Introduction:In the UK, NHS Blood and Transplant (NHSBT), the national transplant regulatory body, monitors 30-day graft loss and patient mortality by CUmulative SUMmation methodology (CUSUM). A CUSUM trigger is generated each time the observed rate of graft loss and/or mortality exceeds the expected rate. Between 2010 and 2013, 4 triggers were identified in Manchester related to 15 graft losses. This initiated a centre generated invited external review followed by a NHSBT review. All pancreas graft losses and major surgical complications between 2011-13 were reviewed. The reasons were deemed to be technical failure and prolonged cold ischaemia time (CIT)(12-17 hrs). the review recommended developing: uniform protocols for recipient assessment and selection, standardized donor selection criteria, clinics for assessment and monitoring of patients on waiting list, pancreas transplant specific listing multi-disciplinary team (MDT) meetings, standardized surgical technique for pancreas transplantation, logistical pathway to reduce cold ischaemia time, and, consensus-based management of post-operative complications. This study explores the process of restructuring the programme and its subsequent impact on outcomes. Methods:All the review recommendations were implemented. Surgical technique across the team was standardised. The use of separate teams for back-benching and implantation was made mandatory. The key clinical outcomes were compared between periods before and after practice change. Results: There was a significant increase in the number of virtual crossmatches reported in period 2 (50% v/s 94%; p<0.0001, Chi-square test). After change, there was a significant reduction in CIT ( 760 min to 562 min) (p<0.0001, unpaired t-test), re-exploration rate (39.5% to 25.0%) and major surgical complications rate (37.5 % to 11.9%) (p=0.02, Chi-Square test), pancreatic graft loss (29% to 6%) [p=0.01, Chi-square test] and mean hospital stay (28 to 19 days) [p=0.03, t-test]. Discussion: Restructuring the pancreas transplant programme following a peer review has led to significantly reduced CIT and resultant improved graft and patient outcomes. This illustrates the positive impact a peer review can have on improving the overall quality and outcomes of a prgoramme. Therefore, periodical external review may help in sustained improvement in practice.

CITATION INFORMATION: Moinuddin Z, Arif A, Masood O, Tavakoli A, Pararajsingam R, Poulton K, Worthington J, Forgacs B, Augustine T, Dhanda R. Periodical Peer Review of a Pancreas Transplant Programme: Can It Enhance Performance? Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress