PD, Catheter Exit Site PD, Catheter Exit Site OptionsOptions

PD catheters : lap vs PD catheters : lap vs openopen

Pre-sternal PD catheterPre-sternal PD catheter

Chronic Perm Cath PatientsChronic Perm Cath PatientsPossible SolutionsPossible Solutions

Second Surgical OpinionSecond Surgical Opinion

ImagingImaging

Unusual Access Procedures: Fem Grafts, Unusual Access Procedures: Fem Grafts, Necklace GraftsNecklace Grafts

PDPD

HeRO cathetersHeRO catheters

HeRO cath-graft HeRO cath-graft right central vein occlusionright central vein occlusion

Kidney Kidney TransplantationTransplantation

Not for everyone !Not for everyone !

Transplantation versus Transplantation versus DialysisDialysis

Treatment option and not a cureTreatment option and not a cure Quality of LifeQuality of Life

time constraints of dialysistime constraints of dialysis return to workreturn to work

Life ExpectancyLife Expectancy CostCost

dialysis cost remains constantdialysis cost remains constant transplantation cost reduces after first year transplantation cost reduces after first year

to 1/3 cost of dialysisto 1/3 cost of dialysis

Notable BreakthroughsNotable Breakthroughs Immunosuppressant DrugsImmunosuppressant Drugs Tissue typingTissue typing Organ recovery & preservationOrgan recovery & preservation Surgical techniquesSurgical techniques Non-traditional donor sourcesNon-traditional donor sources

Post Transplant SuccessPost Transplant Success

Deceased Donor Kidney Recipients

Live Donor Kidney Recipients

1 Year 94.5% 97.9%

5 Year 81.8% 90.5%

UNOS, 2009

Transplant Team Transplant Team MembersMembers

Transplant CoordinatorTransplant Coordinator NephrologistNephrologist Transplant Nurse Practitioner/ Physician Transplant Nurse Practitioner/ Physician

AssistantAssistant SurgeonSurgeon Social WorkerSocial Worker DieticianDietician Financial CoordinatorFinancial Coordinator PsychologistPsychologist

Evaluation OverviewEvaluation Overview

Meet all team membersMeet all team members Review medical and social historyReview medical and social history Answer questionsAnswer questions Determine plan for further testingDetermine plan for further testing

Health screeningHealth screening Cardiac, Pulmonary, Urologic, AnatomicCardiac, Pulmonary, Urologic, Anatomic

Consent FormsConsent Forms

Your ResponsibilitiesYour Responsibilities

Be active in your evaluationBe active in your evaluation Keep all of your appointmentsKeep all of your appointments Recommend stop smokingRecommend stop smoking Limit alcohol intakeLimit alcohol intake No illegal drug useNo illegal drug use Ask questionsAsk questions

Compatibility Testing

Step #1 ABO Testing Determination of blood type Require blood typing on two separate blood draws

ABO CompatibilityRecipient Blood Type Donor Blood Type

O OA O, AB O, BAB O, A, B, AB

Matching Donors & Matching Donors & RecipientsRecipients

ABO groupABO group HLA (Human Leukocyte HLA (Human Leukocyte

Antigen)Antigen) Proteins located on surface Proteins located on surface

of white blood cellsof white blood cells Inherited from parents.Inherited from parents.

PRA (Panel Reactive Antibody)PRA (Panel Reactive Antibody) Measurement of anti-HLA Measurement of anti-HLA

antibodiesantibodies CrossmatchCrossmatch

Donor lymphocytes mixed Donor lymphocytes mixed with recipient serumwith recipient serum

Sources of AntibodiesSources of Antibodies

Previous transplant Previous transplant Blood transfusionsBlood transfusions PregnanciesPregnancies VirusesViruses VaccinationsVaccinations Unknown factorsUnknown factors Approximately 30% of patients on Approximately 30% of patients on

the kidney transplant list are the kidney transplant list are sensitizedsensitized

Benefits of Living Donation

Avoid long waiting time of 3-5 years Avoid or Limit time on dialysis Kidney usually works right away Kidney works longer Less recovery time in hospital Transplant can be scheduled at a

convenient time

Paired Kidney ExchangePaired Kidney Exchange When donor and recipient are When donor and recipient are

incompatibleincompatible Incompatible blood typeIncompatible blood type Positive CrossmatchPositive Crossmatch

Uses a computer optimization Uses a computer optimization program to match incompatible pairsprogram to match incompatible pairs

What if my Donor is not What if my Donor is not a Match?a Match?

ImmunosuppressionImmunosuppression

Medicines to prevent rejection of Medicines to prevent rejection of new organnew organ

Medicines are taken every day Medicines are taken every day These medicines are needed for the These medicines are needed for the

rest of your life!rest of your life! Side effect of increased risk of Side effect of increased risk of

infection and cancerinfection and cancer

ImmunosuppressionImmunosuppression

Triple RegimeTriple Regime PrednisonePrednisone Cellcept/ Mycophenolate MofetilCellcept/ Mycophenolate Mofetil Prograf/ TacrolimusPrograf/ Tacrolimus

Making the ChoiceMaking the Choice

Complicated processComplicated process Make sure that transplant is right Make sure that transplant is right

for youfor you Weigh the risks and benefitsWeigh the risks and benefits Another form of kidney therapy, not Another form of kidney therapy, not

a curea cure