New Kidney Allocation and What it Means to Your Transplant Center and Your Patients

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "New Kidney Allocation and What it Means to Your Transplant Center and Your Patients"

Transcription

1 New Kidney Allocation and What it Means to Your Transplant Center and Your Patients Alexander Wiseman, M.D. Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of Colorado Health Sciences Center

2 The Kidney Transplant Waiting List: How do you get priority points in 2013? Time: Longest wait =1 point, with fractions of a point given for each candidate in order 1 Year=1 point Match: HLA DR match=1 point for each DR locus that is not mismatched (maximum of 2) Sensitization: Panel reactive antibody level>80%=4 points Good Samaritan: Prior kidney donation=4 points UNOS Policy 3.5

3 Case 1 A 24 y/o male is declared brain dead following an MVA and is an organ donor. Perfect health prior to MVA. The match run performed by UNOS identifies a recipient with the highest priority: 74 y/o man with DM, CAD s/p CABG, on dialysis/listed for 3 years, panel reactive antibody= 10% HLA DR matched at both loci=2 points 3 years of wait time=3 points Total=5 points

4 Case continued: #2 on the match run is a 30 yo female with IgA nephropathy on dialysis/waiting list for 3 years with a PRA of 70%, 4 Ag match (2 A, 1 B, 1 DR), listed with a different transplant program in the area HLA DR matched at one loci=1 point 3 years of wait time=3 points Total points=4 #3 on the match run is a 50 y/o with PKD, PRA 0% and no other medical problems on the waiting list for 4 years, potential 4 Ag match (2 A, 2 B) 4 years of wait time=4 points Total points=4

5 Major Rationale for Change The current system Uses few available objective medical criteria Kidneys with long projected post-transplant survival are allocated to candidates with short post-transplant survival (and vice versa)

6 Objectives for the Proposed Kidney Allocation System Improve outcomes of recipients of deceased donor kidneys through improved matching of graft/recipient projected survival Improve access for biologically disadvantaged kidney transplant candidates (highly sensitized, blood group B, minority candidates)

7 Overview of proposed policy Current Proposed All allocation sequences to be based on kidney donor profile index (KDPI)

8 Factors used to determine groups KDPI Donor age Race/ethnicity Hypertension Diabetes Serum creatinine COD CVA Height Weight DCD HCV Candidate Estimated Post-Transplant Survival (EPTS) Candidate Age Candidate Diabetes Prior transplant ESRD time

9 Overview of proposed policy Proposed Allocation to those with longest expected posttransplant survival Allocation first to Pediatric list, then according to waiting time Allocation according to waiting time Allocation to those who consent (similar to today s ECD ) All allocation sequences to be based on kidney donor profile index (KDPI)

10 Kidney Donor Profile Index (KDPI) KDPI Variables Donor age Height Weight Ethnicity History of Hypertension History of Diabetes Cause of Death Serum Creatinine HCV Status DCD Status

11 Case (for the referring nephrologist): Your 55 yo patient with T2DM, not yet on dialysis (but is close, with GFR 13) has consented to a KDPI >85. He gets an offer for a kidney that has KDPI of >85. Do you: A. Advise him to take it B. Advise him to decline it C. Ask about the KDPI

12 Case (for the transplant center): You receive an offer for a 55 yo patient with T2DM, not yet on dialysis (but is close, with GFR 13) who has consented to a KDPI >85. The donor is a 59 yo obese AA with CVA and HTN. The KDPI is 95. Do you: A. Accept the kidney B. Decline the kidney

13 Highly sensitized patients rarely get offers under current allocation policy

14 New Policy: Sensitization Points (Current) (Proposed) Current policy awards 4 points to candidates with PRA>80% Candidates <80% do not receive any points Proposed policy would generate a sliding scale for priority so that highly sensitized candidates get improved access

15 Modeling transplant results by CPRA (95-100%)

16 Projected results >8000 additional life years annually Slight increase in transplants to African Americans, blood type B, and high PRA recipients % of transplants current estimated Changes in age distribution < Recipients, by age

17 Allocation Scheme

18 Scenario 1: 48 yo with FSGS on HD for 7 years, variably adherent, missed transplant evaluations x 2 in past (illness). Still modestly nonadherent. Makes appointment, is ultimately placed on waiting list. Scenario 2: 68 yo with DM on HD for 2 years, very adherent, missed transplant evaluation in past (illness). Still very functional on CCPD, is ultimately placed on waiting list.

19 Proposed Point Changes: Waiting Time Current policy begins waiting time points for adults at registration with: GFR<=20 ml/min Dialysis time Proposed policy would also award waiting time points for dialysis time prior to registration Applies to both pediatric and adult candidates Better recognizes time spent with ESRD as the basis for priority Pre-emptive listing would still be advantageous for 0-ABDR mismatch offers

20 Discussion For the physician: How do you educate patients regarding new allocation policies? For the transplant center: How do you manage the waiting list with the new allocation policies?

21 Conclusions KDPI will permit efficient allocation but does not necessarily increase number of transplants, unless demand for high KDPI increases Sliding scale for sensitization/%pra are components that have gained approval

22 Case A 17 yo patient with Henoch-Schonlein Purpura (HSP) and CKD V not yet on dialysis She has a family member who is interested in donating with compatible blood type. Average waiting time for an adult blood type O candidate is 5 years What is the likelihood that she will get an offer for a kidney within 2 months? 12 months? What do you recommend: A) living donor transplant B) wait for deceased donor transplant

23 Pediatric Kidney Allocation

24 Pediatric kidney transplantation With introduction of Share 35 in November 2005 (in which all deceased donors < 35y are offered first to candidates <18y), waiting time is shorter, rates of living donation have fallen Age at Registration <1 Year Years Years Years Years Is shortening pediatric waiting time by 2-4 months really the best strategy? SRTR Annual Report 2011 Fig 8.13

25 Inferior outcomes with deceased donor vs living donor in pediatric recipients Higher acute rejection rates Worse graft survival Is the shorter waiting time worth the de-emphasis on living donation? SRTR Annual Report 2011 Figs 8.26, 8.27

26 Utility of Share 35 donor kidneys are NOT optimized by use in pediatric population Using Share 35 donors, overall graft survival and deathcensored graft survival is better in adults than those 17 Higher graft loss in younger recipients Higher death rate in older recipients Best utility is in recipients age 31-45, not the pediatric recipients Moudgil A et al, Transplantation 2013; 95:319

27 Pancreas Allocation and Transplantation

28 Patients receiving SPK transplants have the greatest net lifetime benefit * from transplantation *(estimated survival with functioning graft) - (estimated survival on dialysis x 0.8) 4% 32% 64% Wolfe R et al, AJT 2008; 8:

29 Organ Allocation: The kidney follows the pancreas Organ Donor: 2 kidneys, 1 pancreas Pancreas list A (E on kidney list) B C (G on kidney list) D Kidney list A B C D E F G If Pancreas follows kidney : Candidates A and B get kidneys, and B gets panc If Kidney follows pancreas : Candidate A gets kidney, and E gets SPK INCENTIVE TO PUT PATIENTS ON SPK LIST (EVEN T2DM???)

30 Organ Allocation for Diabetes: The kidney follows the pancreas Median waiting time to transplant (days) 2004 SPK A: 323 B: 520 O: 533 AB:214 Kidney A: 815 B: 1655 O: 1568 AB: 602 INCENTIVE TO PUT PATIENTS ON SPK LIST (EVEN T2DM???) SRTR Annual Report 2009

31 Case 46 yo man with T1DM who underwent SPK transplant after only 14 months of waiting tells his buddy with T2DM on dialysis how great it is to be off dialysis and without insulin. His buddy, a 49 yo with BMI 29, has been waiting on the kidney transplant waiting list for 2 years and wonders if he can undergo an SPK transplant What do you advise him? A) He is not a candidate due to T2DM B) SPK is much less successful in T2DM than T1DM C) SPK may be a reasonable option

32 Simultaneous Pancreas Kidney Transplantation: For T2DM? In U.S.-Eligibility for SPK waiting list: 1. DM with c-peptide <2 ng/ml 2. DM, c-peptide >2 ng/ml with BMI <28-30kg/m 2

33 Pancreas transplant outcomes are equivalent in T1DM vs. selected T2DM OPTN/UNOS Data analysis of SPK recipients T2DM recipients vs 6141 T1DM recipients Patient Survival Pancreas Graft Survival Pancreas-related complications T1DM T2DM P One-year kidney and/or pancreas rejection Pancreas complications abscess/local infection anastomosis leak pancreatitis primary nonfunction surgery to convert bladder to enteric drainage Sampiao M et al, CJASN 2011; 6: 1198

34 Does the added pancreas transplant lead to better outcomes for young, thin patients with T2DM? SRTR analysis of patients with T2DM, age 18-59, with BMI kg/m 2 receiving an SPK (n=424), LDKA or DDKA during : Multivariate analysis: HR 0.9 (p=ns) Multivariate analysis: HR 0.5 (p<0.001)) SPK: better patient survival than DDKA, but inferior compared to LDKA SPK: Waiting time much shorter, donor age much younger than DDKA Wiseman AC and Gralla J, CJASN 2012 Apr;7(4):656

35 Summary/Conclusion: SPK as a Transplant Option Avoid dialysis know the waiting time expectations for SPK and advise your patients accordingly For most T1DM: SPK is preferable to deceased donor kidney transplant. LD kidney transplant vs SPK: depends on dialysis/waiting time For most T2DM: LD > DD <10% of T2DM may be eligible for SPK, better than DD but may be inferior to LD

New UNOS Kidney Allocation System (KAS)

New UNOS Kidney Allocation System (KAS) New UNOS Kidney Allocation System (KAS) UNOS: United Network for Organ Sharing OPTN: Organ Procurement and Transplantation Network Lee Ann, Baxter-Lowe, Ph.D. The content is the responsibility of the authors

More information

*6816* 6816 CONSENT FOR DECEASED KIDNEY DONOR ORGAN OPTIONS

*6816* 6816 CONSENT FOR DECEASED KIDNEY DONOR ORGAN OPTIONS The shortage of kidney donors and the ever-increasing waiting list has prompted the transplant community to look at different types of organ donors to meet the needs of our patients on the waiting list.

More information

The New Kidney Allocation System: Resources for Protocols and Processes webinar.

The New Kidney Allocation System: Resources for Protocols and Processes webinar. The New Kidney Allocation System: Resources for Protocols and Processes webinar. 1 Speakers for the webinar are: Dr. Richard Formica Associate Professor of Medicine and Surgery, Yale University School

More information

Questions and Answers for Transplant Candidates about the New Kidney Allocation System

Questions and Answers for Transplant Candidates about the New 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 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 Questions and Answers for Transplant Candidates about the New Kidney Allocation System United

More information

Where Will my New Kidney Come From?

Where Will my New Kidney Come From? Where Will my New Kidney Come From? The Organ Shortage There is a severe shortage of organs for transplant. This means that the wait for a kidney transplant can be many years. The UW Transplant Program

More information

Saint Francis Kidney Transplant Program Issue Date: 6/9/15

Saint Francis Kidney Transplant Program Issue Date: 6/9/15 Kidney Transplant Candidate Informed Consent Education Here are educational materials about Kidney Transplant. Please review and read these before your evaluation visit. The RN Transplant Coordinator will

More information

Frequently Asked Questions For Waitlisted Patients

Frequently Asked Questions For Waitlisted Patients Frequently Asked Questions For Waitlisted Patients Questions About My Follow-up On the Waitlist Q: How long will I have to wait for a new kidney? Wait time for a donor organ is dependent upon several factors.

More information

David Axelrod, MD, MBA. Associate Professor of Surgery Section Chief- Solid Organ Transplantation Dartmouth- Hitchcock Medical Center

David Axelrod, MD, MBA. Associate Professor of Surgery Section Chief- Solid Organ Transplantation Dartmouth- Hitchcock Medical Center David Axelrod, MD, MBA Associate Professor of Surgery Section Chief- Solid Organ Transplantation Dartmouth- Hitchcock Medical Center Owner of XynManagement which produces software to track and improve

More information

MELD System: Past and Present. Patrick S. Kamath, MD Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology

MELD System: Past and Present. Patrick S. Kamath, MD Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology MELD System: Past and Present Patrick S. Kamath, MD Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology MELD for Liver Transplantation: Outline What is the MELD Score? Why was liver

More information

THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION. feel better knowing

THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION. feel better knowing THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION feel better knowing your choice will help create more memories. Methods of Kidney Donation Kidneys for transplantation are made available through deceased

More information

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 TA L K I N G A B O U T T R A N S P L A N TAT I O N United Network for Organ Sharing (UNOS) is a non-profit charitable organization that manages the nation s transplant system known as the Organ Procurement

More information

Center Activity (07/01/2009-06/30/2010) Center Region United States Tables for More Information

Center Activity (07/01/2009-06/30/2010) Center Region United States Tables for More Information Program Summary Center Activity (07/01/2009-06/30/2010) Center Region United States Tables for More Information Deceased donor transplants (n=number) 0 169 0 07C,08C,09C On waitlist at start (n) 0 0 0

More information

ANNUAL REPORT ON KIDNEY TRANSPLANTATION

ANNUAL REPORT ON KIDNEY TRANSPLANTATION ANNUAL REPORT ON KIDNEY TRANSPLANTATION REPORT FOR 2013/2014 (1 APRIL 2004 31 MARCH 2014) PUBLISHED SEPTEMBER 2014 PRODUCED IN COLLABORATION WITH NHS ENGLAND Contents 1 Executive Summary... 1 2 Introduction...

More information

Deceased-Donor Renal Transplant Information for patients

Deceased-Donor Renal Transplant Information for patients Deceased-Donor Renal Transplant Information for patients Exceptional healthcare, personally delivered As part of the work-up for the NHS Blood and Transplant (NHSBT) kidney transplant waiting list, you

More information

User Guide. A. Program Summary B. Waiting List Information C. Transplant Information

User Guide. A. Program Summary B. Waiting List Information C. Transplant Information User Guide This report contains a wide range of useful information about the pancreas transplant program at Saint Louis University Hospital (MOSL). The report has three main sections: A. Program Summary

More information

Transplantation: Living Kidney Donation. May 9, 2016 PKD Foundation

Transplantation: Living Kidney Donation. May 9, 2016 PKD Foundation Transplantation: Living Kidney Donation Seth Goldberg, MD May 9, 2016 PKD Foundation Conflicts of Interest Abbott Kadmon PKD Otsuka PKD Pfizer PKD Renal Replacement Therapies When kidneys fail, we now

More information

Kidneys. Kidney Failure4. Transplantation

Kidneys. Kidney Failure4. Transplantation Kidneys & Kidney Failure4 Transplantation This booklet helps you understand the process of transplantation. It defines the criteria for a donor and the recipient. It also clearly explains the concepts

More information

ALLOCATION CRITERIA FOR DECEASED DONOR KIDNEY TRANSPLANT DRAFT GUIDELINES

ALLOCATION CRITERIA FOR DECEASED DONOR KIDNEY TRANSPLANT DRAFT GUIDELINES Page 1 of 6 ALLOCATION CRITERIA FOR DECEASED DONOR KIDNEY TRANSPLANT DRAFT GUIDELINES Preamble Organ transplant has two sources; living donor and deceased donor. In case of living donor source, donor is

More information

New-Onset Diabetes after Transplantation

New-Onset Diabetes after Transplantation New-Onset Diabetes after Transplantation Dr Mahmoud Darouich Ministry of Health - Damascus The tenth conference of syrian society of nephrology and transplantation Mashta-Alhelou 6-8/11/2008 Cause of Death

More information

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 TA L K I N G A B O U T T R A N S P L A N TAT I O N Who are UNOS and the OPTN? United Network for Organ Sharing (UNOS) is a non-profit charitable organization that manages the nation s transplant system

More information

Is a kidney transplant right for me?

Is a kidney transplant right for me? Is a kidney transplant right for me? Your guide to the transplant process www.esrdncc.org Contents Introduction 3 What is a Transplant Center? 4 What is the Waiting List? 5 What Happens After the Surgery?

More information

Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival

Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival Scott Auerbach, MD, Jane Gralla, PhD, Shelley Miyamoto, MD, David Campbell, MD, and Biagio Pietra,

More information

Kidney Transplant Program. Guide to Understanding Transplant

Kidney Transplant Program. Guide to Understanding Transplant Kidney Transplant Program Guide to Understanding Transplant The wonderful physicians and staff of the Stanford Kidney Transplant Program are always there to contact if I have a question or concern. They

More information

Living Donor Paired Exchange Registry. What is Living Kidney Donor Paired Exchange?

Living Donor Paired Exchange Registry. What is Living Kidney Donor Paired Exchange? Living Paired Exchange Registry What is Living Kidney Paired Exchange? The Living Paired Exchange Registry. At Canadian Blood Services, we are committed to helping Canadians help each other. By building

More information

How does a kidney transplant differ from dialysis?

How does a kidney transplant differ from dialysis? 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 information

Medicine & Emergency Department Pre-transplantation decisions and preparation

Medicine & Emergency Department Pre-transplantation decisions and preparation Medicine & Emergency Department Pre-transplantation decisions and preparation Information for renal patients Who can have a kidney transplant? Kidney transplantation is the preferred choice of treatment

More information

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

Transplant Waiting List

Transplant Waiting List Transplant Waiting List This section will provide you with information you need to know once you have been listed on the national waiting list for kidney transplant. Even recipients with a living donor

More information

Candidates about Multiple Listing and Waiting Time Transfer

Candidates about Multiple Listing and Waiting Time Transfer 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 Multiple Listing and Waiting Time Transfer 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

More information

Disclaimer for Bait and Switch

Disclaimer for Bait and Switch Disclaimer for Bait and Switch JNC 8 due out 2011- now due out 2012 JNC 7 2003 ATP IV - due out 2011 now due out 2012 ATP III 2002 Obesity Guidelines due out 2011 now due out 2012 Obesity Guideline 1998

More information

Expanded criteria donors for kidney transplantation

Expanded criteria donors for kidney transplantation American Journal of Transplantation 2003; 3 (Suppl. 4): 114 125 Blackwell Munksgaard 2003 Blackwell Munksgaard ISSN 1601-2577 Expanded criteria donors for kidney transplantation Robert A. Metzger a, Francis

More information

CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES

CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES Reviewed and approved 5/2014 Risk Chronic kidney disease is defined as either kidney damage or decreased kidney function (decreased GFR) for 3 or more months.

More information

LIVING KIDNEY DONATION

LIVING KIDNEY DONATION LIVING KIDNEY DONATION 1 THE MICHIGAN DIFFERENCE Why Living Donation? As of May 2011, there were close to 2,500 individuals on the waiting list for a kidney transplant in the state of Michigan and more

More information

How does the lung allocation system work?

How does the lung allocation system work? TA L K I N G A B O U T T R A N S P L A N TAT I O N 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 How does the lung allocation system work? The lung allocation system determines the order in which

More information

PANCREAS, PANCREAS-KIDNEY, SEGMENT OF PANCREAS AND ISLET PANCREATIC TISSUE TRANSPLANTATION SUR703.013

PANCREAS, PANCREAS-KIDNEY, SEGMENT OF PANCREAS AND ISLET PANCREATIC TISSUE TRANSPLANTATION SUR703.013 PANCREAS, PANCREAS-KIDNEY, SEGMENT OF PANCREAS AND ISLET PANCREATIC TISSUE TRANSPLANTATION SUR703.013 COVERAGE: A simultaneous or combined pancreas-kidney transplant (SPK) from a cadaver donor or a simultaneous

More information

Renal Transplantation

Renal Transplantation Renal Transplantation Technical Aspects from Donor to Recipient Jeremy M. Blumberg, M.D. Assistant Professor of Urology, UCLA Surgical Director of Kidney Transplantation, Harbor UCLA Medical Center Neither

More information

Does Diabetes Control Matter?

Does Diabetes Control Matter? Does Diabetes Control Matter? Laurence Kennedy, MD, FRCP Endocrinology Department Cleveland Clinic, OH Disclosures None Does Diabetes Control Matter? Generality of patients Relative Risk Complications

More information

Kidney Transplant. If you have questions or would like more. information about Cleveland Clinic s. Kidney Transplant Program, please call us

Kidney Transplant. If you have questions or would like more. information about Cleveland Clinic s. Kidney Transplant Program, please call us Kidney Transplant Guide for recipients and donors In 1963, Cleveland Clinic performed the first kidney transplant in Northeast Ohio and became a recognized pioneer in the field of organ transplantation.

More information

All data from Necker Hospital regarding the donors and recipients were extracted from the

All data from Necker Hospital regarding the donors and recipients were extracted from the SUPPLEMENTAL MATERIAL Data collection procedures All data from Necker Hospital regarding the donors and recipients were extracted from the DIVAT clinical prospective cohort (official website: www.divat.fr).

More information

Emory Transplant Center

Emory Transplant Center Emory Transplant Center MAKING A DIFFERENCE IN THE LIVES OF OUR PATIENTS AND OUR COMMUNITY I n f o r m a t i o n f o r POTENTIAL LIVING DONORS FOR KIDNEY TRANSPLANT P h a s e O n e THE TELEPHONE INTERVIEW

More information

The New Role of STAT Creatinine Testing Presenter: Brad S. Karon MD, PhD. Sponsored by

The New Role of STAT Creatinine Testing Presenter: Brad S. Karon MD, PhD. Sponsored by The New Role of STAT Creatinine Testing Presenter: Brad S. Karon MD, PhD Sponsored by We will begin shortly. If you need assistance with audio, call 434 202 8365. Brad S. Karon MD, PhD Director, Point

More information

GIVING THE GIFT OF LIFE

GIVING THE GIFT OF LIFE GIVING THE GIFT OF LIFE THE BENEFITS OF LIVING DONATION It takes a special person to serve as a kidney donor for a family member or friend. At Stanford Hospital & Clinics, we look at donors as heroes,

More information

Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification

Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification Lesley Stevens MD Tufts-New England Medical Center National Kidney Foundation Objectives Kidney Failure Stages of Chronic Kidney

More information

Seeking Normality: Life on the Kidney Transplant List

Seeking Normality: Life on the Kidney Transplant List Seeking Normality: Life on the Kidney Transplant List Seeking Normality: Life on the Kidney Transplant List Magi Sque 1, Jane Frankland 2, Tracy Long-Sutehall 2, Julia Addington-Hall 2, Juan Mason 3 1

More information

LIVER TRANSPLANTATION Update on Allocation Living Donor Liver Tx.

LIVER TRANSPLANTATION Update on Allocation Living Donor Liver Tx. LIVER TRANSPLANTATION Update on Allocation Living Donor Liver Tx. Steven L. Flamm MD Associate Professor of Medicine Medical Director, Liver Transplantation Northwestern University Medical School 1958

More information

KIDNEY TRANSPLANT.

KIDNEY TRANSPLANT. KIDNEY TRANSPLANT www.kidney.org Know Your Stage of Kidney Disease Did you know that the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-KDOQI ) has guidelines and commentaries

More information

Kidney and Pancreas Transplant Program

Kidney and Pancreas Transplant Program Kidney and Pancreas Transplant Program Information for Potential Kidney Donors: What You Need to Know about Becoming a Kidney Donor You have the power to Donate Life SM our living donor program INNOVATIVE

More information

Mohamed Akoad, MD, FACS Chair, Department of Transplantation Alicia Parrott, RN Living Donor Nurse Coordinator

Mohamed Akoad, MD, FACS Chair, Department of Transplantation Alicia Parrott, RN Living Donor Nurse Coordinator Mohamed Akoad, MD, FACS Chair, Department of Transplantation Alicia Parrott, RN Living Donor Nurse Coordinator Living Donor Liver Transplantation is a surgical innovation that has been developed to address

More information

What YOU need to know

What YOU need to know Kidney Disease What YOU need to know International Society of Nephrolo Advancing Nephrology around t A briefing on the global impact of kidney disease - from the International Society of Nephrology Awareness

More information

The Current State of Organ Procurement

The Current State of Organ Procurement The Current State of Organ Procurement Sue Dunn President & CEO Colorado Center for Transplantation Care, Research and Education Wednesday, March 7, 2012 Who is Donor Alliance? Organ Procurement Organization

More information

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 TA L K I N G A B O U T T R A N S P L A N TAT I O N UNITED NETWORK FOR ORGAN SHARING United Network for Organ Sharing (UNOS) is a private non-profit 501(c)(3) organization that operates the Organ Procurement

More information

Is a Kidney Transplant Right for Me?

Is a Kidney Transplant Right for Me? Is a Kidney Transplant Right for Me? Network 8 Introduction What do singer Natalie Cole, actor Ken Howard, funny men Tracy Morgan and George Lopez and fashion reporter Steven Cojocaru have in common? They

More information

Demystifying Transplant Performance Reviews. Robyn Zernhelt Performance Analyst

Demystifying Transplant Performance Reviews. Robyn Zernhelt Performance Analyst Demystifying Transplant Performance Reviews Robyn Zernhelt Performance Analyst Pre-Assessment Transplant Performance Reviews The PAIS reviews which transplant programs? 1. Kidney, Pancreas, Intestine 2.

More information

Living Donor Liver Transplantation

Living Donor Liver Transplantation Revised March 2012 Living Donor Liver Transplantation American Society of Transplantation 1120 Route 73, Suite 200 Mount Laurel, NJ 08054 Phone: 856-439-9986 Fax: 856-439-9982 E-mail: info@myast.org The

More information

survival, morality, & causes of death Chapter Nine introduction 152 mortality in high- & low-risk patients 154 predictors of mortality 156

survival, morality, & causes of death Chapter Nine introduction 152 mortality in high- & low-risk patients 154 predictors of mortality 156 introduction 152 < mortality in high- & low-risk patients 154 < predictors of mortality 156 < impact of anemia & dialysis therapy on mortality 158 < mortality in esrd patients with rare s 16 < expected

More information

Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology*

Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology

More information

Models of Chronic Kidney Disease Care and Initiation of Dialysis. Dr Paul Stevens Kent Kidney Care Centre East Kent Hospitals, UK

Models of Chronic Kidney Disease Care and Initiation of Dialysis. Dr Paul Stevens Kent Kidney Care Centre East Kent Hospitals, UK Models of Chronic Kidney Disease Care and Initiation of Dialysis Dr Paul Stevens Kent Kidney Care Centre East Kent Hospitals, UK Early Crash Landings Talk Outline Pathways & Definitions Guideline recommendations

More information

Live Organ Donation: Learning the Facts and Debunking the Myths

Live Organ Donation: Learning the Facts and Debunking the Myths Live Organ Donation: Learning the Facts and Debunking the Myths Meet the donor team Nahel Elias: surgical director Eliot Heher: medical director Karen Tanklow: social worker and donor advocate Anne Seaward-Hersh

More information

NHS BLOOD AND TRANSPLANT PATIENT SURVIVAL FROM TIME OF LISTING FOR TRANSPLANT SUMMARY

NHS BLOOD AND TRANSPLANT PATIENT SURVIVAL FROM TIME OF LISTING FOR TRANSPLANT SUMMARY INTRODUCTION NHS BLOOD AND TRANSPLANT PATIENT SURVIVAL FROM TIME OF LISTING FOR TRANSPLANT SUMMARY 1 Registry data are widely used to provide information on graft and patient survival time following transplantation,

More information

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE Kidney Disease WHAT IS KIDNEY DISEASE? Kidney disease is when your kidneys are damaged and not functioning as they should. When kidney disease is not going away it is called chronic kidney disease or CKD.

More information

8/12/2016. HEART TRANSPLANTATION: Past, Present, and Future CARDIAC TRANSPLANTATION TOM ESTEP, MD HEART TRANSPLANT SURGEON

8/12/2016. HEART TRANSPLANTATION: Past, Present, and Future CARDIAC TRANSPLANTATION TOM ESTEP, MD HEART TRANSPLANT SURGEON HEART TRANSPLANTATION: Past, Present, and Future TOM ESTEP, MD HEART TRANSPLANT SURGEON CARDIAC TRANSPLANTATION 1 HISTORY 1900 S: CARREL AND GUTHRIE HETEROTOPIC TRANSPLANT 1951: FIRST ORTHOTOPIC CARDIAC

More information

renal transplantation: A single-center comparative study

renal transplantation: A single-center comparative study Impact of posterior urethral valves on pediatric renal transplantation: A single-center comparative study BY Mohamed Kamal Gheith, MD Oberarzt die Urologie, Universitätsmedizin Mainz Ass. Prof. of Urology,

More information

Kidney Transplantation

Kidney Transplantation ilearning about your health Kidney Transplantation www.cpmc.org/learning What is Kidney Failure? Normally, kidneys filter waste products from your blood, control the balance of salt and water in your body,

More information

Transplant Options When You Don t Have a Good Match

Transplant Options When You Don t Have a Good Match Transplant Options When You Don t Have a Good Match 1 Transplant Options When You Don t Have a Good Match Being told you need a transplant may bring about many feelings, including anxiety and uncertainty.

More information

AUSTRALIAN DONATION AND TRANSPLANTATION ACTIVITY REPORT 2015

AUSTRALIAN DONATION AND TRANSPLANTATION ACTIVITY REPORT 2015 AUSTRALIAN DONATION AND TRANSPLANTATION ACTIVITY REPORT 215 Australia achieved its highest ever donation and transplantation outcomes in 215. Last year, a record 1,241 lives were saved and transformed

More information

New York State Living Liver Donor Data Deliverables

New York State Living Liver Donor Data Deliverables New York State Living Liver Donor Data Deliverables A Report to: New York State Department of Health March 2015 Living Liver Donor Data Deliverables Living liver donation has received increasing attention

More information

Information for patients (and their families) waiting for liver transplantation

Information for patients (and their families) waiting for liver transplantation Information for patients (and their families) waiting for liver transplantation Waiting list? What is liver transplant? Postoperative conditions? Ver.: 4/2016 1 What is a liver transplant? Liver transplantation

More information

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:

More information

Kidney Health: Secrets we all need to be talking about

Kidney Health: Secrets we all need to be talking about Kidney Health: Secrets we all need to be talking about Tipu S. Puri M.D., Ph.D. University of Chicago Medicine Chair, NKFI Professional Advisory Board A patient Michael o 36 year old male o African-american

More information

Technical Methods for the OPO-Specific Reports

Technical Methods for the OPO-Specific Reports Technical Methods for the OPO-Specific Reports Reports Released June 2016 For the Spring 2016 Cohorts Technical Methods June 2016, page 1 Table of Contents Introduction..... 3 A. Description of the Donation

More information

GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working

GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National

More information

LIVING DONATION. What You Need to Know. www.kidney.org

LIVING DONATION. What You Need to Know. www.kidney.org LIVING DONATION What You Need to Know www.kidney.org 2 NATIONAL KIDNEY FOUNDATION TABLE OF CONTENTS About Living Donation.... 4 The Evaluation Process.... 6 Surgery and Recovery.... 12 After Donation....

