Overview. Evaluation of Potential Kidney Transplant Recipients. Projected Years of Life in Patients with ESRD
|
|
- Duane Quinn
- 6 years ago
- Views:
Transcription
1 Evaluation of Potential Kidney Transplant Recipients Donald E. Hricik MD Professor of Medicine and Chief, Division of Nephrology and Hypertension University Hospitals Case Medical Center Conflict of Interest Disclosure Donald E. Hricik, MD Employer: University Hospitals Case Medical Center Research Funding: Astellas Honoraria: Genentech, Novartis Overview Benefits and risks of kidney transplantation Indications and contraindications Special circumstances Recurrent kidney diseases Hepatitis/HIV Pre-existing malignancy Psychosocial issues High risk or known cardiovascular disease Evaluation Laboratory studies Imaging studies Principles of tissue typing and crossmatching Informed consent for Expanded Criteria Donor kidneys Projected Years of Life in Patients with ESRD Age and Diabetes Status Wait-Listed Transplanted yr, no DM yr, DM yr, no DM yr, DM yr, no DM yr, DM 5 8 Wolfe RA, et al. NEJM 1999; 341:
2 Survival Benefit of Transplantation vs. Waiting on Dialysis Cost Comparison: Maintenance Dialysis vs Transplantation Wolfe RA et al, N Engl J Med 1999; 341:1725 Per Patient Per Year Costs Transplant Versus Dialysis Patients Waiting for A Kidney Transplant 2006 USRDS Annual Report 2005 USRDS Annual Report 2
3 Absolute Contraindications to Transplantation Active infection (HIV no longer an absolute contraindication) Active malignancy Active drug use, alcoholism, or psychosis High potential for noncompliance Anatomy that makes transplantation technically impossible Indications for Transplantation End stage renal disease (stage V CKD), or CKD with GFR < 20 ml/min*, or Significant symptoms of uremia, or Acid-base or electrolyte abnormalities that are unresponsive to medical interventions *required for waitlist activation Allograft Survival: Impact of Donor Source and Waiting Time Relative Contraindications to Kidney Transplantation Cardiovascular disease Coronary, peripheral, cerebrovascular Pulmonary disease Gastrointestinal or hepatic disease Active smoking High (BMI > 35,? 40,? higher) Systemic amyloidosis Psychosocial/financial situation resulting in inability to achieve adequate posttransplant care Advanced age 3
4 Recurrent Diseases SLE quiescent on < 10 mg prednisone for 6 months (?clinical vs serologic quiescence) Anti-GBM disease quiescent with undetectable ant- GBM antibody Vasculitides quiescent for 6 months (controversy about ANCA titers) FSGS 20-30% recurrence rate but much higher with history of recurrence in first allograft; 30% graft loss HUS higher recurrence rate in nondiarrheal form MPGN Recurrences of % in type 2 with high rate of graft loss Recurrent Diseases, continued Primary oxalosis high rate of graft loss from oxalate deposition. A staged or combined liverkidney transplant preferred for Type 1 IgA nephropathy recurrence rate 20-50%; low rates of graft loss Membranous recurrence rate 10%; rare cause of graft loss Diabetic nephropathy 100% recurrence ; rare cause of graft loss Prevalence of Hepatitis in Transplant Candidates Pre-transplant Evaluation and Management of Patients with Hepatitis B or C Hepatology consult Screening for HCC (ultrasound) Liver biopsy consider combined liver transplantation for severe disease Encourage pre-transplant therapy; IFN increases risk of rejection post-transplant Consider hepatitis C positive donor for hepatitis C positive recipients 2004 USRDS Annual Report 4
5 Outcomes of Patients with Hepatitis B or C HIV and Kidney Transplantation Relatively high rates of acute rejection Strong interaction between HAART and immunosuppressants metabolized by CYP450 (CNIs, TOR Inhibitors) Long-term outcomes remarkably good (patients with hepatitis C do less well) NIH consortium performing ongoing studies in kidney and liver transplantation 2004 USRDS Annual Report Outcomes of Patients with HIV 2004 USRDS Annual Report Waiting Times for Preexisting Malignancies Most malignancies require at least a 2-year period of remission At least 5 years required for: Colorectal Dukes B1 or higher Advanced Breast cancer Invasive Cervical cancer Renal Cell Carcinoma > 5 cm or < 5 cm with invasion In situ lesions no wait Non-melanoma skin ca no wait Multiple myeloma contraindicated unless with stem cell transplant MGUS no wait 5
6 Special Procedures for Special Patients Patients with a history of drug or alcohol abuse may require random drug screening before proceeding further Patients with a history of noncompliance may be asked to comply with a compliance contract before proceeding further Cardiac Screening and Evaluation Men > 45 y.o.; women > 50 y.o. All diabetics Patients with history of coronary disease Patients with symptoms of coronary disease Patients with EKG evidence of ischemia Evaluation: Cardiac echo Stress testing with perfusion studies Cardiology consultation and catheterization for patients with a positive stress test Recipient Evaluation Laboratory Evaluation Patient education History and physical examination Social history Family history of medical/kidney disease Medications/allergies History of sensitizing events (blood transfusions, pregnancies prior transplants Colonoscopy > 50 y.o. or > 40 y.o. with family history Pap and pelvic examinations Chemistry BUN, Cr, electrolytes, LFTs, lipid panel Estimated GFR if predialysis Hematology ABO blood type HLA typing Panel reactive antibodies CBC, INR & PTT, Hypercoagulability panel if history of thromboses Serology Hepatitis B (core and surface Ab, surface Ag) CMV, EBV and Varicella antibody titers HIV Hepatitis C Ab screen (PCR to confirm) RPR or VDRL Urinalysis/Urine culture Urine drug screen PPD 6
7 Optional Laboratory Evaluation Urine cytology in patients exposed to cyclophosphamide, or if diagnosed with analgesic nephropathy or Chinese herbal nephropathy PSA men > 50 y.o. or > 45 y.o. if family history Imaging Studies Chest x-ray Mammograms women > 40 y.o. or > 35 y.o. if family history Imaging of aorto-iliac arterial tree (diabetics, age > 50 y.o., diminished pulses, history of PVD) Duplex scanning High resolution CT Optional Ancillary or Supplemental Evaluations Recipient Vaccinations Dental evaluation Social service evaluation Dietary evaluation Ophthalmologic evaluation Financial evaluation Psychiatric evaluation VCUG Peripheral vascular studies Upper endoscopy Pulmonary function tests Vaccinate pre-transplant! Hepatitis B Pneumovax if > 5 years since last dose Varicella if titers negative Tetanus and diptheria booster if > 10 years since last dose? Hepatitis A? HPV? Meningococcus? Hemophilus 7
8 Principles of Tissue Typing and Crossmatching Accurate tissue typing and crossmatching are essential for optimal transplant outcomes ABO Blood Group Typing ABO blood group must be compatible A2 into O and A2 and A2B into B are compatible combinations MHC GENE EXPRESSION The Pretransplant Crossmatch Standard complement dependent crossmatch (CDC, NIH technique) Anti-human globulin enhanced crossmatch Flow cytometry crossmatch (B cell crossmatching) Limited tissue distribution Found on all nucleated cells 8
9 Antiglobulin-Enhanced Technique More sensitive Can detect noncomplement binding antibodies Can detect antibodies present in small amounts Patel and Terasaki, NEJM 280:735,
10 Role of Anti-Human Globulin Enhanced Crossmatch on Two Year Kidney Transplant Outcomes All patients had negative NIH standard crossmatches. Deceased Donor Recipients 1st Transplants Negative NIH Standard Crossmatch All Patients 81% (N = 166) Re-Transplants 64% (N = 70) Anti-Human Globulin Crossmatch Negative Two Year Graft Survival 82% (N = 151) 77% (N = 48) Positive 67% (N = 15) 36% (N = 22) P-Value < 0.01 < 0.01 Kerman et.al. Transplantation. 51:316, 1991 Flow Cytometry Crossmatch Most sensitive of all the crossmatches In some labs, not used if the less sensitive crossmatches are positive Can be used if the don or lymphocytes are dead 10
11 Purpose of Determining if a Patient Is Sensitized Defines high risk status triggers different management Simplifies work in the tissue typing laboratory Determines organ allocation Predicts when a patient might be transplanted Highly sensitized patients wait longer Highly sensitized patients have inferior graft survival rates Expanded Criteria Donor (ECD) 3-Year Graft Survival by Donor Type Deceased donor 60 years of age Deceased donor 50 to 59 years of age with at least two of the following: History of hypertension Terminal SCr >1.5 mg/dl Death from cerebral vascular accident Associated with 70% higher risk of graft failure compared with non-ecd transplants Merion RM et al. JAMA. 2005;294: Port FK et al. Transplantation. 2002;74:1281. OPTN/SRTR 2005 Annual Report OPTN/SRTR 2005 Annual Report 11
12 Survival Benefit of Kidney Transplantation ECD Rules Inform all potential recipients Informed consent required Who should get an ECD kidney?? Ojo et al. J Am Soc Nephrol 2001; 12:
Heart Transplant Family Education Class
Heart Transplant Family Education Class Celebrating 30 years History of Heart Transplantation First successful adult heart transplant in United States- January 6, 1968 First heart transplant at OHSU -
More informationKidney Transplantation
Kidney Transplantation Current Kidney Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr Current Kidney
More informationPATIENT SELECTION FOR DECEASED DONOR KIDNEY ONLY TRANSPLANTATION
PATIENT SELECTION FOR DECEASED DONOR KIDNEY ONLY TRANSPLANTATION This policy has been created by the Kidney Advisory Group on behalf of NHSBT. The policy has been considered and approved by the Organ Donation
More informationOntario s Referral and Listing Criteria for Adult Kidney Transplantation
Ontario s Referral and Listing Criteria for Adult Kidney Transplantation Version 3.0 Trillium Gift of Life Network Adult Kidney Transplantation Referral & Listing Criteria PATIENT REFERRAL CRITERIA: The
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 informationInova Transplant Center
Inova Transplant Center I think I am a great candidate! Out with the old! in with the new! Help us help you! Pretransplant evaluation: goals Determine suitability as candidate Nature of surgery Optimize
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 informationEvaluation Process for Liver Transplant Candidates
Evaluation Process for Liver Transplant Candidates 2 Objectives Identify components of the liver transplant referral to evaluation Describe the role of the liver transplant coordinator Describe selection
More informationOntario s Referral and Listing Criteria for Adult Pancreas-After- Kidney Transplantation
Ontario s Referral and Listing Criteria for Adult Pancreas-After- Kidney Transplantation Version 2.0 Trillium Gift of Life Network Adult Pancreas-After-Kidney Transplantation Referral & Listing Criteria
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 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 informationMEDICAL POLICY SUBJECT: KIDNEY TRANSPLANT
MEDICAL POLICY SUBJECT: KIDNEY TRANSPLANT PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including an
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT. J. H. Helderman,MD,FACP,FAST
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT J. H. Helderman,MD,FACP,FAST Vanderbilt University Medical Center Professor of Medicine, Pathology and Immunology Medical Director, Vanderbilt Transplant
More informationJohns Hopkins Hospital Comprehensive Transplant Center Informed Consent Form for Thoracic Organ Recipient Evaluation
Johns Hopkins Hospital Comprehensive Transplant Center Informed Consent Form for Thoracic Organ Recipient Evaluation The decision to undergo transplantation can be extremely difficult and often confusing.
