Transplant First Quality Improvement Programme
It is well recognised that a pre-emptive living donor kidney transplant (i.e. before starting dialysis) leads to the best clinical outcomes and experience for patients. Despite this, there is huge variability in equity of access to the transplant waiting list and living donation across the UK, with pre-emptive transplant listing rates in steady decline over recent years.
The Kidney Quality Improvement Partnership (KQIP) is a dynamic network of kidney health professionals, patients and carers who are committed to developing, supporting and sharing improvement in kidney services in order to enhance outcomes and quality of life for people with kidney disease.
Starting in the West Midlands Clinical Network in 2016, the Transplant First programme has been supporting regions in England to implement the Transplant First project, by delivering two-year programmes of quality improvement training and support.
Within each region, projects have focused on different aspects of transplant workup and listing pathways depending on local variation and need.
To date these have included:
- Midlands: Improving access to living kidney donation
- North West: ‘Talk Transplant at 25’ and ‘Live Donor 25’ projects
- North East: Improving recipient workup pathway and equity of access to transplantation
- South West: Increasing pre-emptive LKD transplant and listing rates
- South East: Improving documented transplant decisions for kidney patients
- Yorks & Humber: Improving pre-emptive transplant listing rates from the low clearance clinic
The KQIP Transplant First improvement hub is available to access on the UK Kidney Association website. This includes online resources developed by the project team to support teams in getting started with Transplant First:
- Transplant First data collection tool which encourages units to perform a mini route cause analysis (RCA) on every patient who reaches dialysis without being listed for transplantation
- A How to Guide for people embarking on Transplant First or a similar project
- Collaborative Working QI case studies
- Summary of barriers and improvement opportunities along the transplant pathway
A series of biannual Transplant First webinars have been held since 2023, which have included the sharing of learning from regional QI projects, as well as expert speakers and interactive discussions focusing on specific areas of improvement such as cardiac workup, weight management and diabetes. These events have been well attended and feedback from delegates has been very positive. The next webinar will be held on 6 May 2025 and will focus on overcoming barriers to living kidney donation.
In summary, the KQIP Transplant First programme has supported many regional renal networks across England to try to address the significant inequity in access to pre-emptive listing and transplantation. Many successful QI projects have already been completed at a local and regional level to address the barriers that have been identified. There has been fantastic enthusiasm from across the kidney community, including multidisciplinary professionals and patient representatives, to continue to drive this improvement and achieve better outcomes for people living with advanced kidney disease.