“Assessing the feasibility and acceptability of blood flow sensing technology in kidney transplant surveillance”.

Abstract

Abstract
Introduction
Vascular thrombosis is a disastrous postoperative complication resulting in the loss of 3.5% to 5.7% of all kidney transplants. The use of novel blood flow-sensing technology in the early postoperative period may allow loss of vascular patency or thrombosis to be detected immediately, which is critical in reducing thrombosis-related graft loss. An implantable Doppler probe utilises blood flow sensing technology to provide continuous feedback on blood flow when connected to a vascular anastomosis. This clinical research aimed to assess the theoretical basis and feasibility of an implantable Doppler probe as a blood flow-monitoring device in kidney transplant recipients and to evaluate its usefulness in preventing early graft loss.

Materials and Methods
The Medical Research Council's (MRC) framework for developing and evaluating complex interventions in clinical settings was followed. Step 1. Development, Step 2: Feasibility, Step 3: Evaluation, and Step 4: Implementation. This research comprised an order of studies with different designs that were undertaken to address the above steps (i.e. literature review, retrospective cohort study, instructive case reports in the specialist area, descriptive-analytical cross-sectional study, patient-public involvement consultation (pre-trial), feasibility randomised controlled trial, embedded qualitative study (post-trial), and a systematic review).

Results
Blood flow sensing technology may be used as a beneficial adjunct for graft monitoring after kidney transplants. This preliminary research fills gaps in the evidence and will inform future research. Patient involvement in the study provided valuable insights for developing an intervention that could improve the postoperative care of kidney transplant patients and enhance their overall outcomes and experience.

Conclusion
This research represents a significant effort to expand our understanding of the potential benefits of blood flow sensing technology in kidney transplantation. A pragmatic large-scale randomised controlled trial is warranted to evaluate the effectiveness of implantable Doppler probes in clinical practice.

Implications
Our research has achieved suitable feasibility-level progression criteria and transferability to other transplant centres across the United Kingdom. Moving forward (i.e. Step 3: Evaluation), a pragmatic large-scale controlled study is recommended to evaluate the effectiveness of blood flow sensing technology in clinical settings.

Date of Award	2025
Original language	English
Supervisor	Robert Fern (Director of Studies (First Supervisor)) & Aled Jones (Other Supervisor)