More informationSeptember 28, 2013 Jennifer Butler, RN, CCTC
How To Get Listed for Kidney Transplant September 28, 2013 Jennifer Butler, RN, CCTC Objectives What kidney failure is 3 major forms of treatment Kidney transplant evaluation Kidney transplant List Functions
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 informationBK Viral Infection and Malignancy in Renal Transplantation ~A Case History~
BK Viral Infection and Malignancy in Renal Transplantation ~A Case History~ Mariko Toyoda, MD Department of Nephrology, Japanese Red Cross Kumamoto Hospital Statement of Disclosure The author does not
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 informationLiving Donor Liver Transplantation NATCO Introductory Course
Living Donor Liver Transplantation NATCO Introductory Course Patricia Harren, RN, ANP, MSN, PNP, CCTC New York Presbyterian Medical Center Center for Liver Disease & Transplant New York, NY Living Donor
More informationThe Evaluation of Kidney Transplant Candidates and Potential Living Donors
The Evaluation of Kidney Transplant Candidates and Potential Living Donors Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case #1 37 yo male, ESRD due to FSGS Living-related
More informationEvaluation of Kidney Transplant Recipients
Evaluation of Kidney Transplant Recipients Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Methodist University Hospital, Transplant Institute Division of Transplantation, Department
More informationSummary of Significant Changes. Policy
This Policy replaces POL185/3 Copy Number Effective 02/08/2016 Summary of Significant Changes Inclusion of Simultaneous Islet and Kidney transplants Policy This policy has been created by the Pancreas
More informationEvaluation Process for Liver Transplant Candidates
Evaluation Process for Liver Transplant Candidates 2 Objectives Identify components of the liver transplant referral to evaluation Describe the role of the liver transplant coordinator Describe selection
More informationChronic Kidney Disease (CKD) Stages. CHRONIC KIDNEY DISEASE Treatment Options. Incident counts & adjusted rates, by primary diagnosis Figure 2.
Chronic Kidney Disease (CKD) Stages Stage 1 GFR > 90 (evidence of renal disease) Stage 2 GFR 60-89 Stage 3 GFR 30-59 Stage 4 GFR 15-29 Stage 5 GFR
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 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 informationPancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP
Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas transplant recipients are usually under age 50. The majority of pancreas transplants are performed on diabetics, who are generally
More informationLiver Transplantation Evaluation: Objectives
Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation
More informationIowa Methodist Medical Center Transplant Center. Informed Consent for Kidney Transplant Recipient
Iowa Methodist Transplant Center Iowa Methodist Medical Center Transplant Center 1215 Pleasant Street, Suite 506 Des Moines, IA 50309 515-241-4044 Phone 515-241-4100 Fax Iowa Methodist Medical Center Transplant
More information2.0 MINIMUM PROCUREMENT STANDARDS FOR AN ORGAN PROCUREMENT ORGANIZATION (OPO)
2.0 MINIMUM PROCUREMENT STANDARDS FOR AN ORGAN PROCUREMENT ORGANIZATION (OPO) In order to maximize the gift of donation and optimize recipient outcomes and safety, the Organ Procurement Organization (OPO)
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 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 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 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 informationHOTA PARAMETERS OF CASE SUBMISSION FOR LIVER TRANSPLANT
HOTA PARAMETERS OF CASE SUBMISSION FOR LIVER TRANSPLANT 1. COMPLETE AND DETAILED INTRODUCTION OF BOTH THE PATIENT AND THE INCLUDING: 1- COMPLETE PRESENT ADDRESS 2- CELL NUMBERS OF THE PATIENT, THE AND
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 informationTRANSPLANTATION IN DIABETIC PATIENTS. A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center
TRANSPLANTATION IN DIABETIC PATIENTS A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center Diabetes is the pandemic of the new millennium 24 million diabetics
More informationProfessor Suetonia Palmer
Professor Suetonia Palmer Department of Medicine Nephrologist Christchurch Hospital Christchurch 14:00-14:55 WS #108: The Kidney Test - When To Test and When to Refer ( and When Not To) 15:05-16:00 WS
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 informationAre two better than one?
