Renal and transplantation research

About our research

Renal transplantation is the largest of the solid organ transplant programmes with around 3,000 performed annually in the UK. It is often the best treatment for patients with end stage kidney disease, with survival, quality of life and health economic advantages.

As one of the biggest kidney transplant centres in the UK, much of our research energy is focused on transplantation but we are also very active in other areas of kidney research. 

We have a fast growing clinical research programme in keeping with our aim to be at the forefront of treatment for kidney disease and transplantation.

The Biomedical Research Centre patient and public involvement advisory group (PPIAG) develops methods of engagement with the local population. They also provide a patient/public perspective on a variety of research practices and approaches.

Current research studies

We are currently looking for volunteers to take part in the following studies. Click on the headings below to find out more about each study and see if you might be eligible to take part and help us with our research.

  • National registry of rare kidney diseases (RaDaR)

    The national registry of rare kidney diseases (RaDaR) is a Renal Association initiative designed to pull together information from patients with certain rare kidney diseases. This will give a much better understanding of how these illnesses affect people. It will also speed up research.

    Over 8,000 patients have been recruited so far from 72 renal units. RaDaR draws information from PatientView, an online system which records renal patient’s results, medications and clinic letters. Recruited patients are provided with a secure log-in to Patient View to access and check their own information online.

    Patient benefits of joining RaDaR:

    • access to your clinical data online via PatientView
    • ability to be contacted about potential research studies or patient information events
    • contribute to the increase in knowledge about your condition.

    For more information, please visit the Rare Renal website.

    We will approach patients to take part in selected outpatient clinics.

  • Survival improvement with cholecalciferol in
    patients on dialysis (SIMPLIFIED)

    Vitamin D deficiency is common in kidney failure patients, and is linked with death from cardiovascular disease, infections and cancer.

    Almost all dialysis patients receive pre-activated vitamin D, since it was thought that only the kidneys can activate vitamin D. However, this approach increases blood calcium concentrations which may be harmful and even make vitamin D deficiency worse.

    International treatment guidelines therefore now recommend that kidney patients receive inactive vitamin D (known as cholecalciferol), since we now know that every organ activates its own vitamin D as required, even in patients with kidney failure. However this is not currently used in the NHS, as trials have not yet shown whether this actually improves survival in patients.

    We will test whether supplementation with cholecalciferol increases survival in UK dialysis patients.

    • We will randomly assign adult UK dialysis patients to high dose cholecalciferol or standard care. Instead of seeing patients for extra study visits, we will use existing data sources such as the UK Renal Registry (UKRR), Hospital Episode Statistics (HES) and death records to find out what happens to patients in the study. This makes a very large study possible for a much lower cost than would otherwise be the case.
    • We will determine the number of deaths over time in the two groups, to establish whether cholecalciferol improves survival. Whether patients are alive or dead at the end of the study will be determined from the national deaths register, and the date of death identified.
    • We will also measure any differences in survival with no cardiovascular events, infections and cancers, the three leading causes of death in those on dialysis.
    • We will use questionnaires to compare the quality of life of those in the two groups.
    • We will measure whether cholecalciferol use is cost-effective from the point of view of the NHS.

    For more information, please visit the  University of Cambridge primary care website.

    We will be approaching eligible patients to take part in this study.
  • PAVE

    Haemodialysis is a treatment used when kidneys are no longer able to function properly.

    Doctors need access to the patient’s blood vessels for the treatment. The best method is with an arteriovenous fistula (AVF), made by surgically joining an artery and a vein.

    The fistulae commonly develop narrowed segments which can lead to hospital admission for fistuloplasty. The narrowed segments are treated in the x-ray department with a special balloon which is inflated to stretch the narrowed segment. However, the narrowing can return and around 60% of patients need a repeat procedure during the first year.

    There is evidence that using a balloon coated with certain drugs (such as paclitaxel) can stop the biological processes that cause narrowing after balloon treatment. In this project we plan to use drug-coated balloons in AVF used for haemodialysis.

    • The research will include haemodialysis patients with a narrowed fistula. Patients will receive the drug coated balloon treatment after a narrowed fistula has been dilated with a normal balloon.
    • We will compare the outcomes in patients that were treated with the paclitaxel coated balloon and the control group who were treated with an uncoated balloon. The main assessment of outcome will be the time taken for the narrowing to recur, preventing the fistula from being used or necessitating another procedure.
    • We will collect blood samples for future studies that may help to develop tests that predict the response to treatment and suggest the best therapeutic option for a specific patient.

    We anticipate that we will recruit participants for two years and the study will finish when the last patient has completed at least one year of follow up.

    We will approach eligible patients requiring fistuloplasty to take part in this study.

