Aims The aim of this study was to evaluate the feasibility, safety, and costs associated with a dedicated flexible cystoscope for the removal of ureteric stents from transplant recipients in the outpatient setting. Methods In our centre, we routinely performed post renal transplant ureteric stent removal in theatres. Recently we have switched this practice to outpatient settings. We performed retrospective analysis of prospectively collected data from two settings between Aug 2018-Dec 2021 to compare the impact on the timing of post renal transplant ureteric stent removal, associated complications, cost effectiveness and patient satisfaction. Results In total 99 ureteric stents were removed from 100 transplant recipients in theatre and 100 stents in outpatient department. 2 patients in clinic cohort did not tolerate procedure under LA. 5 patients in theatre cohort and 6 patients in clinic cohort underwent PD catheter removal in theatres along with stent removal. Earlier stent removal was achieved in clinic compared with theatre with (36 versus 55 days after transplant; p=0.001) There was no statistically significant difference in infection rates following stent removal in either groups. Outpatient stent removal proved to be very cost effective to the trust with savings of over £250 per procedure in comparison to the theatre setting. Patient satisfaction was measured by numerical rating score for pain and discomfort which showed that the patients tolerated the outpatient procedure under local anaesthesia very well,(mean score 4/10). Conclusions A dedicated outpatient ureteric stent removal service for kidney transplant recipients seems to be feasible, cost effective, and safe.

Aims To evaluate the impact of virtual cross match in donation following brain death (DBD) kidney transplants on the cold ischaemia time (CIT) as one of the factors in achieving better renal graft outcomes. Methods Every patient on the deceased donor renal transplant waiting list in our centre was asked to give a blood sample to test for Human Leucocyte Antigen (HLA) antibodies. Our transplant coordinators ensured that this process is updated three monthly as part of the eligibility criteria to perform virtual cross match. Other factors contributing to CIT were intentionally ignored given that there are no significant changes in the kidney allocation scheme or kidney acceptance criteria. Comparison was made between CIT in the financial years 2014/ 2015 and 2020 /2021. Results Since the introduction of this strategy, our centre was the only centre in all 23 UK kidney transplant centres to achieve 100% transplantation within 18 hour CIT for DBD kidneys transplants in the financial year 2020/2021. This represented a significant improvement compared to 58% in the financial year 2014/2015. Conclusions Virtual cross match was a key factor in achieving the 18 hours target for DBD kidney transplant regardless of other contributing factors. It is highly recommended that a three-monthly screening for HLA Antibodies is regularly performed to achieve this result.