Are two better than one?
|
|
- Kristopher Howard
- 5 years ago
- Views:
Transcription
1 Are two better than one? Disclosures Ryutaro Hirose, MD Professor in Clinical Surgery University of California, San Francisco I have no relevant disclosures related to this presentation The PROBLEM There are 95,116 patients in the US waiting for a kidney transplant (9/20/2018) We performed 19,489 kidney transplants in the US in 2017 (15k DD) 35,000 30,000 25,000 20,000 15,000 10,000 US Organ Transplants 5,980 6,184 5,989 6,610 6,561 6,022 5,866 5,988 5,819 24% Increase 27,630 28,588 21,850 22,101 22,518 22,187 22,967 23,720 24,985 5, deceased donor living donor Source: data reports/national data/ slide from Kevin O Connor CEOT
2 US Deceased Donor Organs Recovered and Discarded BUT the discard rate of kidney is quite high DISCARD RATE ( ) was 19.7% DISCARD RATE Has been CLIMBING We haven t been able to decrease discards! Source: OPTN DSA Dashboard for 2017 slide from Kevin O Connor CEOT 2018 and his personal correspondence with J. Rosendale Dilemma Two is definitely better than none (from the donor supply standpoint) PROBLEMS Wait time for transplant varies across the country Older individuals are not likely to get a Low KDPI kidney Mortality on dialysis is high Some useable kidneys are being discarded The Options Change organ allocation Not list as many patients (another controversy) Promote more organ donation All the potential will be in older donrs Use more of the less than perfect kidneys in an appropriate patient population incentivize this! High KDPI kidneys that are hard to place With high likelihood that they will not be used or transplanted Saving kidneys from the trash can 2
3 Two is better than none (from a candidate standpoint?) Definitely better than staying on dialysis Likely yes for those individuals that have to wait longer to get a better kidney offer KDRI DONOR FACTORS Age Height Weight Ethnicity (African American) Hypertension Diabetes Serum Creatinine HCV + DCD KDPI and age KDPI and graft survival 3
4 MORE BAD NEWS (unfortunately, not FAKE NEWS) NEWS FLASH WE ARE GETTING OLDER!! WE ARE GETTING FATTER!! Kidney Donor Trends Source: Stewart, D. E., Garcia, V. C., Rosendale, J. D., Klassen, D. K., & Carrico, B. J. (2017). Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the US. Transplantation. The Rising Deceased Donor Kidney Discard Rate in the U.S. Long-run increasing trend in median age, BMI, and KDRI among recovered kidney donors. 15 FIGURE 1. Trends in deceased donor kidneys recovered for transplant and the kidney discard rate, 1987 to The percentage of kidneys recovered for transplant but discarded rose from 5.1% in 1988, the first full year available, to 19.2% in 2009 and remained around 18% to 19% through The number of kidneys recovered for transplantation has more than doubled. Historical events potentially related to kidney recovery and discard, such as policy, system, or oversight changes, are annotated for reference. Stewart, Darren; Garcia, Victoria; Rosendale, John; Klassen, David; Carrico, Bob Diagnosing the Decades Long Rise in the Deceased Donor Kidney Discard Rate in the United States. Transplantation 2017; 101(3): kidneys were discarded in
5 Explaining the Kidney Discard Rate Trend ( ) OPTN/SRTR 2016 Annual Data Report: Kidney Rates of kidneys recovered for transplant and not transplanted by KDPI Source: Stewart, D. E., Garcia, V. C., Rosendale, J. D., Klassen, D. K., & Carrico, B. J. (2017). Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the US. Transplantation. 5.7% rise 17 American Journal of Transplantation pages , 2 JAN 2018 DOI: /ajt fig 0035 Kidney Discard Rate: Pre (~5 years) vs. Post KAS (16 months) (p<0.0001) Why use two suboptimal kidneys? (p=0.55) (p=0.08) The use of ECD/high KDPI kidneys are associated with higher risk of graft failure Currently 20% of kidneys that are procured are DISCARDED and 59% of kidneys with KDPI >85% are DISCARDED After age 40, GFR, kidney mass begin to decrease with time, and reach 60% of baseline by 80 years of age Histology of renal senescence Intimal arterial thickening Arteriolar hyalinosis Interstitial Fibrosis/Tubular Atrophy Glomerular sclerosis Statistically significant rise for higher KDPI kidneys. 5