  • Dialysis outcomes and practice patterns study (DOPPS)

    The DOPPS is a prospective cohort study of haemodialysis practices. It is based on the collection of observational longitudinal data for a random sample of patients from dialysis facilities, in a representative and random sample of units in more than 20 countries.

    The samples are designed to provide a reliable picture of practices and outcomes in each facility, and in each geographic area. In view of differences in patient outcomes of mortality and morbidity by country and by dialysis unit, the study helps researchers to:

    • describe differences in practice patterns that correlate with differences in outcomes
    • understand the factors associated with patient outcomes which will lead to improved patient care and lower mortality and morbidity.

    For more information, please visit the DOPPS website.

    We will approach eligible patients in specific patient centres to take part in this study.
  • Biomedical informatics for post-transplant
    recurrent GMN

    This study is part of the National Institute for Health Research Health Informatics Collaborative (NIHR HIC). This brings together five of the country's leading NHS Trusts with large NIHR biomedical research centres to make NHS clinical data more available to researchers, industry and the NHS community. One of the five scientific themes is kidney transplantation.

    An important problem for kidney grafts is the reappearance of the same disease that caused the need for transplant. Recurrent disease is seen in 4–20% of patients that receive a kidney transplant.

    In this study we will:

    • identify the frequency of recurrent disease and the epidemiological and clinical factors that are associated with recurrence
    • use previously collected laboratory data (including genetic data) to assess the risk of recurrence and the severity of it.

    The four centres involved in the transplant theme are some of the largest kidney transplant centres in the country, performing around one third of all kidney transplants in the UK.

    We're focusing on recurrent disease in order to optimise the benefits of the present collaboration. The number of patients that we can incorporate will allow us to answer questions that could not have been answered in a single centre approach.

    For more information, please visit the NIHR website.

  • Ex-vivo normothermic perfusion in DCD
    kidney transplantation

    To make more kidneys available for transplantation, it is necessary to use organs from less optimal donors. These include kidneys that are retrieved after the heart has stopped, known as donation after circulatory death (DCD) donors.

    DCD donor kidneys suffer a period of damage that cause a high percentage of them to not function immediately after transplantation. This doesn’t appear to reduce the long-term survival of the kidney, but it can lead to prolonged hospital stays, additional requirement for dialysis therapy and complications shortly after transplantation.

    Under normal circumstances a kidney is preserved by flushing and cooling with preservation solution, and is then stored on ice until ready for transplantation. This conditioning can increase the risk of early graft dysfunction, particularly in DCD donor kidneys.

    We have developed a new technique of kidney preservation that involves warming the kidney with a blood-based solution for a short period just prior to transplantation. This is called ex-vivo normothermic perfusion (EVNP).

    Restoring circulation and providing the kidney with oxygen in a protective environment can improve the condition of the kidney, enabling it to function better after transplantation.

    Approximately 400 patients who are waiting for a kidney transplant will be recruited into the study. Only kidneys from DCD donors will be included in the trial. They will be randomly allocated to one of two groups: the kidney will either undergo the standard cold storage or EVNP.

    Three centres in the UK will be involved in the study (Cambridge, Guy’s and St Thomas’ and Newcastle). Provided consent is given by the patients, they will remain in the trial for 12 months.

    We will be approaching eligible patients to take part in this study.

    For more information, please contact the principal investigator of this study Chris Callaghan.

  • Understanding barriers and outcomes of unspecified kidney donation

    The waiting list for a kidney transplant in the UK includes over 7,000 people and is increasing.

    The best available treatment for kidney failure is a kidney transplant from a living donor. The donor is usually a friend or relative.

    In 2006 donation to a stranger (known as unspecified altruistic donation) was introduced in the UK. Since then the number of unspecified altruistic donations has increased year on year. In 2012, 60 transplants used kidneys from unspecified altruistic donors, accounting for around 1 in 20 of all kidney transplants from living donors.

    These donations provide a high quality kidney to patients on the national transplant list and to someone in the paired/pooled scheme who would not otherwise obtain a transplant due to incompatibility with their donor.

    The number of unspecified altruistic donations varies widely across transplant centres. In 2012, three (out of a total of 23) centres accounted for 45% of all unspecified altruistic donations.

    There is considerable variation between centres in the proportion of people making contact who then actually proceed to donate a kidney. Reasons for this variation are unknown but may include resource issues, concerns regarding an individual's motivations, or that the individual may develop physical or psychological issues after donation.

    The aim of this project is to perform a comprehensive assessment of the unspecified altruistic donor programme in the UK:

    • to explore variation between centres
    • to identify barriers and facilitators to donation for those that have expressed a willingness to do so.

    These questions will be addressed by interviews and questionnaires sent to potential or actual unspecified donors in the UK.

    We will be approaching eligible patients to take part in this study.

