Chapter 3 Demographic and biochemistry profile of kidney transplant recipients in the UK in 2010: national and centre-specific analyses.

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 numbers of live and deceased kidney donors increased in 2010. The death-censored graft failure rate fell slightly to 2.4% and the transplant patient death rates remained stable at 2.5 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 13.7% with an eGFR <30 ml/min/1.73 m(2) and 1.5% with an eGFR <15 ml/min/1.73 m(2). Of those with CKD stage 5 T, 36.1% had haemoglobin concentrations <10.5 g/dl, 22.9% phosphate concentrations ≥ 1.8 mmol/L and 6.2% adjusted calcium concentrations ≥ 2.6 mmol/L. Malignancy (23%) and infection (22%) remained the commonest two causes of death in prevalent transplant patients.

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.