kidney transplant bcbs presentation · benefits of kidney transplantation •freedom from dialysis...

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What’s new in PKD: A day of learning Transplant Evaluation

Tammy Kozel, RN,CCTC

March 25, 2017

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Objectives

• Discuss who is a candidate for kidney transplant

• Discuss referral process

• Discuss evaluation process

• Provide overview of kidney transplant

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Mayo Clinic Locations

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Pre-Transplant RN Care Coordinators

• Deb Dicke-Henslin, RN, CCTC

• Lynette Fix, RN,CCTC

• Tammy Kozel, RN,CCTC

• Carla McDonough, RN

Pediatric RN Care Coordinator

• Therese Moore, RN,CCTC

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• Renal transplant is the standard of care for end stage renal failure

• Mortality rates on dialysis up to 25%

• One year patient survival rate 99.7%

• Improved quality of life

• Returning to work

• Early referral to transplant center best before dialysis if possible

Why Transplant?

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Kidney Transplant

• Is a treatment for some people

• Is NOT a cure for renal failure

• No guarantees

• Organ may never work

• Infection

• Rejection

• Disease may reoccur

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Benefits of Kidney Transplantation

• Freedom from dialysis

• Increased feeling of well-being

• Few restrictions on your diet and activities

• Increased energy level

• Live longer with better health

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Eligibility for Transplant

• Estimated GFR < 20 or on dialysis

• BMI < 40

• Psychosocial clearance

• Financial clearance

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Referral Process

• Contact number to Transplant Center:

866/249-1648 (toll-free)

• Fax demographics and medical information within last year to:

507/266-3519

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Referral Process

• Who can refer a candidate?

• Phone screen with RN care coordinator

• Kidney transplant evaluation arranged once insurance approval obtained

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Absolute contraindications

• Inability to comply with transplant-related management and medical follow up

• Active malignant neoplasm

• Active infectious disease

• Severe immune deficiency state

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Absolute contraindications

• Technical inability to perform the transplant surgery

• Cannot safely undergo anesthesia

• Life expectancy < 5 years

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Mayo Model Of Care

• Recognized for having teams of specialists who work together

• Multidisciplinary team – nephrologist, surgeon, RN care coordinator, social worker, dietician, pharmacist, endocrinology, cardiology, psychiatry, NPs/PAs, financial representative

• Collaboration with local providers

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Recipient Evaluation

• Outpatient over 3-4 days

• Blood work/urine tests

• Chest x-ray/EKG

• MRI head for PKD patients

• Cardiac testing

• Cancer screening tests

• Education class

• Consults with team members

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Pretransplant Process

• Education class for pretransplant candidates

• Discuss transplant process, anti-rejection medications and potential side effects, surgical procedure, hospital course, and follow-up care

• Selection Conference- multidisciplinary team

• Approved

• Deferred

• Not approved

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Types of Transplants

• Living donors

• Living related

• Living unrelated

• Paired Donation

• Deceased donors

• Average waiting time is 3-6 years

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Organ Donation and Transplant

• 118,561 people awaiting organ transplants (as of 2/19/17)

• Median wait time for first kidney is 3.6 years

• In 2015, 17,878 kidney transplants in US

• 5,989 living donors in 2015

• YTD 1,322 total donors as of 2/16/17 with 2,802 transplants

• 30,974 organ transplants in US in 2015 www.unos.org (Feb. 19, 2017) OPTN.Transplant.hrsa.gov (Feb. 17, 2017)

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Organ Donation and Transplant

• 3,000 people added to kidney waiting list each month

• 22 people die each day waiting for a kidney

• Every 10 minutes someone is added to the list

• 1:8---one donor can save 8 lives

www.unos.org (Feb. 19, 2017)

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Benefits of Living Donation

• