Liverpool University Hospital NHS Trust, University of Liverpool

ILD91

Kidney transplantation in patients with End-Stage Kidney Disease can enable patients to live both a longer life and a better quality of life. Kidney transplantation reduces healthcare costs and allows recipients to contribute to society economically and functionally. However, there remains a significant gap between the number of patients who would benefit from transplantation and the availability of donors. At the end of 2018/19, 4954 adult patients were active on the national waiting list. On average, adult patients can expect to wait approximately two to three years for a deceased donor kidney transplant. Relisting patients for a second or subsequent transplant leads to additional pressure on the national waiting list. Also, there are conflicting data on outcomes after second, third or subsequent kidney transplants compared to first transplants, with some studies showing poorer outcomes in those who were re-transplanted over those receiving their first transplant. Therefore, research for preferential waiting listing of patients for their first deceased donor transplant is required. Also, the allocation of good quality kidneys to those with the shortest expected survival and vice versa increases the gap between supply and demand. By identifying the ideal pair of risk scores (donor and recipient), the goal would be to significantly decrease the gap between supply (total deceased donor kidneys available) and demand (transplants with good function which lasts for longer) to reduce the need for re-transplantation significantly. There is a need to validate the existing risk scores (recipient and donor) and develop a new composite risk score that would match a graft (kidney) to a recipient using sophisticated machine learning techniques to ensure extended graft and patient survival. UKRR data will help us to A. Compare outcomes of patients who have received first, second or subsequent transplants and a comparison group of dialysis patients on the national waiting list for their first transplant. B. Validate existing donor and recipient risk scores and develop a new risk score that will enable the optimum matching of a donor kidney to a recipient to ensure the maximum longevity of a transplanted kidney. The proposed work aims to inform the national allocation policy on both listing for kidney transplantation and the optimal allocation of deceased donor kidneys.

10/06/2021