%) remained amongst the commonest causes of death in patients with a functioning renal transplant. CONCLUSIONS: Significant variations in clinical outcomes (unadjusted for patient specific variables) amongst kidney transplant recipients continued to exist in the UK and may reflect differences in healthcare delivery between renal centres.
Authors: Tristan M Snowsill; Jason Moore; Ruben E Mujica Mota; Jaime L Peters; Tracey L Jones-Hughes; Nicola J Huxley; Helen F Coelho; Marcela Haasova; Chris Cooper; Jenny A Lowe; Jo L Varley-Campbell; Louise Crathorne; Matt J Allwood; Rob Anderson Journal: Nephrol Dial Transplant Date: 2017-07-01 Impact factor: 5.992