New ways of reporting on Dutch kidney transplantations

M.B.A. Heemskerk, A.J. Hoitsma, F.J. van Ittersum, A.P.J. de Vries, A.D. van Zuilen, S.P. Berger

Thursday 15 march 2018

11:30 - 11:45h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 3: Clinical

Renal transplant centres differ in policies concerning patient wait list registration, donor kidney acceptance, HLA matching, etc. Insight in these differences was only available after special and time consuming requests. To have more accurate and extensive information on the outcome of these policies the Dutch Transplant Foundation and the national kidney transplantation advisory committee (LONT) developed a new annual kidney wait list, transplant and outcome report.

This report includes both an overview on national and centre level. Information on wait list, and transplantation is portrayed in (cross) tables. Long-term graft failure and patient mortality on national level per donor type are shown with Kaplan Meier curves and log rank tests, as well as short-term outcome in more recent cohorts. Comparison per centre is performed with funnelplots on incidence of graft failure and patient mortality; both crude and recipient case mix corrected.

The reports show for instance that the active wait list (T) is around 650 patients and that the median waiting time from start dialysis has declined to 2.6 years (25^th and 75^th percentile: 1.7 – 4.2 years) in 2016; Blood group O patients have an evident disadvantage with 3.6 waiting years (25^thand 75^th percentile: 2.2 – 5.0 years) in normal ETKAS allocation. Trends like an increase of elderly wait list patients (26% in 2016), non transplantable (NT) patients (75% of total list), and preemptive post-mortem donor transplantation (10%) are easily visible. The Kaplan Meier curves show less difference in early graft loss between DBD and DCD kidney transplants in more recent cohorts. A joint publication with Nefrovisie on national dialysis and transplant data gives a total picture on Dutch renal replacement therapy practice. The report also shows striking differences between kidney transplant centres for the proportions of NT wait list (range 52% - 84%), post-mortem donor transplants (range 31% - 51%) and preemptive post-mortem transplants (range 5% - 19%), and median dialysis waiting time (range 2.1 - 3.9 year). Funnel plots with or without recipient case mix correction show that mortality and graft survival incidence per centre is within range.

This annual report uncovers trends in Dutch transplant practice and can be useful for centres to evaluate their policies. Furthermore, the cooperation with Nefrovisie can lead to a more inclusive overview on the national renal replacement therapy practice.