Abstract: TH-PO1015

Assessment of a Dedicated Transplant Low Clearance Clinic and Patient Outcomes on Dialysis after Graft Loss at Two UK Transplant Centres

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Evans, Rhys David Russell, UCL Centre for Nephrology, London, United Kingdom
  • Bekele, Soliana, Barts Health NHS trust, London, United Kingdom
  • Clark, Sarah Grace, Barts Health NHS trust, London, United Kingdom
  • Harris, Lauren, Royal Free Hospital, London, United Kingdom
  • Campbell, Samantha Mary-Anne, Royal Free Hospital, London, United Kingdom
  • Thomas, Alice, Barts Health NHS trust, London, United Kingdom
  • Jones, Gareth L, Royal Free Hospital, London, United Kingdom
  • Thuraisingham, Raj, Barts Health NHS Trust, London, United Kingdom
Background

Recipients with a failing kidney transplant (RFKT) receive worse care than those with native disease and outcomes on dialysis after graft loss (DAGL) are poor. Dedicated low clearance transplant clinics (LCTC) are recommended for the management of RFKT but data to support their use is limited. We assessed the management of RFKT at two London transplant centres, one with a dedicated LCTC (Centre A) and one without (Centre B).

Methods

Transplant patients at Bart’s Health (Centre A) and the Royal Free Hospital (Centre B) who transitioned to an alternative form of renal replacement therapy (RRT) between 01/01/2012-30/11/2016 were included. Patients with graft failure within a year of transplantation or due to an unpredictable acute event were excluded. Data were recorded after review of medical records.

Results

179 patients were included; mean age at dialysis restart was 48.6 (+/- 13.4) years, 99 (55.3%) were male, and mean transplant duration was 3678 (+/- 2851) days. Pre-dialysis counseling was documented in 79 (91%) and 68 (74%) patients at Centre A and B respectively (p=0.003). Listing for re-transplantation at restart occurred in 61 (34.1%) patients across both groups. Table 1 outlines clinical parameters at restart and modes of RRT restarted. Outcomes at 1 year after initiation of DAGL were determined in 136 patients; 1-year mortality was 6.6% overall.

Conclusion

A dedicated LCTC improved pre dialysis care. Rates of pre-emptive re-transplantation were low, but 1-year mortality across both centres was better than published estimates.

Clinical parameters at restart and modes of RRT restarted
Parameter at restart (mean; SD)Centre A (n=87)Centre B (n=92)p-value
Haemoglobin (g/L)89.4 (15.3)96.1 (17.1)0.007
Phosphate (mmol/L)1.69 (0.46)1.77 (0.52)0.28
PTH (pmol/L)52.2 (44.6)41.8 (36.7)0.09
Bicarbonate (mmol/L)19.5 (3.5)19.8 (4.6)0.64
Creatinine (μmol/L)626 (225)675 (302)0.22
Urea (mmol/L)30 (9)30 (11)0.63
Systolic Blood Pressure (mmHg)147 (27)146 (22)0.68
Diastolic Blood Pressure (mmHg)81 (15)86 (13)0.019
Mode of RRT restarted (n; %)   
Haemodialysis70 (80.5)70 (76.1)0.35
Peritoneal Dialysis11 (12.6)17 (18.5)
Transplant (pre-emptive)4 (4.6)5 (5.4)
Supportive care2 (2.3)0 (0.0)