Identifying differences between centres in outcomes following kidney transplant failure
Dr Maria Pippias from the University of Bristol has received a Michael Nicholson Award Research Project Grant of £90,000 to investigate any pattern or trends in good health outcomes, and any inequalities that exist, for patients with failing or failed transplants.
The problem
Some people with kidney failure will be offered a kidney transplant as part of their treatment. Unfortunately, over time transplants can stop working well or stop working completely. People who have a failing kidney transplant might have changes made to their medications, and they may be prepared for another transplant and/or dialysis.
The treatment of adults and children with kidney transplant failure is different between UK hospitals. For example, some hospitals run specialist failing transplant clinics, and others do not. Some hospitals routinely stop certain transplant medications whilst others continue them after a transplant has failed.
It is not known if the differences in treatment between different hospitals results in different outcomes and the well-being of individuals experiencing kidney failure. The best treatment approaches remain undefined.
“We know that people with failing or failed kidney transplants have different treatment plans depending on where they are treated, but we don’t know which treatment plan is associated with the best outcomes. We also don’t know if people of different personal, social and economic situations receive the same type of care.
"This research will help us identify which treatment plans are associated with better outcomes and if people are receiving the same level of care regardless of their personal, social and economic situations. We will use the information gathered from this study to carry out a clinical trial to work out what the best treatment plan for people with failing or a failed kidney transplant is. We hope that this will mean people with failing or failed kidney transplants will be able to access the best treatment for them.” Maria Pippias
The solution
This study will investigate whether a patient’s personal characteristics and social and economic situation are associated with differences in access to care and health outcomes with failing and failed transplants.
Maria and the team will carefully study anonymised data, from the UK Renal Registry (UKRR) and NHS Blood and Transplant (NHSBT) databases. They will use statistical techniques and models to look for patterns to see if there are any inequalities in access to treatment and treatment outcomes for patients with failing and failed transplants. They will compare treatment practices between UK hospitals to determine best practice.
To identify best practice, they will study what happens to people in the UK (a) before their transplant fails, (b) in the first year on dialysis after transplant failure and (c) after receiving another kidney transplant. Findings will be compared to people with kidney failure who have not had a transplant.
What this means for kidney patients
By understanding any patient factors linked to outcomes in failing or failed transplants this study will identify the best ways to manage this very difficult situation in the future. These practices can be applied in different centres, which may lead to updated guidelines and more consistent care in the future.
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