UK guidelines on transplantation from deceased donors after circulatory death

Transplantation offers patients with end-stage organ failure a cost-effective treatment that can improve quality of life and increase life expectancy. Prior to the introduction of guidance defining the concept of brain death in the 1970s, all organs donated for transplantation were from donation after circulatory death (DCD) donors. Following the introduction of neurological testing to diagnose death, the majority of organs donated for transplantation were from donation after brain death (DBD) donors or living donors.

Guidelines for Hepatitis B & Solid Organ Transplantation

Hepatitis B is a common infectious disease that can result in progressive liver damage requiring liver transplantation. Due to the high prevalence of hepatitis B infection worldwide many patients who are transplanted with other solid organs will have either had hepatitis B in the past or have active disease. The availability of a potent vaccine also means that new infections can be prevented. It is, therefore, important that all members of the transplant multidisciplinary team are aware of this infection and that steps are put in place to manage it in the pre-, peri- and post-transplant period. This is the first British Transplantation Society (BTS) guideline on the management of hepatitis B in the transplant setting.

Guidelines for living donor kidney transplantation

Kidney transplantation from a living donor, when available, is the treatment of choice for most patients with end stage renal disease, offering optimum patient and graft survival and reduced time on the national transplant waiting list. Living donor transplantation also offers a proportion of complex recipients the opportunity to benefit from a transplant that they might otherwise not have received from the deceased donor waiting list; or, through the UK Living Kidney Sharing Schemes (UKLKSS), a better quality or better matched kidney than might otherwise have been available. For all these reasons, and the opportunity to expand the kidney donor pool, living kidney donation has been actively promoted in the UK over the last 20 years. At the time of writing, approximately 1 in 3 kidney transplants performed in the UK are from living donors. The latest national statistics show that there were 998 living kidney donor transplants in the UK in 2016-17 (1). Of 926 adult donor transplants, 484 were related, 442 were unrelated, 18 were HLA incompatible, 65 were ABO incompatible, 109 were paired/pooled, and 81 were altruistic donor transplants. 36% of the patients transplanted from living donors were transplanted pre-emptively, i.e. without a need for dialysis (1). The expansion of the UKLKSS has represented a significant change in practice since the last edition of this guideline, not least by reducing the need for HLA- and ABO-incompatible transplantation. In parallel, increasing confidence in the safety of living kidney donation has permitted the expansion of the potential donor pool; to date, the oldest living kidney donor in the UK was aged 85. Nonetheless, it must be recognised that living kidney donation carries some risk. The welfare of the donor remains paramount, and vigilance in donor care and management is essential to ensure that appropriate safeguards are in place to protect individuals and to inspire public confidence. These guidelines are intended to act as a resource for the transplant community, and to underpin best practice in living donor kidney transplantation.

Guidelines for Hepatitis E & solid organ transplantation

The incidence and prevalence of hepatitis E virus (HEV) infection has increased in many developed countries over the last decade. It has also been recognised that HEV infection can persist in immunosuppressed individuals, leading if left untreated to chronic hepatitis and significant liver fibrosis. Transplant recipients are therefore at risk of developing persistent HEV infection. There are currently no international guidelines on the management of hepatitis E in transplant recipients. These guidelines have therefore been developed to inform clinical teams and patients about hepatitis E, to help increase the recognition of persistent hepatitis E infection, and to provide clear guidance on its management.