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 2013 was the use of donors after brainstem death. The death-censored graft failure rate was similar to previous years at 2.4% and the transplant patient death rates remained stable at 2.4 per 100 patient years. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year post transplant patients. Analysis of prevalent transplants by chronic kidney disease stage showed 13.4% with an eGFR,30 ml/min/1.73 m2 and 1.7% with an eGFR ,15 ml/min/1.73 m2. Of those with CKD stage 5T, 32.4% had haemoglobin concentrations ,100 g/L 28.4% phosphate concentrations 51.7 mmol/L and 16.8% adjusted calcium concentrations 52.5 mmol/L. Infection (26%) and malignancy (24%)remained amongst the commonest causes of death inpatients with a functioning renal transplant. CONCLUSION: 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 2013 was the use of donors after brainstem death. The death-censored graft failure rate was similar to previous years at 2.4% and the transplant patient death rates remained stable at 2.4 per 100 patient years. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year post transplant patients. Analysis of prevalent transplants by chronic kidney disease stage showed 13.4% with an eGFR,30 ml/min/1.73 m2 and 1.7% with an eGFR ,15 ml/min/1.73 m2. Of those with CKD stage 5T, 32.4% had haemoglobin concentrations ,100 g/L 28.4% phosphate concentrations 51.7 mmol/L and 16.8% adjusted calcium concentrations 52.5 mmol/L. Infection (26%) and malignancy (24%)remained amongst the commonest causes of death inpatients with a functioning renal transplant. CONCLUSION: 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: A Gramaticu; D Siriopol; A Miron; D Tacu; I Sinescu; C Gingu; C Bucsa; A Nastasa; A Covic Journal: Int Urol Nephrol Date: 2017-11-17 Impact factor: 2.370