6 What is the Controversy About Dual Transplants? PRO Potential shorter wait time to transplant for appropriate recipients With appropriate selection of organs, outcomes are acceptable CON Kidney quality not the same as SCD I don t want the patient to get a bad kidney Inconsistent allocation criteria of dual organs UNOS Policy In areas where the wait time is long, death is more likely while waiting for a kidney on dialysis Concern about and adverse effect on SRTR data Longer and more complicated surgery Using up two kidneys for one recipient How to use high KDPI kidneys Reduction of cold ischemic time can improve graft outcome Reduction of CNI exposure Belatacept CNI sparing protocols in patients receiving ECD kidneys had better long term renal function DUAL KIDNEY TRANSPLANTS to increase nephron mass Outcomes of Dual Kidney transplant difficult to tease out Data is generally single center experience N is small Heterogeneity of donors (dual vs single), BUT Dual kidney recipients of donors with highest KDPI (e.g. >90) had a significantly higher 3 year graft survival rate 6
7 How to make decision single vs dual kidney? Biopsy? Has never been shown to correlate with any outcome Histologic scores egfr? Some use egfr <65 cc/min to allocate as duals KDPI? Dual Kidney Outcomes OPTN data Deceased donors > 50 yrs Practical decision? OPO inability to place as single kidney Gill, J. Transplantation 2008;86 Which recipients should be considered to receive a dual kidney transplant? Age: Generally > age 50 yrs Consider a younger age for diabetics Size matters Consider nephron dose Weight or BMI match Anticipated wait time for transplant Consider the cardiovascular health of the recipient Those not well suited for dual kidneys Obese Prior pelvic surgery Higher cardiovascular risk Unable to tolerate induction with lymphocyte depleting agents UCSF recent experience dual kidney txp age Tx date Donor 6 mo Cr 1 yr Cr 2 yr Cr Last Cr Notes /28/13 ECD 0.91 Expired 2 yrs post /1/15 Type 1 DM DKA /17/17 HCV + KDPI 53% /26/ Reexp bleeding /30/17 KDPI 56%, CMV DCD /5/17 KDPI 93% Ureteral revision /7/17 KDPI 99% /2/18 KDPI 90% PGS /29/18 KDPI 97% 0.98 CF /29/18 KDPI 98%
8 Death Censored Graft Survival UNOS Data Tanriiover AJT 2014 Feb 1492) Massie, Transplantation 2014;14 Complications with Dual Transplant What are the barriers? Concerns that the recipient could get a better kidney Concerns about SRTR data being underperforming center Lack of ability to have timely biopsy for review Prolonged cold ischemia times Remuzzi NEJM
9 Regulatory Consideration Tension Between Transplant Center and OPO Performance Metrics Transplant Outcomes Better Patient and Graft survival at 1 and 3 years Organ Utilization Higher Conversion rates Organ Placement Slide Worse adapted from Kevin O Conner, Lower CEOT 2018 Massie. Transplantation 2014 Summary Questions? There are patients who would benefit from Dual Kidney Transplant There are kidneys we could be using as dual kidney transplant that we are currently discarding Need a way to allocate these kidneys to patients who will benefit the most How to abrogate the concern about impact on outcomes actually outcomes have been excellent! 9
FAIRNESS/EQUITY UTILITY/EFFICACY EFFICIENCY. The new kidney allocation system (KAS) what has it done? 9/26/2018. Disclosures
The new kidney allocation system (KAS) what has it done? Disclosures No financial disclosure Ryutaro Hirose, MD Professor in Clinical Surgery University of California San Francisco Objectives Describe
More informationScores in kidney transplantation: How can we use them?
