Keeping your options open. Transplant In Center Hemodialysis Home Hemodialysis Peritoneal dialysis No dialysis

Transcription

1 Keeping your options open Transplant In Center Hemodialysis Home Hemodialysis Peritoneal dialysis No dialysis

2 Survival With/Without Transplant

3 % of Transplants 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Recipient Age Distribution Over Time < Age

4 We want you as soon as we can have you! Early referral To be placed on the Kidney Transplant list: GFR less than or equal to 20 On dialysis How to get referred Your Nephrologist Your dialysis unit Yourself

5 Kidney Class What s next.. Education Baseline assessment by Multidisciplinary team Receive your office appointment Office appointment Surgeon assessment Nephrologist assessment Social worker assessment

6 Multidisciplinary Team Every member of the Multidisciplinary Team is important. We assess you with Transplant in mind. How can we help you to be a more ideal candidate? What support can we offer? What barriers can we help you overcome? Transplant Surgeon Transplant Nephrologist Transplant Coordinator Social Worker Financial Coordinator Dietician Pharmacist

7 TEAMWORK

8 What are we thinking? What s your cause of kidney failure? It s rarely a deal breaker Age It s an issue of mind over matter. If you don t mind it doesn t matter. Mark Twain Medical status Past Present Future

9 How are you? We evaluate the status or presence of: Coronary Artery Disease Diabetes Lung disease Infection Malignancy Obesity Frailty

10 Transplant candidates are.. Good communicators Report changes in address/phone number Report changes in health status Report changes in insurance Respond to messages I call you You call me!

11 Transplant candidates also. Have a good support system and at least one co-learner. Have the financial resources in place to not put yourself/your family in financial jeopardy. Have the ability to comply with the post transplant regimen.

12 Just because you aren t now, doesn t mean you are not ever Diabetes control can be improved Smoking can be stopped Surgery to repair Your heart and its valves Your narrow veins or arteries in your leg Infections can be cleared up Weight can be decreased Bad habits can be unlearned, we hope

13 What can you do on your end? Complete the recommended good health screenings, when appropriate Pap Smear Mammogram Dental Clearance Colonoscopy Work up any nagging, ongoing problems

14 Getting added to the wait list Waiting time is EVERYTHING! Complete your ordered testing. The sooner your work up is completed, reviewed and presented, the soon your coordinator can get you listed.

15 Kidney Transplant Waiting List and Transplants Performed 120, ,000 Patients Waiting 80,000 60,000 40,000 20,000 Candidates on Waiting List Kidney transplants/year Deceased donor Transplants Year

16 Now we wait

17 Just because you are now, doesn t mean you always will be We reevaluate you to assess your health status every one to two years. New or worsening health problems or frailty may make you temporarily or permanently ineligible.

18 On hold-what does that mean? You continue to earn waiting time, but you are not eligible for organ offers. You do not need to have your Gift of Hope tubes drawn. We are not able to evaluate any living donors.

19 Living related/non related donor Good physical and mental health No diabetes No kidney stones No high blood pressure Over 18 years old (consenting adult) Genetic relations are NEVER a requirement.

20 Are you two compatible? Donor Blood Type Recipient Blood Type A B O AB A or AB B or AB A, B, AB or O AB

21 Crossmatch Mixing donor and recipient blood together A positive crossmatch means the recipients cells would attack the donated kidney and cause an immediate loss of transplant.

22 If you two can get along Evaluate the donor in a similar manner to the recipient with a Multidisciplinary assessment. Perform tests to assess kidney function and anatomy. Make sure donors are coming forward freely and willingly and are not under physical, financial or emotional obligation.

23 Living donation Ups Recipient can be in the best place health wise Donor kidney comes from a healthy, not recently stressed person Likely to receive a transplant sooner Downs Emotional stress on all parties Surgery for donor

24 If you two cannot get along Paired Exchange may be your answer

25 What does that look like? Donor and recipient complete work ups and are then entered into databases that look for compatible pairs throughout the United States. Once compatible pairs are located, Transplant Centers look closely at matches for their patients.

26 Recipients and donors will stay at their own transplant center All parties in the exchange have their surgeries done at the same time Kidney is transported to its new location

27 It s All About Waiting

28 Allocation Schemes Liver Heart Lung Medical Urgency All have in common no other life-saving therapy All primarily focused on preventing death on the waiting list L

29 Allocation Schemes KIDNEY Medical Urgency not part of equation dialysis provides alternate therapy In 1980 s allocation based on histocompatibility matching between donor and recipient with waiting time as a tie breaker With improved immunosuppression, allocation scheme shifted away from matching and toward waiting time Waiting time has become dominant factor in allocation

30 Why change kidney allocation? Current Limitations ounrealized graft years ounnecessarily high re-transplant rates

31 Donor Factors that Affect Graft Longevity Donor age Height Weight Ethnicity History of Hypertension History of Diabetes Cause of Death Serum Creatinine HCV Status DCD Status

32 Expected Graft Survival by Kidney Donor Factors

33 Recipient Factors that Affect Post-Transplant Survival Age Diabetic Status Time on Dialysis Number of Prior Transplants

34 New Allocation System Designed to match anticipated longevity of donor kidney and recipient All deceased donor kidneys and potential recipients assigned score that denotes expected longevity System allocates best 20% of donor kidneys to best 20% of recipients Remainder of donor kidneys allocated primarily by waiting time

35 New Allocation System Waiting time begins: Patient referred for transplant and has chronic kidney disease with GFR <20 ml/min OR Date of first dialysis treatment for patients referred after starting dialysis

36 Transplant Medications Post-transplant medications now generic Health insurance carriers specify patient s pharmacy Mail order pharmacies very common SO Caregivers and patients need to be ever more vigilant about medications verify correct doses and correct meds, keep up on refills and re-orders

37 Financial Issues

38 Financial Issues Good News Illinois Medicaid more widely available and less likely to be cancelled St. Francis Medical Center Transplant Program approved by all Medicare/Medicaid Plans Medicare Part D donut hole getting smaller (but very slowly)

39 Financial Issues Bad News Healthcare plans have their own restrictions and requirements for kidney transplant recipients smoking cessation Weight reduction for obese patients Medication assistance programs less available from pharmaceuticals because generic medications available because patients are guaranteed coverage from Obamacare Health care payment system much more complex

40 We re Glad you are here! QUESTIONS?

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42 Longevity Matching Estimated Post Transplant Survival (EPTS) Candidate age, time on dialysis, prior organ transplant, diabetes status Top 20% of candidates by EPTS to receive kidneys matched on longevity (KDPI<20%) Candidates can have an EPTS score in the top 20% even at age 50 Applies only to kidneys with KDPI scores <=20% not allocated for multi-organ, very highly sensitized, or pediatric candidates