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2615565-3843870-1176874656455-355812Dear ColleaguesWelcome to the third edition of the LKD Network newsletter.? We are looking forward to having our first meeting together at UKKW (details below) and working with KQUIP and Transplant First to promote education and shared learning in transplantation over the coming year.?Dates for the diaryUKKW LKD Network meeting Wednesday 20th June 2018, 07:45 - 08:45, Kings suite, Harrogate ICC. Please see Agenda below:UKKW LKD Network meeting Date:Wednesday 20th June 2018Time:7.45 - 8.45am Venue:Kings suite, Harrogate ICCTea/coffee and breakfast pastries will be providedAgendaIntroduction and Welcome Exploring the plateau in living kidney donor numbers in the UK- why is this happening and what should we do? Group discussion led by Caroline Wroe, Consultant Nephrologist, Chair of the UK LKD networkSharing best practice-what is the ideal donor pathway?Group discussion led by Katie Vinen, Consultant Nephrologist, RA lead for Living Kidney DonationWhat resources are there for me as a professional?Lisa Burnapp, Lead Nurse Living Donation, NHSBTBTS Living Donor Forum and Ethics Symposium: 15th November 2018, YorkBTS Annual Conference, March 6 - 8th 2019, Harrogate ?What I tell my patients about…the Living Donor Kidney Sharing Scheme- Aisling CourtneyIn about a third of people who are suitable to donate a kidney, there is a problem with the ‘matching’ so unfortunately giving their particular kidney directly to their relative / friend is not straightforward. This can occur if the person needing the transplant is a different blood group, or if he/she has developed ‘antibodies’ to other people’s cells, (typically because they have had a previous transplant, pregnancy, or blood transfusion).In the UK there is a sharing scheme for ‘swapping’ living donor kidneys. For example, I am the wrong blood group for my sister, but it may be that my kidney will suit Mrs Blogs in St. Elsewhere and that Mr Blogs (who can’t donate directly to his wife because of her antibodies) has a kidney that would suit my sister. Quite often there can be two other pairs involved – a ‘3-way swap’. If a donor and recipient pair enter this scheme then their details are registered with the national centre. Four times in the year (January, April, July and October) there is a ‘matching run’ when the computer programme looks at all the people who are registered and works out who would match whom (perhaps the ultimate !).It is important to note that:the person giving the kidney stays in the same place as the person being transplanted; the kidneys are transported rather than the patientsthe donor will not be giving a kidney unless there is a kidney coming for their friend / relative (almost always on exactly the same day) all living donors in this scheme have been through the same thorough tests and investigations so we know that they, and their kidney, are healthyThe advantage of this scheme is that the patient will receive a good ‘straightforward’ living donor kidney without any antibody problems. The disadvantage is that there is no guarantee of getting a match. For everyone who is unsuccessful in getting a match after three or four runs, then a higher risk option for transplantation may be considered.ABO Blood group incompatible transplantation- Katie Vinen Over the last few years NHS Blood and Transplant has been studying laboratory tests that determine whether a donor recipient pair is suitable for an ABO incompatible transplant. Here are the key points from the resultant paper which can be found by clicking the attachment below.Transplantation across ABO barriers is sometimes possible and carries very good success rates. It accounted for 7% of living donor transplants in 2016/17. Feasibility of transplantation is determined by antibody titres where low tires (< 1: 8) on the day of surgery allow transplantation whilst high titres (1 : 512) preclude this option and support long term inclusion in the UK Living Kidney Sharing Scheme (KSS) Several different assays are available for antibody titre testing and laboratories may then use either standard or ‘in house’ techniques to perform the assays. These include the indirect agglutination test (AIT) and the direct agglutination test at room temperature (DRT). Accurate and reproducible results are essential for guiding patients and optimising transplant success as well as comparing outcomes between centres. In 2014/15 a test exercise was run where 98 laboratories were sent three plasma samples and group A1 red cells and asked to determine their anti-A titre levels using their normal laboratory protocols. This revealed wide variation in antibody titre found. The same sample could have allowed ABO incompatible transplantation in one laboratory yet suggested indefinite inclusion in the KSS in another. Such variation may result in inaccurately high ABO titres denying some patients a good transplant or inaccurately low titres subjecting them to unacceptable immunologic risk. The indirect agglutination test (IAT) was the most consistently reproducible technique The paper makes a number of recommendations of which an opportunity to perform a central parallel titre measurement (recommendation 1) maybe considered by centres to reduce inter - laboratory variation. For further information about this paper please contact Nizam Mamode at nizam.mamode@gstt.nhs.uk, Chair of the workstream for Recipients at Higher Immune Risk, LDKT 2020 Strategy Implementation Group.Update on UK LKD transplant numbers from 2017/18Latest NHSBT data shows a slight increase from 1,043 donors in 2016/17 to 1052 living donor transplants in 2017/18, of which 1018 are kidney. ? The ATTOM study showed that there was inequity of access to LKDT’s in the UK so this data challenges us to understand why LKD numbers have plateaued and therefore if and how we should change practice.? From the work that has been done through the LDKT 2020 Strategy implementation group, it is clear that we need to make it easier for people to donate and receive a kidney from a living donor. This includes providing high quality educational resources and consistent information for donors and recipients, easy access to the LDKT programme and shorter work-up times. Our aim is to make donors and recipients the ambassadors for LDKT by improving their experience.As well as working closely with patient group to achieve this, the network is a really important part of how we do this as a renal and transplant community and we look forward to engaging with you over the coming months. A list of up to date resources and how to access them is attached below.??Kind regards32042101346200006858000Dr Caroline Wroe Dr Katie VinenChair of the UK Living Kidney Donation NetworkRA Lead for Living Kidney DonationConsultant NephrologistConsultant Nephrologist, South Tees NHS Foundation TrustKings College Hospital ................
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