Scores in kidney transplantation: How can we use them? Actualités Néphrologiques 2017 M Hazzan (Lille France ) Contents Scores to estimate the quality of the graft Scores to estimate old candidates to
More informationThe New Kidney Allocation System: What You Need to Know. Anup Patel, MD Clinical Director Renal and Pancreas Transplant Division Barnabas Health
The New Kidney Allocation System: What You Need to Know Anup Patel, MD Clinical Director Renal and Pancreas Transplant Division Barnabas Health ~6% of patients die each year on the deceased donor waiting
More informationThe New Kidney Allocation System (KAS) Frequently Asked Questions
The New Kidney Allocation System (KAS) Frequently Asked Questions Contents General: The Need for the New System and Key Implementation Details... 4 Why was the newly revised KAS necessary?... 4 What were
More informationThe Kidney Allocation System Changed in a Substantive Way on December 5, Your Patients Have Been, and Will Be, Affected by These Changes
The Kidney Allocation System Changed in a Substantive Way on December 5, 2014 Your Patients Have Been, and Will Be, Affected by These Changes 1 The New Kidney Allocation System Terms of Importance Pediatric
More informationDonor Quality Assessment
Donor Quality Assessment Francesc Moreso, MD, PhD Renal Transplant Unit Hospital Universitari Vall d Hebron Barcelona. Spain 4/9/2017 Donor Quality Assessment 1 What is the problem? Across all age ranges,
More informationThe New Kidney Allocation Policy: Implications for Your Patients and Your Practice
The New Kidney Allocation Policy: Implications for Your Patients and Your Practice Clinical Practice Today CME Co-provided by Learning Objectives Upon completion, participants should be able to: Explain
More informationInsert your talk title here
Insert your talk title here Insert your name, title, and institution here Disclosures I have no financial relationships to disclose relevant to my presentation AND My presentation does not include discussion
More informationRenal Transplantation: Allocation challenges and changes. Renal Transplantation. The Numbers 1/13/2014
Renal Transplantation: Allocation challenges and changes Mark R. Wakefield, M.D., F.A.C.S. Associate Professor of Surgery/Urology Director Renal Transplantation Renal Transplantation Objectives: Understand
More informationUpdate on Kidney Allocation
Update on Kidney Allocation 23rd Annual Conference Association for Multicultural Affairs in Transplantation Silas P. Norman, M.D., M.P.H. Associate Professor Division of Nephrology September 23, 2015 Disclosures
More informationEmbracing the Magic: Increasing Organ Acceptance Rates Through Data Review and Risk Stratification
Embracing the Magic: Increasing Organ Acceptance Rates Through Data Review and Risk Stratification Presented by: Sandy Felty, RN, MSN, MHA Lynette Martin del Campo, RN, MSN, FNP-C Sharon Norfles, RN, BSN
More informationThree Sides to Allocation. ECD Extended Criteria Donor
Kidney Allocation- Optimal Use of Deceased Donors The New US System..and impact on wait list management Three Sides to Allocation Justice Peter G Stock MD, PhD Utility Efficiency Standard Criteria Donor
More informationTransplant Update New Kidney Allocation System Transplant Referral Strategies. Antonia Harford, MD University of New Mexico
Transplant Update New Kidney Allocation System Transplant Referral Strategies Antonia Harford, MD University of New Mexico Financial Disclosures Doctor Harford has received financial support for dialysis
More informationThe New Kidney Allocation System: What You Need to Know. Quality Insights Renal Network 3 Annual Meeting October 2, 2014
The New Kidney Allocation System: What You Need to Know Quality Insights Renal Network 3 Annual Meeting October 2, 2014 Pre Dialysis Era Dialysis Status in USA 500,000 patients on dialysis in 2013 100,000
More informationKidney Allocation- Will it ever be fair? Peter G Stock MD, PhD UCSF Department of Surgery. Would you accept this offer?
Kidney Allocation- Will it ever be fair? Peter G Stock MD, PhD UCSF Department of Surgery Question 1: A 19 y/o deceased donor kidney (O mismatch) from NYC is allocated to a 72 y/o highly sensitized caucasian
More informationInterventions in the Deceased Organ Donor to Improve Organ Quality and Quantity
Interventions in the Deceased Organ Donor to Improve Organ Quality and Quantity Sandy Feng, MD PhD Professor of Surgery University of California San Francisco Conflict of Interest Disclosure I have no
More informationKidney Transplant Outcomes In Elderly Patients. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Kidney Transplant Outcomes In Elderly Patients Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case Discussion 70 year old Asian male, neuropsychiatrist, works full
More informationQuestions and Answers for Transplant Candidates about the Kidney Allocation System
TA L K I N G A B O U T T R A N S P L A N TAT I O N Questions and Answers for Transplant Candidates about the Kidney Allocation System United Network for Organ Sharing (UNOS) is a non-profit charitable
More informationUser Guide. A. Program Summary B. Waiting List Information C. Transplant Information
User Guide This report contains a wide range of useful information about the kidney transplant program at (FLMR). The report has three main sections: A. Program Summary B. Waiting List Information The
More informationOPTN/SRTR 2016 Annual Data Report: Preface
OPTN/SRTR 2016 Annual Data Report: Preface This Annual Data Report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) is the twenty-sixth
More informationTransplant Program Performance Measures Review Outcome Measures Work Group Update. Membership and Professional Standards Committee December 2015
Transplant Program Performance Measures Review Outcome Measures Work Group Update Membership and Professional Standards Committee December 2015 Collaboration MPSC Work Group David Cronin, Chair David Axelrod
More informationDeveloping a Kidney Waiting List Calculator
Developing a Kidney Waiting List Calculator Jon J. Snyder, PhD* Nicholas Salkowski, PhD, Jiannong Liu, PhD, Kenneth Lamb, PhD, Bryn Thompson, MPH, Ajay Israni, MD, MS, and Bertram Kasiske, MD, FACP *Presenter
More informationKIDNEY TRANSPLANTATION: THE BIG PICTURE
KIDNEY TRANSPLANTATION: THE BIG PICTURE Alden Doyle, MD, MS, MPH Aim To provide practical overview of the how kidney transplantation works and why it is an attractive option for patients with advanced
More informationkidney OPTN/SRTR 2012 Annual Data Report:
kidney wait list 18 deceased donation 22 live donation 24 transplant 26 donor-recipient matching 28 outcomes 3 pediatric transplant 33 Medicare data 4 transplant center maps 43 A. J. Matas1,2, J. M. Smith1,3,
More informationOutcomes of Adult Dual Kidney Transplants by KDRI in the United States
American Journal of Transplantation 2013; 13: 2433 2440 Wiley Periodicals Inc. Brief Communication C Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
More informationThe Art and Science of Increasing Authorization to Donation
The Art and Science of Increasing Authorization to Donation OPO Metrics: The Good, The Bad, and The Maybe Charlotte Arrington, MPH Arbor Research Collaborative for Health Alan Leichtman, MD University
More informationCurrent status of kidney and pancreas transplantation in the United States,
American Journal of Transplantation 25; 5 (Part 2): 94 915 Blackwell Munksgaard Blackwell Munksgaard 25 Current status of kidney and pancreas transplantation in the United States, 1994 23 Gabriel M. Danovitch
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationOPTN/SRTR 2015 Annual Data Report: Deceased Organ Donation
OPTN/SRTR 2015 Annual Data Report: Deceased Organ Donation A. K. Israni 1,2,3, D. Zaun 1, C. Bolch 1, J.D. Rosendale 4,5, C. Schaffhausen 3, J. J. Snyder 1,2, and B. L. Kasiske 1,3 1 Scientific Registry
More informationOrgan Procurement and Transplantation Network
OPTN Organ Procurement and Transplantation Network POLICIES This document provides the policy language approved by the OPTN/UNOS Board at its meeting in June 2015 as part of the Operations and Safety Committee
More informationLUNG ALLOCATION SCORE SYSTEM UPDATE
LUNG ALLOCATION SCORE SYSTEM UPDATE Current Lung Allocation System System was implemented on May 4, 25 The Lung Allocation Score (LAS) is based on a combination of Expected survival in next year without
More informationU.S. changes in Kidney Allocation
U.S. changes in Kidney Allocation Match kidneys with longest survival to patients with longest survival No parallel matching for kidneys with lower survival potential Decrease discard of kidneys with lower
More informationTransplant Options for Patients: Choices and Consequences. Olwyn Johnston Medical Director Kidney Transplantation Vancouver General Hospital
Transplant Options for Patients: Choices and Consequences Olwyn Johnston Medical Director Kidney Transplantation Vancouver General Hospital BC Kidney Days October 6 th 2017 Non contributory Conflict of
More informationClinical Questions of Combined Liver Kidney Transplantation