    For more information, please visit the international standard randomised controlled trials number (ISRCTN) registry website.

Ongoing studies

Read about ongoing studies. Please note we are no longer recruiting volunteers for these trials. Links to any overall study findings will be published here as soon as they are made available.

  • Shared haemodialysis (SHAREHD)

    SHAREHD is a Health Foundation-funded programme that aims to support patients receiving haemodialysis treatment in hospital so that they can be more independent and confident in participating in aspects of their own haemodialysis care.

    There is considerable evidence that greater patient engagement and helping people to manage their own health is associated with better outcomes across a range of medical conditions.

    Across England, 12 dialysis centres plan to extend the learning from local initiatives and the Yorkshire and Humber Shared Haemodialysis Care programme to build a body of evidence that can support a nationwide change towards better patient choice.

    This study is based on the hypothesis that people who undertake haemodialysis at dialysis centres benefit from the opportunity to take a greater role in their own care.

    The study will collect information using questionnaires at regular intervals. These will measure factors including:

    • the number of dialysis related tasks that patients perform for themselves
    • patient activation
    • quality of life
    • symptom scores
    • cognitive function
    • health literacy perception around self-needling
    • health economic indicators.

    For more information, please visit the SHAREHD website.

  • HUMANITY

    This study compared a widely used plastic graft (ePTFE graft) with a new experimental graft developed by Humacyte called the human acellular vessel (HAV).

    The HAV is a 6mm diameter tissue-engineered tube that is surgically implanted in the forearm or upper arm. It can be used for haemodialysis access in patients with end-stage renal disease.

    The HAV is grown from aortic vascular smooth muscle cells (special cells that partially make up normal blood vessels) obtained from an organ donor.

    As the cells grow, they produce proteins, such as collagen, which is a normal component of human blood vessels. When the HAV is fully formed, the cells are removed so the HAV itself does not contain any living cells.

    Early studies suggest that patients’ own cells may move into the HAV so that it becomes more like a natural blood vessel. If that happens the HAV may more closely act like a human blood vessel and possibly reduce complications such as clots and infections which, in turn, may mean that the HAV will continue to work for a longer period of time compared with an ePTFE graft.

    Study subjects were randomised to receive either a HAV or a commercially available ePTFE graft and will be followed up for up to five years post-implantation at routine study visits.

  • Surveying people experiencing young adult kidney failure (SPEAK)

    The surveying people experiencing young adult kidney failure (SPEAK) study is the first national survey of young adults on kidney replacement therapies. It is to investigate the impact of permanent kidney failure of the lives of young people in the UK.

    This study is needed because the outcomes for these young adults are not well known. Young adulthood is an important time. It involves becoming independent in life, completing education, establishing careers and families and taking responsibility for your own healthcare.

    We know that being aged 17-23 dramatically increases the risk of losing a transplant. Even though most kidney patients move to adult services at 18, brain growth and development continues until your mid-20s.

    Healthcare services for young adult kidney patients vary across the UK. The SPEAK study is needed to tell us how we need to change services to completely address all the needs of a young adult kidney patient. It will also give future patients a much clearer idea about the different ways in which having kidney failure affects your life.

    For more information, please visit the UK Renal Registry website.

  • OuTSMART

    Treatment of kidney disease accounts for a significant proportion of NHS spending. Although transplantation is the best treatment for kidney failure, most transplants do not survive for the recipient's natural lifespan, but instead fail after 10-12 years.

    Damage by the immune system, called 'chronic rejection' accounts for 50% of failing transplants. It is now possible to identify patients at risk by screening for 'HLA antibodies' in the blood.

    This study tested a screening and treatment protocol for antibodies in a randomised controlled trial. Those with antibodies were randomised into biomarker-led care (BLC) or standard care (SC) groups.

    In BLC groups, test results were revealed. Recruits had their anti-rejection drugs changed to a regime of prednisone, tacrolimus and MMF, each already licensed for use in transplant recipients. We have evidence that this regime is effective at preventing graft dysfunction and expect this to feed through to improvements in survival.

    Testing will continue every eight months. The primary outcome is kidney failure rates within three years of randomisation in HLA antibody recruits, predicted to be approximately 20% in the SC groups but less than 10% in the BLC groups.

    Secondary outcomes include:

    • rates of deterioration
    • incidences of infection
    • cancers and diabetes
    • an analysis of the role of non-adherence with medication
    • a scientific study to identify new biomarkers associated with outcomes.

    A cost analysis will confirm whether the screening programme and treatment protocol can save money by keeping kidney transplants functioning for longer.

    For more information, please visit the international standard randomised controlled trials number (ISRCTN) registry website.

Take part in a clinical trial

Find out how you can take part in a clinical trial at Guy’s and St Thomas’ and what is involved.