BLAZING TRAILS IN TRANSPLANTATION. Danielle Fritze, MD
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1 BLAZING TRAILS IN TRANSPLANTATION Danielle Fritze, MD
2 BETTER TODAY THAN YESTERDAY BETTER TOMORROW THAN TODAY. Jim Harbaugh,via Twitter (and others)
3 Transplant s Joseph Murray Legacy The Herrick Twins NPR, NYT, and Boston Globed
4 Transplant s Legacy I never heard anyone who was there describe this as the first human liver transplantation. If they mentioned it at all, it was always just about Bennie. Blog,.scoutingmagazine.org
5 SRTR Transplant s Legacy Kidney Pumps Laparoscopic Donor Nephrectomy Transplant Professionals: Nursing, pharmacy, nephrology, Social work, nutrition, etc Cyclosporine
6 Transplant s Legacy Transplanters are born into a legacy of innovation. We bear the same burden of responsibility for our patients. We have the same opportunity to change the world.
7 RENAL REPLACEMENT
8 Wearables Computerhope.com, Forbes,com, Westwoodenabler.com, JCI Insight
9 Wearable Artificial Kidney Effective electrolyte mgmt Stable hemodynamics Improved QOL Issues: Study stopped early for CO2 bubbles in the device Tube kinking Has fast-track FDA status JCI Insight Jun 2; 1(8): e86397.
10 Implantables U of Michigan Otorhinolaryngology
11 Implantables BBCNews.com, Syncardia.com
12 The Kidney Project HEMOFILTER: - Silicon nanopore membrane - Ultrafiltration driven by blood pressure BIOREACTOR: - Human renal tubule cells - Resorption of Na and water - Production of Vitamin D - Regulation of blood pressure The Kidney UCSF
13 The Kidney Project The Kidney UCSF
14 Bioengineering a kidney DECELLULARIZATION RECELLULARIZATION
15 Bioengineering a kidney
16 Bioengineering a kidney
17 Bioengineering a kidney A perfect system would provide excellent renal function AND: Eliminate the risk of rejection the expected lifespan of an organ the organ shortage need for treatment of rejection and its complications of treatment Eliminate barriers to transplantation for highly sensitized pts Eliminate the need for immunosuppression Infectious risk Toxicity of medications Cost of medications and monitoring Need for infectious prophylaxis??? Artificial rather than cadaveric scaffold
18 While we are shooting for the moon What if we could prevent patients from ever needing a transplant? Nephcure.org
19 Meanwhile We have the same responsibility to our patients with renal disease as those investigators developing the next paradigm shift in transplantation
20 MAKING TRANSPLANT BETTER NOW Improving Access Improving Outcomes Improving Patient Care
21 Kidney Allocation System ISSUES: Discarded organs Access to transplantation Injustice in wait time calculation Mismatch between recipient and organ longevity Transplant kidneys that outlive the patient Patients who long outlive their transplant Solvable problem?
22 Kidney Allocation System RECIPIENT (EPTS) Estimated Post- Transplant Survival KIDNEY (KDPI) Kidney Donor Profile Index Recipient Longevity Organ Longevity
23 Kidney Allocation System
24 Kidney Allocation System
25 Kidney Allocation System
26 Kidney Allocation System Patients traditionally disadvantaged receive greater priority: PRA Blood type B access to A 2 and A 2 B organs Late referrals wait time starts at RRT start Other priority groups Prior living donors Children
27 Kidney Allocation System: Results The Good 7% in deceased donor transplants Bolus in transplants for previously underprioritized patients Highly sensitized Long dialysis times The Bad DGF, stabilizing kidney discard rate, 18.5% 19.8% Slight in pediatric transplant rates, BUT kids transplanted with better kidneys
28 Living Donation National Kidney Registry
29 Kidney Paired Donation National Kidney Registry
30 Kidney Paired Donation KidneyLink
31 Kidney Paired Donation Involving compatible pairs to improve HLA match and access for non-compatible pairs Living Kidney Donor Profile Index: LKDPI Increasing participation nationally
32 Nat l Living Donor Assistance Center
33 Nat l Living Donor Assistance Center Funded by the federal government Administered under HHS and DoT Provides reimbursement for non-medical expenses related to donor evaluation and donation Travel Lodging Meals Does not address the issue of lost wages
34 Living Donors: Single Day Evaluation Designed to: Diminish the burden of the evaluation for the donor Diminish time to transplantation for the recipient Full evaluation in a single day: Transplant Nephrology Transplant Surgery Social Work Other providers as needed Labs and Imaging
35 Living Donors: Laparoscopic Nephrectomy 1995: First living donor nephrectomy performed laparoscopically by Dr. Lloyd Ratner POD 1 Discharge POD 14 Returned to work Multi-modal pain control: Toradol Long acting sub-fascial local anesthetic Tylenol Opioids as needed
36 Social Media in Kidney Transplantation
37 Social Media in Kidney Transplantation
38 Mobile Technology
39 Recipient Care: Everyday Streamlined evaluation process Evidence-based recipient selection Expanding the potential recipient pool Improving recipient education and re-education Communication and follow-up while waitlisted Preventing patients from developing contraindications to transplantation while waitlisted Improving deceased donor organ selection and organ-recipient matching
40 Recipient Care: Everyday Clean, efficient operations Peri-operative monitoring and imaging Post-operative pain control Discharge planning and outpatient resources Immunosuppression protocols Rejection monitoring: protocol biopsies and urinary biomarkers Easy accessibility to patients throughout the process Kindness
41 BETTER TODAY THAN YESTERDAY BETTER TOMORROW THAN TODAY. Jim Harbaugh,via Twitter (and others)
42 CONTACT US 4502 Medical Dr. MS-18, San Antonio, TX UniversityTransplantCenter.com Hospital to Hospital Transfer: Main:
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