Clinical Questions of Combined Liver Kidney Transplantation Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Methodist University Hospital, Transplant Institute Division of Transplantation,
More informationTA L K I N G A B O U T T R A N S P L A N TAT I O N
TA L K I N G A B O U T T R A N S P L A N TAT I O N Frequently Asked Questions about Kidney Transplant Evaluation and Listing If your kidneys have stopped working properly, or may stop working soon, you
More informationPerverse Incentive System How Regulations and Perceptions are: - Costing Lives - Wasting Dollars - Dishonoring the Gift of Donation
Perverse Incentive System How Regulations and Perceptions are: - Costing Lives - Wasting Dollars - Dishonoring the Gift of Donation J. Kevin Cmunt, President and CEO, Gift of Hope Organ & Tissue Donor
More informationCase 1 AND. Treatment of HCV: Pre- vs Post- Transplant. 58 yo male, ESRD/diabetic nephropathy, HD for 3 weeks
Treatment of HCV: Pre- vs Post- Transplant Roy D. Bloom MD Professor of Medicine University of Pennsylvania Roy D. Bloom MD Professor of Medicine Medical Director, Kidney Transplant Program University
More informationFor more information about how to cite these materials visit
Author(s): Silas P. Norman, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Noncommercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
More informationPediatric Kidney Transplantation
Pediatric Kidney Transplantation Vikas Dharnidharka, MD, MPH Associate Professor Division of Pediatric Nephrology Conflict of Interest Disclosure Vikas Dharnidharka, MD, MPH Employer: University of Florida
More informationInfluence of kidney offer acceptance behavior on metrics of allocation efficiency
Accepted: 11 July 2017 DOI: 10.1111/ctr.13057 ORIGINAL ARTICLE Influence of kidney offer acceptance behavior on metrics of allocation efficiency Andrew Wey 1 Nicholas Salkowski 1 Bertram L. Kasiske 1,2
More informationSimultaneous Pancreas Kidney Transplantation:
Simultaneous Pancreas Kidney Transplantation: What is the added advantage, and for whom? Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney
More informationAnswers to Your Questions about a Change in Kidney Allocation Policy What you need to know
Answers to Your Questions about a Change in Kidney Allocation Policy What you need to know Who are UNOS and the OPTN? The United Network for Organ Sharing (UNOS) is a nonprofit organization that operates
More informationKeeping your options open. Transplant In Center Hemodialysis Home Hemodialysis Peritoneal dialysis No dialysis
Keeping your options open Transplant In Center Hemodialysis Home Hemodialysis Peritoneal dialysis No dialysis Survival With/Without Transplant % of Transplants 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Recipient
More informationRenal Transplant Past Present and Future David Landsberg
2012 Renal Transplant Past Present and Future David Landsberg Outline Changing pattern of Donors Types of Donors Allocation Results Challenges in the Elderly LDPE Transplants By Year LD LRD LUD NDAD DD
More informationCKD in Other Organ Transplants
CKD in Other Organ Transplants Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of Colorado
More informationKidney and Pancreas Transplantation in the United States, : Access for Patients with Diabetes and End-Stage Renal Disease
American Journal of Transplantation 29; 9 (Part 2): 894 96 Wiley Periodicals Inc. No claim to original US government works Journal compilation C 29 The American Society of Transplantation and the American
More informationConcepts for Kidney Allocation
ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK Concepts for Kidney Allocation The Organ Procurement and Transplantation Network (OPTN) is seeking feedback regarding the use of two concepts in the allocation
More informationQuantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
More informationLiterature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
More informationProgress in Pediatric Kidney Transplantation
Send Orders for Reprints to reprints@benthamscience.net The Open Urology & Nephrology Journal, 214, 7, (Suppl 2: M2) 115-122 115 Progress in Pediatric Kidney Transplantation Jodi M. Smith *,1 and Vikas
More informationDeterminants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion
American Journal of Transplantation 2008; 8: 783 792 Blackwell Munksgaard C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant Surgeons
More informationPatient Name: MRN: DOB: Treatment Location:
Page 1 of 5 I. TO (Required) This Section is required to be completed by all patients who undergo kidney transplant surgery. I hereby consent to and authorize Dr. and his/her assistant(s), including supervised
More informationNational Transplant Guidelines
National Transplant Guidelines Quo Vadis? Scott Campbell, Princess Alexandra Hospital, Brisbane. Quo Vadis Whither goest thou? Where the F#$% do we go next? Overview WAITING LIST ELIGIBILITY ALLOCATION
More informationTransplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation
Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation Titte R Srinivas, MD, FAST Medical Director, Kidney and Pancreas Transplant Programs Objectives: Describe trends
More informationKidney Transplant in the Elderly. Robert Santella, M.D., F.A.C.P.