More information

4/25/2016. Transplant Journey. Objectives. Reason for Transplantation at Mayo Clinic. Mayo Clinic Model of Care

4/25/2016. Transplant Journey. Objectives. Reason for Transplantation at Mayo Clinic. Mayo Clinic Model of Care Transplant Journey Lynette Fix, RN, BAN, CCTC Objectives Identify key components of transplant evaluation process Identify the patient follow-up process Describe diseases indicated for transplantation

More information

Transplant Coordinator

Transplant Coordinator Have you signed your organ donor card? Hearts, kidneys, livers, and lungs can all be transplanted. When you die, one of your organs could help a critically ill patient live a longer life. What I do every

More information

The kidneys are a pair of vital organs that perform many functions to keep the blood clean and chemically balanced.

The kidneys are a pair of vital organs that perform many functions to keep the blood clean and chemically balanced. KIDNEY DISEASE The kidneys are a pair of vital organs that perform many functions to keep the blood clean and chemically balanced. The kidneys are bean-shaped organs, each about the size of a fist. They

More information

Patients as Partners. Kidney Care in a Holistic Perspective

Patients as Partners. Kidney Care in a Holistic Perspective Patients as Partners Kidney Care in a Holistic Perspective All of me All the time All the way Holistic approach Prevention Detection Slowing of progression Replacement Rehabilitation Chronic Kidney Disease

More information

Dialysis and Kidney Transplantation in Children

Dialysis and Kidney Transplantation in Children Dialysis and Kidney Transplantation in Children Jeffrey M. Saland, M.D. Chief, Pediatric Nephrology & Hypertension Icahn School of Medicine at Mount Sinai Pediatric ESRD Overview: Besides USRDS and UNOS/SRTR,

More information

The Paired Donation Network. E. Steve Woodle, M.D. Division of Transplantation University of Cincinnati

The Paired Donation Network. E. Steve Woodle, M.D. Division of Transplantation University of Cincinnati The Paired Donation Network E. Steve Woodle, M.D. Division of Transplantation University of Cincinnati Paired Donation: Definition In a paired donation, two living kidney donor/recipient pairs (both of

More information

Dissecting the pathogenesis of diabetic kidney disease

Dissecting the pathogenesis of diabetic kidney disease Dissecting the pathogenesis of diabetic kidney disease Bryan Conway Scottish Senior Clinical Fellow/Honorary Consultant Nephrologist University of Edinburgh/Royal Infirmary Edinburgh Overview Epidemiology

More information

Introduction. Evaluation

Introduction. Evaluation Introduction Most patients evaluated for kidney transplantation are already on dialysis, but this is not an absolute requirement. The evaluation process for a kidney transplant ensures that the patient

More information

Analysis of waiting times on Irish renal transplant list

Analysis of waiting times on Irish renal transplant list Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01085.x ª 2009 John Wiley & Sons A/S. Analysis of waiting times on Irish renal transplant list Phelan PJ, OÕKelly P, OÕNeill D, Little D, Hickey D, Keogan

More information

NHS BLOOD AND TRANSPLANT LIVER ADVISORY GROUP BLOOD GROUP: WAITING TIMES AND DEATHS ON THE TRANSPLANT LIST SUMMARY

NHS BLOOD AND TRANSPLANT LIVER ADVISORY GROUP BLOOD GROUP: WAITING TIMES AND DEATHS ON THE TRANSPLANT LIST SUMMARY BACKGROUND NHS BLOOD AND TRANSPLANT LIVER ADVISORY GROUP BLOOD GROUP: WAITING TIMES AND DEATHS ON THE TRANSPLANT LIST SUMMARY 1 Restrictions in the allocation of livers were imposed in 26 as a measure

More information

John Sharp, MSSA, PMP Manager, Research Informatics Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio

John Sharp, MSSA, PMP Manager, Research Informatics Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio John Sharp, MSSA, PMP Manager, Research Informatics Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio Co-Director BiomedicalResearch Informatics Clinical and Translational Science Consortium

More information

RENAL PHYSICIANS ASSOCIATION QUALITY IMPROVEMENT REGISTRY IN COLLABORATION WITH CECITY. Non-PQRS Narrative Measure Specifications

RENAL PHYSICIANS ASSOCIATION QUALITY IMPROVEMENT REGISTRY IN COLLABORATION WITH CECITY. Non-PQRS Narrative Measure Specifications RENAL PHYSICIANS ASSOCIATION QUALITY IMPROVEMENT REGISTRY IN COLLABORATION WITH CECITY Non-PQRS Narrative Measure Specifications 1 Table of Contents Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin

More information

Chapter 8: Dialysis Providers

Chapter 8: Dialysis Providers Chapter 8: Dialysis Providers Introduction The 2013 ADR chapter on ESRD providers focused on potential associations between the bundled Prospective Payment System (PPS) and provider practices specifically

More information

LIVING DONOR GUIDE A GUIDE TO BECOMING A LIVING KIDNEY DONOR

LIVING DONOR GUIDE A GUIDE TO BECOMING A LIVING KIDNEY DONOR LIVING DONOR GUIDE A GUIDE TO BECOMING A LIVING KIDNEY DONOR THE ERMA BOMBECK PROJECT The life force of Erma was always optimism and hope. It sustained her throughout her family life and her career and

More information

GUIDELINE. Cadaveric Organ and Tissue Donation and Transplantation

GUIDELINE. Cadaveric Organ and Tissue Donation and Transplantation GUIDELINE Cadaveric Organ and Tissue Donation and Transplantation Purpose The purpose of this guideline is to support ethical and clinically consistent, effective and safe organ and tissue donation for

More information

Understanding. Chronic Kidney Disease

Understanding. Chronic Kidney Disease R E N A L R E S O U R C E C E N T R E Understanding Chronic Kidney Disease Causes of Chronic Kidney Disease Most causes of chronic kidney failure are diseases that are not usually accompanied by symptoms

More information

Detecting and managing Chronic Kidney Disease

Detecting and managing Chronic Kidney Disease Detecting and managing Chronic Kidney Disease KCAT Primary Care Nurse Workshop Conceived and developed by the Kidney Check Australia Taskforce sub-committee for education in nursing in general practice

More information

Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality

Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality C. Tomas, MA Castel, E Roig, I. Vallejos, C. Plata, F. Pérez-Villa Cardiology Department,

More information

2014 Physician Quality Reporting System Data Collection Form: Coronary Artery Bypass Graft (CABG) (for patients aged 18 years and older)

2014 Physician Quality Reporting System Data Collection Form: Coronary Artery Bypass Graft (CABG) (for patients aged 18 years and older) 2014 Physician Quality Reporting System Data Collection Form: Coronary Artery Bypass Graft (CABG) (for patients aged 18 years and older) Physician Name: Patient Name: Last First MI Date of Birth: / / mm

More information

Getting A New Pancreas Facts About Pancreas Transplants

Getting A New Pancreas Facts About Pancreas Transplants Release Date October 1, 2003 Revised December 2006 Revised March 2012 Getting A New Pancreas Facts About Pancreas Transplants American Society of Transplantation 1120 Route 73, Suite 200 Mount Laurel,

More information

The Burden Of Diabetes And The Promise Of Biomedical Research

The Burden Of Diabetes And The Promise Of Biomedical Research The Burden Of Diabetes And The Promise Of Biomedical Research Presented by John Anderson, MD Incoming Chair, ADA s National Advocacy Committee; Frist Clinic, Nashville, TN Type 1 Diabetes Usually diagnosed

More information

Kidney Transplant Education. For the Pretransplant Patient

Kidney Transplant Education. For the Pretransplant Patient Kidney Transplant Education For the Pretransplant Patient Indiana University Health University Hospital Welcome Welcome to Indiana University Health Transplant. We have partnered with Indiana University

More information

Chronic Kidney Disease (CKD) Stages. CHRONIC KIDNEY DISEASE Treatment Options

Chronic Kidney Disease (CKD) Stages. CHRONIC KIDNEY DISEASE Treatment Options 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 information

Talking About Living Kidney Donation with Family and Friends

Talking About Living Kidney Donation with Family and Friends Talking About Living Kidney Donation with Family and Friends Purpose of this guide Y ou may be a person who has kidney disease. Perhaps you know someone with kidney disease. Talking about kidney disease

More information

Chapter 24: Renal Transplantation in the Older Adult

Chapter 24: Renal Transplantation in the Older Adult Chapter 24: Renal Transplantation in the Older Adult Erica L. Hartmann Abdominal Organ Transplant Program, Department of Internal Medicine-Nephrology, Wake Forest University Health Sciences, Winston-Salem,

More information

A07/S/a NHS STANDARD CONTRACT FOR ADULT KIDNEY TRANSPLANT SERVICE SCHEDULE 2 THE SERVICES A. SERVICE SPECIFICATIONS. Service Specification No.

A07/S/a NHS STANDARD CONTRACT FOR ADULT KIDNEY TRANSPLANT SERVICE SCHEDULE 2 THE SERVICES A. SERVICE SPECIFICATIONS. Service Specification No. A07/S/a NHS STANDARD CONTRACT FOR ADULT KIDNEY TRANSPLANT SERVICE SCHEDULE 2 THE SERVICES A. SERVICE SPECIFICATIONS Service Specification No. Service Commissioner Lead Provider Lead Period Date of Review

More information

Another option... Although African Americans make up only about 13% of the national population, they comprise nearly 35% of

Another option... Although African Americans make up only about 13% of the national population, they comprise nearly 35% of Another option... Although African Americans make up only about 13% of the national population, they comprise nearly 35% of national kidney waiting list candidates. The average African American kidney

More information