New Ways to Tackle a Growing Health Care Dilemma - ESRD
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1 New Ways to Tackle a Growing Health Care Dilemma - ESRD J. Keith Melancon, M.D., F.A.C.S. George Washington University Professor of Surgery Chief, Transplant Surgery and Transplant Institute
2 Thanks to our speaker! Dr. Keith Melancon Director of the George Washington Transplant Institute Professor of surgery & the medical director of the Ron and Joy Paul Kidney Center Internationally renowned expert in paired kidney exchanges, ABO incompatible kidney transplantation, pancreas transplantation, and immunologic desensitization for organ transplants On four occasions set the world s record for largest paired kidney exchange
3 Nietzsche The Birth of Tragedy Apollo Dionysis
4 Why ESRD? Diabetes Hypertension Obesity Increased rates in minority population
5 Obesity
6 Hypertension
7 Diabetes
8 Where is ESRD?
9 Who is ESRD?
10 Addressing Disparities
11 Community Outreach
12 Community Health Delivery Models
13 CKD Increasing
14 Incidence ESRD
15 Cost of ESRD
16 Cost of ESRD vs Transplant
17 Outcomes for first-time wait-listed patients three years after listing in 2008, by age, race, & PRA Figure 7.5 (Volume 2) Patients age 18 & older listed for a first-time, kidney-only transplant in 2008; transplanted patients may have subsequent outcomes in the three-year follow-up period.
18 Survival Difference: Transplant vs. Dialysis
19 Number of Kidney Transplants
20 Incidence of ESRD by Race
21 Graft Survival by Race
22 Apol1 in Black Patients Nejm raj 2013
23 African Ethnicities
24 Middle Passage
25 Current Issues in Kidney Transplantation Access Graft survival Sensitization Increasing organ numbers (DD and LD)
26 Addressing Kidney Transplant Issues Access outreach, education Sensitization- PKE (paired kidney exchange), desensitization Graft survival- novel immunosuppressive protocols, tolerance Donors sign up potential donors, educate potential living donors
27 Paired Kidney Exchange
28 Desensitization
29 Addressing Crisis Increasing Organ Availability DCD/ECD organs Increasing living donation/ Altruistic donation ABO incompatible transplantation Desensitization protocols Paired kidney exchanges
30 ABO Incompatible Transplantation Must know and reduce ABO titer incompatibility (Antibody therapy, plasma exchange) Oftentimes better option than sensitized transplantation and timing better than PKE
31 Desensitization Protocols Must have luminex single bead technologies to isolate Antibody specificities and then tract titers during reduction therapy (Antibody therapy, plasma exchange, immunoglobulin therapy) Best fitted for living donor transplantation
32 Paired Kidney Exchanges Utilize computerized matching algorithms to optimize organ utilization schemes in local, regional, and national organ exchanges Can be combined with ABO incompatible transplant and desensitization Domino exchanges can be fashioned to multiply successes
33 Disparities
34 Paired Kidney Exchanges
35 Results
36 Results
37 PKE (Paired Kidney Exchange)
38 The Bonds that Tie
39 Paired Exchanges
40 World s Largest Kidney Exchange
41 Questions?
42 Join us for next month s webinar! Unique Strategies for Improving the Effectiveness of Exercise Training in Patients with Kidney Failure Tuesday, January p.m. (ET) Dr. Ken Wilund Associate Professor in the Department of Kinesiology and Community Health and Division of Nutritional Sciences at the University of Illinois at Urbana-Champaign Join us to learn about: Research regarding exercise in hemodialysis and transplant patients (What has worked, and what has not) Strategies for improving outcomes from exercise training interventions (How much and what type of exercise is recommended) Strategies for improving patient compliance with exercise and physical activity programs Go to to learn more and register!
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