BYWATER L1, LING J1,2, Polkinghorne K1,2, Mark T1, Kanellis J1,2
1Department of Nephrology, Monash Health, Clayton,, Australia, 2Monash Health Department of Medicine, Monash University, Clayton,, Australia
Background: SPKT in Australia uses recipient criteria that are highly selective compared to those internationally, including a conservative recipient upper‐age limit. Mortality rates due to comorbidity are high, therefore early referral is encouraged (eGFR ≤25ml/min) to allow early identification of issues precluding transplantation.
Aim: To describe the characteristics and early outcomes of patients referred to our unit for SPKT.
Methods: All referrals to our centre from 1/6/2010‐30/6/2018 were reviewed. Patient characteristics including age, dialysis status, eGFR, and geographic origin were examined. Early outcomes (within 6 months after first initial assessment) were assessed including death, in principle acceptance / non‐acceptance, and presence of clinical issues precluding transplantation.
Results: During the study period, 290 referrals were received (48% females, mean age 40.3yrs (SD±8.1)) with 240 (83%) referred from other centres. States referring were VIC 76.9%, SA 14.8%, TAS 7%, NSW/QLD/NT 1.3%. After excluding pancreas without kidney referrals, 75/279 (27%) were already on dialysis at referral. For those pre‐dialysis (73%) mean eGFR was 21ml/min (SD±8).
Of the 260 patients who attended the initial review, 16% were deemed unsuitable while 209 (80%) were accepted in principle. The remaining 4% had an acceptance decision deferred. Median time from referral to appointment was 95 days (range 67‐ 140). Seven (2.4%) died prior to review or soon after initial assessment (mean age 40.3, SD±5.5 years). Sixty‐six (32%) had clinical issues precluding transplantation (eg. heart disease, smoking, overweight, psychosocial issues).
Conclusion: Patients referred for SPK transplantation to our centre are generally young and have a high mortality rate. A significant proportion are referred late, having already commenced dialysis. Many have complex clinical issues needing resolution before they can progress to transplantation.
Laura is a third year renal advanced trainee. She has an interest in transplant medicine and immunology.