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Kidney Transplantation PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Kidney Transplantation" by Nebraska Medicine.

This medical PowerPoint presentation talks about Kidney Transplantation.
Kidney transplantation is a surgical procedure in which a healthy kidney from a donor is placed into a person with kidney failure or end-stage renal disease (ESRD). The transplanted kidney takes over the work of filtering waste and excess fluids from the blood, as well as regulating the levels of electrolytes in the body.

Tags : Kidney Transplantation, surgical procedure, kidney failure, end-stage renal disease

Published on : Mar 19, 2023 | Views : 3100 | Downloads : 5

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Slide 1-

Kidney Transplantation Presented by Nebraska Medicine Revision date: 11/11/2021
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Agenda Review treatment options for End-Stage Renal Disease (ESRD) Review of kidney transplant options Overview of the evaluation process Care partner support Review of the listing process The surgery Post-transplant Transplant outcomes
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Treatment Choices for ESRD Medical Management Hemodialysis Peritoneal dialysis Deceased donor kidney transplant Living donor kidney transplant
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Benefits of Kidney Transplantation Improved life expectancy Decrease cardiovascular events (stroke, heart attack, etc) Improve Quality of Life Less expensive than dialysis
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Quality of Life Considerations: Dialysis/Transplant Transplant: The number of medications you take may increase or decrease Pain/Recovery from surgery Fatigue typically improves Usually fewer dietary limitations (eating healthy is important though) Freedom Infections Most report improved quality of life Tonelli, M, et. Al. AJT. 2011;11(10):2093-2109. Dialysis: Fatigue Dietary/Fluid Restriction Cramping Nausea Time Investment Infections Pain
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Demand >> Supply: Critical Organ Shortage SRTR Annual Report, 2015 Roughly 100,000 patients waiting for a kidney transplant National average waiting time is more than 5 years for a deceased donor kidney! National Statistics: >3000 patients added to wait list each month ~13 people die per day while awaiting a kidney transplant
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Who should be considered for a kidney transplant? All patients with ESRD (transplant discussion mandated by CMS) Patients with advanced Chronic Kidney Disease Ideally should be evaluated early (well before starting dialysis). GFR must be <20 ml/min on at least one occasion to be actively listed (although patients can be seen before that) The best outcomes occur when transplant is done before starting dialysis (pre-emptive) or with minimal dialysis time No fixed age restrictions Transplantation is not a cure, but a treatment option for eligible candidates
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Contraindications to transplant? Absolute Exclusion Criteria Active Malignancy Active uncontrolled infection Unstable psychiatric or psychosocial condition (i.e. substance abuse, non compliance, inadequate social support, history of considerable non-compliance) Limited life expectancy Untreatable or advanced cardiovascular or pulmonary disease (CHF, CAD, CVA, PAD)
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Recipients of a Kidney Transplant Have a Longer Life Expectancy Than Patients Who Remain on Dialysis 9 a Data are from the United States Renal Data System (USRDS) 2014 Annual Data Report; estimates are from 2012. USRDS. 2014 ADR chapters. http://www.usrds.org/2014/view/default.aspx. Accessed February 11, 2016. Expected remaining lifetime for recipients of a kidney transplant compared with patients on dialysis (across sexes and various races)a Based on estimates from 2012, recipients of a kidney transplanthad about 2.5 times more remaining years of life than patients on dialysis
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The Kidney Transplant Team
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Steps in the Evaluation Process
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Cost of a Transplant
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Financial / Pharmacy Questions You are assigned a financial counselor and pharmacy financial counselor Your pharmacy financial counselor will assist with prescription coverage post transplant and the benefit of using our Specialty Pharmacy at Nebraska Medicine that is dedicated to our transplant patients You will meet with them as part of your evaluation to discuss insurance coverage Ask questions: - What will my out-of-pocket costs be? - Do I need a supplemental insurance policy? - Do I have travel and lodging benefits? - How much will my medications cost? You must inform the transplant team of insurance changes
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Types of Transplants
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Living Donor vs. Deceased Donor Patient survival and graft survival is better (in other words, patients who receive a living donor kidney transplant live longer and have healthier kidneys that last longer) The kidney is from a healthy person who has undergone a thorough medical evaluation Surgery happens at the same time Transplanted sooner when you have a living donor The longer a person is on dialysis, the higher rate of medical complications. Living donation can happen sooner than waiting on a list therefore decreasing complications
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1-, 5- and 10-Year Graft Survival Rates Data from the USRDS 2014 Annual Data Report; 1-year data are from 2011, 5-year data from 2007, and 10-year data are from 2002.
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Living Donors Donor will complete a separate evaluation Will have a different set of providers and decision makers to ensure it is safe to donate We will not compromise donor safety Donor information is kept confidential Potential donors should fill out form online: nebraskamed.com/kidneydonor
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Living Donor Kidney Options
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Internal Exchange Option