Kidney Transplant in the Elderly! Robert Santella, M.D., F.A.C.P. Incident Rate of ESRD by Age Age 75+ 65-74 From US Renal Data System, 2012 Should there be an age limit? Various guidelines: Canadian,
More informationLIVE KIDNEY DONOR RISK PREDICTION ; NEW PARADIGM, NEW CALCULATORS PEDRAM AHMADPOOR MD
LIVE KIDNEY DONOR RISK PREDICTION ; NEW PARADIGM, NEW CALCULATORS PEDRAM AHMADPOOR MD Outline: PART 1 : Update on safety of nephrectomy for living donor candidate PART 2 : Latest guideline recommendation
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationRecords. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information.
Records Adult Kidney Pancreas Transplant Recipient Registration Worksheet FORM APPROVED: O.M.B. NO. 0915 0157 Expiration Date: 07/31/2020 Note: These worksheets are provided to function as a guide to what
More informationKidney and Pancreas Transplantation in the United States,
American Journal of Transplantation 2006; 6 (Part 2): 1153 1169 Blackwell Munksgaard No claim to original US government works Journal compilation C 2006 The American Society of Transplantation and the
More informationFuture Approaches to Organ Donor Intervention Research Study Design. Bertram Kasiske, MD Project Director, SRTR December 14, 2016
Future Approaches to Organ Donor Intervention Research Study Design Bertram Kasiske, MD Project Director, SRTR December 14, 2016 Disclosures and Disclaimers I have no conflicts pertinent to this topic.
More informationBiological Basis for Increased Risk of Graft Loss in African American (AA)-APOL1 and Beyond
Biological Basis for Increased Risk of Graft Loss in African American (AA)-APOL1 and Beyond Jonah Odim, MBA, MD, PhD Chief, Clinical Transplantation Division of Allergy, Immunology, and Transplantation
More informationHealthcare Disparities and Need for Transplant in our Multicultural Communities
Healthcare Disparities and Need for Transplant in our Multicultural Communities AMAT 20 th Annual Meeting September 19, 2012 Anil S. Paramesh, MD, FACS Associate Professor of Surgery and Urology Tulane
More informationWelcome to Your DSA Action Team Meeting. February 29, 2012
Welcome to Your DSA Action Team Meeting February 29, 2012 Who s on the Call? Questions??? Use the Q & A panel displayed on your screen Type your question in at the very bottom portion of the Q & A panel.
More informationThe Good, The Bad, The Needs: Current Prediction Methods Used in Program Specific Reports
The Good, The Bad, The Needs: Current Prediction Methods Used in Program Specific Reports Ajay K Israni, MD, MS Deputy Director, Scientific Registry of Transplant Recipients Associate Professor of Medicine,
More informationAccess and Outcomes Among Minority Transplant Patients, , with a Focus on Determinants of Kidney Graft Survival
American Journal of Transplantation 2010; 10 (Part 2): 1090 1107 Wiley Periodicals Inc. Special Feature No claim to original US government works Journal compilation C 2010 The American Society of Transplantation
More informationNew National Allocation Policy for Deceased Donor Kidneys in the United States and Possible Effect on Patient Outcomes
New National Allocation Policy for Deceased Donor Kidneys in the United States and Possible Effect on Patient Outcomes Ajay K. Israni,* Nicholas Salkowski,* Sally Gustafson,* Jon J. Snyder,* John J. Friedewald,
More informationThanks to our Speakers!
Thanks to our Speakers! Fizza Naqvi, MD Assistant Professor at the Department of Medicine (Nephrology), Johns Hopkins Attending physician at Johns Hopkins hospital. Involved with kidney recipient evaluation
More informationDoes Kidney Donor Risk Index implementation lead to the transplantation of more and higher-quality donor kidneys?
