Quality statement 2: Transplantation – pre‑emptive

Quality statement

Adults who will need renal replacement therapy are offered a pre‑emptive kidney transplant, if they are medically suitable.

Rationale

Evidence shows that transplant outcomes are better for adults who have not been on dialysis (that is, pre‑emptive transplantation) than those who have, and that transplant survival is negatively influenced by the duration of conventional dialysis before transplantation.

It is recommended that adults with progressive deterioration in kidney function for whom transplantation is an option should be placed on the national transplant list within 6 months of their anticipated dialysis start date. Pre‑emptive transplantation should be considered as the treatment of choice for all suitable patients when a living donor is ideally available because this provides most people with the best chance of long‑term rehabilitation.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults who will need renal replacement therapy have their suitability for kidney transplantation assessed at the earliest opportunity.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that adults who will need renal replacement therapy receive a pre‑emptive kidney transplant, if they are medically suitable.

Data source: Local data collection.

Process

(a) Proportion of adults who will need renal replacement therapy who are assessed for transplant suitability.

Numerator – the number in the denominator who are assessed for transplant suitability.

Denominator – the number of adults who will need renal replacement therapy.

Data source: Local data collection.

(b) Proportion of adults who will need renal replacement therapy and are medically suitable for pre‑emptive kidney transplantation, who receive a pre‑emptive kidney transplant.

Numerator – the number in the denominator receiving a pre‑emptive kidney transplant.

Denominator – the number of adults who will need renal replacement therapy and are medically suitable for pre‑emptive kidney transplantation.

Data source: Local data collection. NHS Digital's Hospital Episode Statistics contains data on kidney transplantation. Also contained in The Renal Association's clinical practice guideline on planning, initiating and withdrawal of renal replacement therapy, audit measure 4.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals and specialist renal centres) work together to ensure that adults who will need renal replacement therapy are offered pre‑emptive kidney transplantation if they are medically suitable.

Healthcare professionals ensure that they assess adults who will need renal replacement therapy for transplant suitability, and offer pre‑emptive kidney transplantation to adults who are medically suitable.

Commissioners (clinical commissioning groups and NHS England area teams) ensure that they work together to commission services for adults who will need renal replacement therapy and are medically suitable for transplantation to receive pre‑emptive kidney transplantation.

What the quality statement means for patients, service users and carers

Adults who have kidney failure are offered a kidney transplant, if it is a suitable treatment for them, before they need to start dialysis. Kidney transplant involves replacing a kidney with one from a person who has recently died or from a relative.

Source guidance

Renal replacement therapy and conservative management (2018) NICE guideline NG107, recommendation 1.3.6

Definitions of terms used in this quality statement

Pre‑emptive transplantation

Pre‑emptive kidney transplantation is carried out for adults who are medically suitable before dialysis is needed. A kidney may be used from a living or deceased donor, although a living donor is preferred.

[Adapted from NICE's guideline on renal replacement therapy and conservative management]

Equality and diversity considerations

People with a BMI greater than 30 should not be excluded from transplantation based on BMI alone.