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Types of Deceased Donors Standard brain dead donor Donation after circulatory death: (on life support, wait for the heart to stop then additional five minutes, no difference in long term patient or organ, survival or complications). Public Health Services (PHS) Donor Risk Criteria: Many organs become available from donors who have been identified to have certain risk factors that may increase your chances for acquiring certain viral infections such as Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C. If an organ becomes available from a donor with a known PHS risk criteria (examples: IV drug use, jail time, multiple sexual partners, etc.), you will be told that it is a donor that meets risk criteria and that you have the option to decline the organ offer. Organs received from a donor meeting risk criteria does not imply that there will be reduced functionality of the organ. All transplant recipients are required to have blood drawn 4-8 weeks after transplant for HIV, Hepatitis B & Hepatitis C and results of the testing will be submitted to UNOS. If you test positive for any of these 3 tests, the transplant center will contact you to coordinate treatment.
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More About PHS Risk Criteria Program Offers The tests we use to look for HIV, Hepatitis B and Hepatitis C are extremely good, but as with every test, there is a small chance that the test is negative even if the virus is present. A negative test might occur if the donor had a very recent infection. For this reason, we identify donors who have potential exposures for HIV, Hepatitis B and Hepatitis C in the last month that might be missed by our testing. When offered a donor meeting risk criteria, you should also consider that your chance of dying while waiting for another organ offer may be greater than the risk of infection. The risk of missing an infection is around 1 in 10,000 to 1 in a million depending on the risk criteria. While this risk is very low, it is important for all organ recipients to know that a small risk exists and for this reason all recipients will be tested for these viruses after transplantation.
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Types of Deceased Donors Hepatitis B donors: (are offered to a patient who is immune to Hepatitis B either from prior exposure or vaccination) Hepatitis C donors: You may be offered a kidney from a deceased donor who tests positive for Hepatitis C. You will have talked with a member of the kidney transplant team during your initial evaluation to be specially listed for these types of kidneys. A comprehensive medical assessment will be performed, including tests of your liver, to see if these kidneys are right for you. If so, post-operatively you will be given medical treatment if you contract hepatitis C and you may meet with a hepatologist. Post-operatively, in addition to your regular immune suppression medications, you may take 1 or 2 extra pills for a few months to eradicate the HCV virus. These pills are generally tolerated quite well, and are covered by your insurance. In general, accepting a kidney from a donor with HCV may significantly reduce your time on the waiting list, while ensuring excellent kidney allograft function in the future. The health of people who receive a kidney transplant is better than the health of people on long-term dialysis. This makes getting a kidney transplant the top priority. Since hepatitis C can be cured without too many side effects, this is now considered an option to transplant more people. At Nebraska Medicine, we have successfully transplanted over 50 people to date with HCV+ kidneys, all of whom have done well post-operatively from a viral standpoint.”
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Types of Deceased Donors Covid Positive Donors: You may be offered a kidney from a deceased donor who tests positive for Covid-19 or has previously been infected with Covid-19. During evaluation from the transplant team, which included input from our transplant infectious disease colleagues, we believe the risk of transmission of Covid-19 to you is very low as a kidney transplant recipient. To date, no confirmed transmission of SARS-CoV-2 from donor to recipient via non-lung organ transplantation has been reported; surveillance is ongoing. Long-term effects of utilizing organs from previously known Covid-19 positive donors is unknown.
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Kidney Donor Profile Index (KDPI) KDPI greater than 85%: The national network (OPTN) is responsible for allocating kidneys and coordinating transplants “Score” assigned to every kidney being offered for transplant its called Kidney Donor Profile Index this score is from 0-100%, this score is based on how the kidney will work: The score is made up of these donor factors: Weight Height Ethnicity Cause of Death (brain vs. head) Stroke as cause of death High Blood Pressure Diabetes Hepatitis C virus Serum Creatinine (a measurement of how the kidney is working) Age A person will be consented for Kidneys over the score of 85% We will not discuss the score of the kidney at any time. We will only notify you if the score is greater than 85%, which your consent is needed to accept this kidney Each offer is screened by the surgeons, this score is only one factor when accepting as offer
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KDPI There are certain situations where a kidney will be given a high KDPI score that is not reflective of the actual quality of the kidney (ex: some pediatric kidneys or en bloc kidneys) As such, limiting KDPI acceptance threshold has the potential to cause a candidate to miss out on some high quality donor kidneys that are expected to perform better than suggested by the KDPI We recommend candidates are listed for all KDPI kidneys in order to increase the opportunity to receive a timely kidney transplant All donor kidneys are carefully screened by our surgeons to ensure the right kidney is given to the right patient Consent is required in order to be listed for kidneys with KDPI >85%
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Possible Outcomes of Evaluation Additional testing needed for team to determine candidacy Must be completed within 6-months of evaluation starting today Placement on the Wait List Not approved as candidate - risk of transplant outweighs potential benefits: Do No Harm
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Listing If you are placed on the National Kidney Wait List managed by the United Network for Organ Sharing (UNOS), you will be notified via phone call and letter The order on the list is driven by the length of time you are on the list, time on dialysis, antibody levels, and age (pediatrics) The type of offer will be explained to you and you have the right to refuse a kidney offer. NO Donor information will be shared