Nephrol Dial Transplant (2017) 32: 1934 1938 doi: 10.1093/ndt/gfx257 Advance Access publication 21 August 2017 Does Kidney Donor Risk Index implementation lead to the transplantation of more and higher-quality
More informationJadranka Buturović-Ponikvar Department of Nephrology, University Medical Center, Ljubljana, Slovenia
Jadranka Buturović-Ponikvar Department of Nephrology, University Medical Center, Ljubljana, Slovenia Hemodialysis or kidney transplantation what is better? Jadranka Buturović-Ponikvar Department of Nephrology,
More informationImproving Allocation of En Bloc Kidneys
Public Comment Proposal Improving Allocation of En Bloc Kidneys OPTN/UNOS Kidney Transplantation Committee Prepared by: Kimberly Uccellini, MS, MPH UNOS Policy Department Contents Executive Summary 1 Is
More informationWho will not benefit from a kidney transplant. Deirdre Sawinski, MD University of Pennsylvania
Who will not benefit from a kidney transplant Deirdre Sawinski, MD University of Pennsylvania Disclosures No financial disclosures relevant to this presentation. I am a transplant nephrologist and I believe
More informationThe Regulatory Alphabet: CMS, OPTN, HRSA, SRTR, UNOS And Monitoring of Transplant Outcomes
The Regulatory Alphabet: CMS, OPTN, HRSA, SRTR, UNOS And Monitoring of Transplant Outcomes John Paul Roberts M.D. University of California San Francisco NONE Disclosures Outcome Monitoring Outcome monitoring
More informationSimultaneous Liver Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources
American Journal of Transplantation 2016; 16: 758 766 Wiley Periodicals Inc. Special Article Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
More informationChapter 7. Australian Waiting List. ANZDATA Registry 39th Annual Report. Data to 31-Dec-2015
Chapter 7 Australian Waiting List 216 ANZDATA Registry 39th Annual Report Data to 31-Dec-215 Stock and Flow The waiting list data reported here are derived from the Australian National Organ Matching System
More informationAnne Barkman. The University of Kansas School of Nursing
Expanding Donor Criteria: Is it Safe? Anne Barkman The University of Kansas School of Nursing About the author: Anne Barkman is from Leawood, Kansas. She was an academic honor roll recipient for Fall 2010,
More informationNew Zealand Kidney Allocation Scheme
New Zealand Kidney Allocation Scheme The New Zealand Kidney Allocation Scheme (NZKAS) has been developed to ensure that kidney allocation in NZ is performed on an equitable, accountable and transparent
More informationWhy are Donated Kidneys Rejected While the Transplant Waiting List is Long and Growing?
Why are Donated Kidneys Rejected While the Transplant Waiting List is Long and Growing? Kurt E. Schnier φ School of Social Sciences, Humanities and Arts University of California, Merced kschnier@ucmerced.edu
More informationOPTN/SRTR 2014 ANNUAL DATA REPORT
OPTN/SRTR 14 ANNUAL DATA REPORT KIDNEY A Hart 1, J M Smith 2,3, M A Skeans 3, S K Gustafson 3, D E Stewart 4,5, W S Cherikh 4,5, J L Wainright 4,5, G Boyle 4,5, J J Snyder 3,6, B L Kasiske 1,3, A K Israni
More informationOrgan Transplantation Program Update
Organ Transplantation Program Update March 7, 2013 Christopher J. McLaughlin Chief, Organ Transplantation Branch Division of Transplantation Department of Health and Human Services Health Resources and
More informationDisparities in Liver Transplant Allocation: An Update on MELD Allocation System
Disparities in Liver Transplant Allocation: An Update on MELD Allocation System Naudia L. Jonassaint, MD MHS Assistant Professor of Medicine and Surgery University of Pittsburgh School of Medicine Historical
More informationFinal Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List
OPTN/UNOS Minority Affairs Committee Descriptive Data Request Final Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List Prepared for: Minority Affairs Committee Meeting
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationUniversity of Pittsburgh Critical Care Medicine
University of Pittsburgh Critical Care Medicine www.ccm.pitt.edu Intensivist-led Donor Care in the Intensive Care Unit Raghavan Murugan MD, MS, FRCP Assistant Professor Dept. of Critical Care Medicine
More informationKIDNEY ALLOCATION SYSTEM (KAS) OUT-OF-THE-GATE MONITORING. Report #3: January 13, 2015
KIDNEY ALLOCATION SYSTEM (KAS) OUT-OF-THE-GATE MONITORING Report #3: January 13, 2015 Purpose: Provide an early look at high-level metrics revealing performance of the system, and detect unanticipated
More informationHeart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017
Heart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017 Randall C Starling MD MPH FACC FAHA FESC FHFSA Professor of Medicine Kaufman Center for Heart Failure Department of Cardiovascular
More informationKIDNEY & PANCREAS TRANSPLANT OUTCOMES 2018
KIDNEY & PANCREAS TRANSPLANT OUTCOMES 201 Vanderbilt Transplant Center James George, kidney transplant patient A HISTORY OF EXCELLENCE anderbilt s transplant services have a long history of excellence.
