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Returning to dialysis after kidney transplant failure: Linking immunology and patients’ experience to mortality and morbidity risk factors
Safe People
Organisation name
Imperial College Healthcare NHS Trust
Organisation sector
Government Agency (Health and Adult Social Care)
Applicant name(s)
Oshini Shivakumar
Funders/ Sponsors
Neill Duncan
DEA accredited researcher?
Unknown
Sub-licence arrangements (if any)?
No
Safe Projects
Project ID
NIBDAPC_2025_0042
Lay summary
Kidney failure happens when the kidneys can no longer filter waste and excess fluids from the blood, leading to serious health problems. Dialysis is a treatment that takes over this filtering process to keep the body functioning. A kidney transplant is a procedure where a healthy kidney from a donor replaces the failed kidney, offering a better long-term solution than dialysis. Despite advances in medications that prevent organ rejection (such as steroids and tacrolimus), many kidney transplant recipients still experience transplant failure and must return to dialysis. However, there is limited research on how these patients fare compared to those starting dialysis without a prior transplant, with existing studies showing conflicting results. Many kidney care centres now have specialized clinics for patients with failing transplants, but once they transition to dialysis, they are usually managed in general dialysis clinics where their specific needs maybe overlooked. My study aims to compare the health outcomes of patients returning to dialysis after transplant failure with those who start dialysis for the first time at a large kidney care center in the UK. There is already evidence that certain blood markers—such as the monocyte-to-lymphocyte ratio (both are types of white blood cells)—and quality of life scores can predict survival in dialysis patients. Other markers, like neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, have also been linked to illness and death in dialysis patients. I aim to investigate whether these easily measurable blood markers can help predict outcomes in patients returning to dialysis after transplant failure, particularly those who have been exposed to immunosuppressive medications like steroids. If these markers show strong associations, they could help identify high-risk patients, allowing for better patient care and risk management. This research will highlight the unique challenges faced by patients returning to dialysis after transplant failure, helping both doctors and patients make informed decisions to improve long-term health outcomes.
Public benefit statement
This study proposal was received positively at Patient and Public Involvement discussion groups in 2022, organised via the National Kidney Federation, UK and the West London Kidney Patient Association. Participants acknowledged that transition from failed transplant to dialysis was a period of immense psychological and physical stress. In addition to predictors of mortality and hospitalisation, they recommended to consider a further study arm - a qualitative analysis of patient experience during this transition phase.
Request category type
Public Health Research
Other approval committees
Latest approval date
10/03/2025
Safe Data
Dataset(s) name
ICHT iCARE Data Model
Data sensitivity level
De-Personalised
Common Law Duty of Confidentiality
Not applicable
National data opt-out applied?
Not applicable
Request frequency
One-off
Safe Setting
Access type
TRE