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Wait List Responsibilities Annual testing; however, some patients may be seen more often Make sure you continue to have a reliable care partner with reliable transportation and a reliable cell phone at all times with voice mail. Monthly HLA Antibody testing Notify your nurse coordinator of any changes: To your insurance, contact information which includes phone numbers, MEDICAL CONDITIONS, any dialysis changes, including changing nephrologists, travel plans
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While on the Wait List
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Receiving an Organ Offer We must be able to contact you within 15 minutes You must have dependable transportation Your care partner must come with you and be present during your hospital stay from 9:00-4:00 We will not share personal information pertaining to your donor at any time There’s a possibility the transplant may fall through at any time
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What to Expect When Called in for Transplant When called with a transplant offer: We have 15 minutes to reach you or someone who will know where you are for the organ acceptance Primary offer Back up offer Coordinator will not discuss personal donor information with you We will inform you where to go and what to do when we call you in for transplant, you need to bring your care partner with you Pack a bag to include: Bottles of home medications All recipients need to anticipate staying in the Omaha area for 6 weeks post transplant. Your individual stay will be dependent on your transplant admission course. Your length of stay in the Omaha area will be discussed at your first clinic visit. Omaha area is considered 1 hour away from the transplant center.
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The Surgery 2-3 hour surgery Kidney attached in the front of body, near the bladder Will stay on Clarkson’s 5th floor Usual hospital stay is 3 to 4 days Up and moving same day of surgery A ureteral stent will be placed and removed six weeks after transplant in an outpatient procedure A foley catheter will be placed and removed post op day 3 Follow your clinical pathways inpatient
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Potential Outcomes of Transplant  = Kidney works immediately (70-80%)  = Slow or delayed graft function; you may need dialysis after transplant (20-30%)  = Fail immediately (1%)
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Complications from Transplant Surgical: Bleeding Wound complications Fluid collections Urinary complications Medical: Infections Rejection Weight gain Diabetes Cancer Hypertension GI side effects
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Daily Bathing Decreases Infection All people have harmful germs or harmful bacteria on their body These germs and bacteria can cause infections after surgery You will be asked to take a shower at the time of admission for surgery You will be asked to shower daily following your surgery Taking a shower prior to surgery and a shower daily following surgery CAN prevent infection
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Post-Transplant Compliance *Please note that visits and lab draws may vary depending on your kidney.
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Medications for Transplant 3 anti-rejection/immunosuppression medications: Prograf Myfortic/Cellcept Prednisone 3 anti-infective medications: Bactrim Valcyte Nystatin Other medications for: Hypertension Gout Diabetes Cholesterol Heartburn Total Medications: 10 to 18 You can not CRUSH, CHEW OR BREAK your antirejection medications
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Pancreas Transplant Only pertains to Type 1 diabetics Evaluation similar to that for kidney transplant Options include pancreas transplant alone, or simultaneous kidney-pancreas, if renal failure present Longer operation, more extensive surgery than kidney transplant alone Higher risk of early failure Medications and long-term risks similar
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Important Information We are recommending that all our patients receive their Hepatitis B vaccine prior to transplant. The hepatitis B vaccine is a vaccine that prevents getting hepatitis B if you are exposed. It is a requirement from United Network of Organ Sharing that a discussion with your transplant team takes place with our recommendations. You will receive a transplant education book, blood pressure machine and a thermometer during your hospital stay. You must contact your pharmacy 7 to 10 days in advance for refills. You will take your medications AFTER your lab draws. You will need to take your blood pressure/heart rate twice a day morning and night, morning temperature, morning weight. This information will be reviewed with your transplant team during clinic visits.
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Transplant Outcomes For updated Scientific Registry for Transplant Recipients (SRTR) data visit us online at: www.nebraskamed.com/transplant
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Repay the Gift You are Given Take your medications Have your labs drawn Go to your physician appointments Maintain relationship with your local nephrologist Call if you have questions: Toll free: 1-800-401-4444 or (402) 559-5000
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Expectations During Visits with Care Providers During your evaluation/interview today, various team members may be asking about the following issues: Financial situation Medical history Psychosocial situation All discussions remain confidential within the transplant team. If there are items that you do not feel comfortable discussing in front of your care partner, please let us know if you would like your care partner to step out during certain discussions
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Next Steps Sign evaluation acknowledgement and listing letter of understanding Finish your evaluation and ask questions Make sure a care partner is present throughout the process Find a living donor! Follow your medical recommendations from your nephrologist and/or dialysis team Get the word out and share your story
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Quiz Are you on the kidney transplant Wait List by coming to this appointment? What is the website you should refer living donors to? Will you have more testing to complete? Will you have to do anything while on the list? Does transplant cure end-stage renal disease (ESRD)? Does your care partner need to be present with your during your evaluation and transplant?
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Consent Forms Evaluation Acknowledgement Form
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Consent Forms Listing Form
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Questions?
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