Quality statement 7: Transplantation – rapid access to a specialist histopathology service

Quality statement

Adults who have a suspected acute rejection episode have a transplant kidney biopsy carried out and reported on within 24 hours.

Rationale

Adults who have had a kidney transplant who are suspected of having an acute rejection episode should have a biopsy within 24 hours in order to inform treatment decisions. It is important that treatment for acute rejection is guided by the transplant biopsy results and is started as soon as possible. This relies on rapid access to a specialist histopathology service so that the transplant dysfunction can be established.

Quality measures

Structure

Evidence of local arrangements to ensure that adults who have a suspected acute rejection episode have a transplant kidney biopsy carried out and reported on within 24 hours.

Data source: Local data collection.

Process

Proportion of adults with a suspected acute rejection episode who have a transplant kidney biopsy carried out and reported on within 24 hours.

Numerator – the number in the denominator who have a transplant kidney biopsy carried out and reported on within 24 hours.

Denominator – the number of adults with a suspected acute rejection episode.

Data source: Local data collection.

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

Service providers (specialist histopathology services) ensure that they provide rapid access (within 24 hours) to transplant kidney biopsies so that transplant dysfunction can be established quickly after a suspected acute rejection.

Healthcare professionals ensure that adults who have a suspected acute rejection episode receive a transplant kidney biopsy that is carried out and reported on within 24 hours.

Commissioners (clinical commissioning groups and NHS England area teams) ensure that they commission services for adults who have a suspected acute rejection episode to have a transplant kidney biopsy that is carried out and reported on within 24 hours.

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

Adults who have had a kidney transplant who may have had an 'acute transplant rejection' (which is when the body's immune system attacks the donated kidney) have a procedure called a kidney biopsy to remove, test and report on a small sample of the kidney. This should be carried out within 24 hours of the possible rejection.

Source guidance

The Renal Association (2017) Clinical practice guideline: post-operative care in the kidney transplant recipient, recommendation 4.1