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
More informationOntario s Referral and Listing Criteria for Adult Heart Transplantation
Ontario s Referral and Listing Criteria for Adult Heart Transplantation Version 3.0 Trillium Gift of Life Network Adult Heart Transplantation Referral & Listing Criteria PATIENT REFERRAL CRITERIA: The
More informationResults of a Phase 1 Trial of Treg Adoptive Cell Transfer (TRACT) in De Novo Living Donor Kidney Transplant Recipients
Results of a Phase 1 Trial of Treg Adoptive Cell Transfer (TRACT) in De Novo Living Donor Kidney Transplant Recipients A Skaro, A LeFever, J Mathew, L Gallon, J Hie, C Hansen, D Stare, G Johnson, J Leventhal
More informationKidney Transplantation in the Elderly. Kristian Heldal, MD, PhD Telemark Hospital Trust, Skien, Norway and University of Oslo
Kidney Transplantation in the Elderly Kristian Heldal, MD, PhD Telemark Hospital Trust, Skien, Norway and University of Oslo Agenda Background: Age and chronic kidney disease End stage kidney disease:
More informationTransplant Applications of Solid phase Immunoassays Anti HLA antibody testing in solid organ transplantation
AACC Professional Course BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD MEDICAL SCHOOL Transplant Applications of Solid phase Immunoassays Anti HLA antibody testing in solid organ transplantation J. Ryan
More informationObjectives. Kidney Complications With Diabetes. Case 10/21/2015
Objectives Kidney Complications With Diabetes Brian Boerner, MD Diabetes, Endocrinology, and Metabolism University of Nebraska Medical Center Review screening for, and management of, albuminuria Review
More informationWho and When to Refer for a Heart Transplant
Who and When to Refer for a Heart Transplant Dr Jayan Parameshwar Consultant Cardiologist Papworth Hospital BSH 24 th November 2017 BSH Annual Autumn Meeting 2017 Presentation title: Who and when to refer
More informationLiver Transplantation By: Kay R. Brown, CLCP
Liver Transplantation By: Kay R. Brown, CLCP Dr. Jeffrey Crippin, Director of Hepatology at the Baylor Institute of Transplantation in Dallas, Texas outlined during the Transplantation '97 seminar the
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT HISTOPATHOLOGIC DISORDERS AFFECTING THE ALLOGRAFT OTHER THAN REJECTION RECURRENT DISEASE DE NOVO DISEASE TRANSPLANT GLOMERULOPATHY Glomerular Non-glomerular
More informationIHA P4P Measure Manual Measure Year Reporting Year 2018
ADULT PREVENTIVE CARE IHA P4P Measure Manual Measure Year 2017 - Reporting Year 2018 *If line of business not labeled, measure is Commercial only Adult BMI (Medicare) 18-74 Medicare members ages 18-74
More informationAction Item for 2019 Review of Tool. Maintain (add include oral cavity) Maintain. Archive. Archive. 12 creatinine)
NEWLY DIAGNOSED/ NEW TO CARE PROGRAM SITE: REVIEWER(S): REVIEW DATE: CORE SERVICES Outpatient/Ambulatory Health Services Tool - 2018 (OLD) SECTION 1: CHART REVIEW Review for newly diagnosed HIV patients
More informationUEMS & EBS: DIVISION OF TRANSPLANT SURGERY
CURRICULUM AND SYLLABUS TRANSPLANTATION Module 1: Multi-organ retrieval Ability to evaluate donor suitability Ability to retrieve abdominal organs for transplantation Evaluation of donor/ organs suitability
More informationWhy so Sensitive? Desensitizing Protocols for Living Donor Kidney Transplantation
Why so Sensitive? Desensitizing Protocols for Living Donor Kidney Transplantation Stephen J Tomlanovich MD Objectives of this Talk Define the sensitized patient Describe the scope of the problem for a
More informationPatient Education. Transplant Services. For a liver transplant
Patient Education Preparing for Medical Evaluation, Labs & Tests For a liver transplant The evaluation process is complex and is unique to each patient. The Transplant Team will determine whether the real
More informationTransplantation in 2012:
Transplantation in 2012: Optimizing Outcomes through Seamless Communication Kidney, Pancreas and Islet Breakout Session Kidney Transplantation as a Treatment of Choice for ESRD Uday S. Nori, MD Assistant
More informationProposed Scope of Work for KDIGO Clinical Practice Guideline for the Evaluation and Management of Candidates for Kidney Transplantation
Proposed Scope of Work for KDIGO Clinical Practice Guideline for the Evaluation and Management of Candidates for Kidney Transplantation Introduction Transplantation is the renal replacement therapy of
More informationGlossary. Anesthesiologist A doctor who puts you or parts of your body to sleep during surgery.