More informationCandidates about. Lung Allocation Policy. for Transplant. Questions & A n s we r s TA L K I N G A B O U T T R A N S P L A N TAT I O N
TA L K I N G A B O U T T R A N S P L A N TAT I O N Questions & A n s we r s for Transplant Candidates about Lung Allocation Policy U N I T E D N E T W O R K F O R O R G A N S H A R I N G What are the OPTN
More informationASTS TRANSQIP Beta Phase Informational Webinar
ASTS TRANSQIP Beta Phase Informational Webinar December 2, 2016 Ryutaro Hirose, MD Stuart Greenstein, MD TransQIP A collaborative effort between ASTS and the American College of Surgeons A National Transplant
More informationHasan Fattah 3/19/2013
Hasan Fattah 3/19/2013 AASK trial Rational: HTN is a leading cause of (ESRD) in the US, with no known treatment to prevent progressive declines leading to ESRD. Objective: To compare the effects of 2 levels
More informationINVITED REVIEW. Zero-time renal transplant biopsies: a comprehensive review. Maarten Naesens 1,2. Leuven, Belgium, EU. Corresponding author:
INVITED REVIEW Zero-time renal transplant biopsies: a comprehensive review Maarten Naesens 1,2 1 KU Leuven - University of Leuven, Department of Microbiology and Immunology, B-3000 Leuven, Belgium, EU
More informationDisclosures. Normothermic Machine Liver Perfusion
Disclosures Normothermic Machine Liver Perfusion I have nothing to disclose Garrett R. Roll, MD Assistant Professor of Surgery Overview Define normothermic machine liver perfusion (NMLP) Show device examples
More informationAnalyze That: Ongoing Policy Efforts for Deceased Donor Intervention
Analyze That: Ongoing Policy Efforts for Deceased Donor Intervention SANDY FENG, MD, PHD PROFESSOR OF SURGERY UNIVERSITY OF CALIFORNIA SAN FRANCISCO ASTS WINTER SYMPOSIUM MIAMI BEACH, FL JANUARY 28, 2017
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Niemann CU, Feiner J, Swain S, et al. Therapeutic hypothermia
More informationOPTN/UNOS Policy and Bylaw Proposals Distributed for Public Comment September 21, 2012
OPTN/UNOS Policy and Bylaw Proposals Distributed for Public Comment September 21, 2012 This document contains six proposals being offered for public comment. These proposals were developed by OPTN/UNOS
More informationGeographic Differences in Event Rates by Model for End-Stage Liver Disease Score
American Journal of Transplantation 2006; 6: 2470 2475 Blackwell Munksgaard C 2006 The Authors Journal compilation C 2006 The American Society of Transplantation and the American Society of Transplant
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationMarch 25, ASTS Responses to OPTN Policy Proposals. 1. Improving Post transplant Communications of New Donor Information
March 25, 2016 ASTS Responses to OPTN Policy Proposals 1. Improving Post transplant Communications of New Donor Information ASTS is very supportive of the effort to minimize data reporting that conveys
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Assessment of donors with sub-optimal kidney function/structure GUIDELINES
Assessment of donors with sub-optimal kidney function/structure Date written: June 2004 Final submission: April 2005 GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR
More information2017 UNOS Liver Distribution Proposal Discussion: David Goldberg
2017 UNOS Liver Distribution Proposal Discussion: David Goldberg Who am I? Transplant hepatologist at the University of Pennsylvania Medical Director of Living Donor Liver Transplant NIH-funded epidemiologist
More informationHome Hemodialysis or Transplantation of the Treatment of Choice for Elderly?
Home Hemodialysis or Transplantation of the Treatment of Choice for Elderly? Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University
More information