The environmental impact of changing to virtual renal transplant aftercare: 2-year experience with a single outpatient clinic

Climate change is the greatest global health threat of the 21st century.1 Healthcare provision is a significant contributor and accounts for 4–5% of the UK carbon footprint.2 Vanholder et al. suggested that nephrology working practices should be altered to reduce the impact on climate change.3 Current UK guidance suggests that uncomplicated renal transplant patients should be monitored 3–6 monthly.4 Royal Preston Hospital is a tertiary renal centre in North West England that looks after approximately 900 patients with a functioning transplant from a large geographical area in Lancashire and South Cumbria (Fig. 1). Traditionally, all consultant-delivered transplant aftercare in our centre was provided through face-to-face appointments mostly at the hub in Preston while nurse-led appointments were all carried out via telephone. As a result, many patients regularly travelled large distances to attend their follow up appointments, almost exclusively in fossil-fuel powered cars with significant environmental impact. However, because of the Coronavirus disease 2019 (COVID-19) pandemic, many of these appointments are now delivered virtually. We were interested to study how this development affects the environmental footprint of our transplant aftercare, compare the effect to other interventions in the field of climate change, and study financial and time savings to our patients.

Fig. 1. Geographical footprint of our catchment area of our renal centre in the North West of England, United Kingdom (approximation). The catchment population is around 1.5 million across some urban conurbations and rural areas. The maximum distance one of our patients could travel by car from the Northernmost point in our region to the renal hub in Preston is around 2 h (Google Maps™).