1-Glossary Glossary Acute rejection A type of rejection that occurs when immune cells from your body attack the transplanted organ(s). Acute rejection may occur at any time after a transplant. But it usually
More informationKidney transplantation 2016: current status and potential challenges
Kidney transplantation 2016: current status and potential challenges 15/12/2016 BVN-SBN : State-of-the-Art on Kidney Transplantation Patrick Peeters Ghent University Hospital, Belgium Challenges in 2016
More informationConsidering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
More informationInformed Consent for Liver Transplant Patients
Informed Consent for Liver Transplant Patients Evaluation Process You will be evaluated with consultations, lab tests and various procedures to determine the medical appropriateness of liver transplant.
More informationJohns Hopkins Hospital Comprehensive Transplant Center Informed Consent Form for Abdominal Organ Recipient Evaluation
Johns Hopkins Hospital Comprehensive Transplant Center Informed Consent Form for Abdominal Organ Recipient Evaluation The decision to undergo transplantation can be extremely difficult and often confusing.
More informationMembranous nephropathy. By Mohammed Kamal Nassar, MD Lecturer of Nephrology Mansoura University
Membranous nephropathy By Mohammed Kamal Nassar, MD Lecturer of Nephrology Mansoura University Membranous nephropathy Definition: Immune complex glomerular disease in which immune deposits of IgG and complement
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 informationDefinitions. You & Your New Transplant ` 38
Definitions Acute Short, relatively severe Analgesic Pain medicine Anemia A low number of red blood cells Anesthetic Medication that dulls sensation in order to reduce pain Acute Tubular Necrosis (ATN)
More informationManagement of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
More informationTransplant in Pediatric Heart Failure
Transplant in Pediatric Heart Failure Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart and Lung Transplantation
More informationSolid Organ Transplant
Solid Organ Transplant Lee R. Goldberg, MD, MPH, FACC Associate Professor of Medicine Medical Director, Heart Failure and CardiacTransplant Program University of Pennsylvania Disclosures Thoratec Consulting
More informationThe Evaluation of Kidney Transplant Candidates and Potential Living Donors
The Evaluation of Kidney Transplant Candidates and Potential Living Donors Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case #1 37 year old male, ESRD due to FSGS
More information2/28/2017. Adult Heart Transplants Donor and Recipient Characteristics UNOS, Retransplant VCM. Other /2015 (N = 24,474)
1 46% 2% 3% 4% 0% 2% 2% CHD HCM ICM NICM RCM 49% 3% 3% 3% 1% 3% 3% Retransplant VCM 42% Other 35% 1/1982 6/2015 1/2009 6/2015 2016 JHLT. 2016 Oct; 35(10): 1149-1205 UNOS, 2017 Adult Heart Transplants Donor
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationUW MEDICINE REGIONAL HEART CENTER HEART TRANSPLANT. Orientation Class at University of Washington Medical Center
UW MEDICINE REGIONAL HEART CENTER HEART TRANSPLANT Orientation Class at University of Washington Medical Center OVERVIEW This slideshow explains: Your Transplant Evaluation Transplant Listing Heart Transplant
More informationRenal Transplant. Tony Chacon. Program Head BCIT Nephrology Nursing Program.
Renal Transplant Tony Chacon Program Head BCIT Nephrology Nursing Program Email: tony_chacon@bcit.ca Summary of CNA Renal Transplant Competencies Potential contraindications to renal transplant. Assessment/selection
More informationExpanded Criteria Recipients: Are there any Limits
Expanded Criteria Recipients: Are there any Limits Andreas Paul, MD, MSc, FRCS Department of General-, Visceral- and Transplant Surgery, University Hospital Essen Ruhr Area 5.200 000 inhabitants University
More informationCancer in kidney transplant recipients: epidemiology and prevention
BTS 2018, Brighton Cancer in kidney transplant recipients: epidemiology and prevention Adnan Sharif Queen Elizabeth Hospital Birmingham Outline 1. The burden of cancer after kidney transplantation 2. Epidemiology
More informationACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS. Myriam Farah, MD, FRCPC
ACUTE KIDNEY INJURY A PRIMER FOR PRIMARY CARE PHYSICIANS Myriam Farah, MD, FRCPC Clinical Assistant Professor Division of Nephrology, University of British Columbia November 2016 1. How to recognize acute
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 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 informationObjectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives
The Role of the Primary Physician and the Nephrologist in the Management of Chronic Kidney Disease () By Brian Young, M.D. Assistant Clinical Professor of Medicine David Geffen School of Medicine at UCLA
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 informationYour Health Matters. What You Need to Know about Adult Liver Transplantation. Access our patient education library online at
Access our patient education library online at www.ucsfhealth.org Your Health Matters What You Need to Know about Adult Liver Transplantation Table of Contents 1. Introduction 2. The Preliminary Process
More informationEchocardiography analysis in renal transplant recipients
Original Research Article Echocardiography analysis in renal transplant recipients S.A.K. Noor Mohamed 1*, Edwin Fernando 2, 1 Assistant Professor, 2 Professor Department of Nephrology, Govt. Stanley Medical
More informationAllocation of deceased donor kidneys. Phil Clayton NSW Renal Group 14 June 2012
Allocation of deceased donor kidneys Phil Clayton NSW Renal Group 14 June 2012 Outline Why study kidney allocation? Equity vs utility Current Australian model Previous work in Australia US allocation research
More informationDecoding the USPSTF. By: Dr Vikram Arora Heritage Valley Health System
Decoding the USPSTF By: Dr Vikram Arora Heritage Valley Health System Objectives O Gain insight into function of USPSTF O Review grading system O Critically appraise key current recommendations of the
More informationPatient Education Transplant Services. Glossary of Terms. For a kidney/pancreas transplant
Patient Education Glossary of Terms For a kidney/pancreas transplant Glossary of Terms Page 18-2 Antibody A protein substance made by the body s immune system in response to a foreign substance. Antibodies
More informationBMTCN REVIEW COURSE PRE-TRANSPLANT CARE
BMTCN REVIEW COURSE PRE-TRANSPLANT CARE Jennifer Shamai MS, RN, AOCNS, BMTCN Professional Practice Leader Department of Clinical Practice And Professional Education Click How to edit the Master Experts
More information3/6/2017. Prevention of Complement Activation and Antibody Development: Results from the Duet Trial
Prevention of Complement Activation and Antibody Development: Results from the Duet Trial Jignesh Patel MD PhD FACC FRCP Medical Director, Heart Transplant Cedars-Sinai Heart Institute Disclosures Name:
More informationStep One: The Referral
Step One: The Referral There are 3 phases of your journey through kidney transplant. They are: 1. Referral and Evaluation 2. Wait List 3. Post-Kidney Transplant In this section, you will find information
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 informationStrategies for Desensitization
Strategies for Desensitization Olwyn Johnston MB, MRCPI, MD, MHSc BC Nephrology Day October 8 th 2010 Pre-transplant crossmatch (CMX) with donor lymphocytes has been standard of practice Positive CDC CXM
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 informationCaring for your Kidney Transplant. Aneesha A Shetty, MD MPH Northwestern Memorial Hospital
Caring for your Kidney Transplant Aneesha A Shetty, MD MPH Northwestern Memorial Hospital Overview Transitions Transplant Medications Health Maintenance Taking control of your care This lecture pertains
More informationESRD Mortality. Causes of CKD in Children. Causes of Late Graft Failure. 5-Year Allograft Survival. All-cause mortality rates, 2005, by age
North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Causes of CKD in Children Founded in 1992 78 participating centers in Canada & U.S. 16,339 CKD patients age 0 18 years 9,506 renal
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 informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
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 informationChronic Kidney Disease. Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital
Chronic Kidney Disease Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital Health Seminar Series Date 12 May 2013 Objectives Normal functioning of Kidneys. Risk factors to
More informationKidney and p ancreas t ransplantation
7 Kidney and p ancreas t ransplantation Joshua J Augustine, Kenneth A Bodziak, Aparna Padiyar, James A Schulak, and Donald E Hricik University Hospitals Case Medical Center and Case Western Reserve University,
More informationPost-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies
Post-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies Lorita M Rebellato, Ph.D., D (ABHI) Associate Professor Department of Pathology The Brody School of Medicine at ECU Scientific
More informationResource Document for the Medical Evaluation of Living Kidney Donors
NOTE: At its September 2007 meeting, the Board of Directors approved only the Introduction and Purpose sections of the proposed resource document. The Board further directed that the resource document
More information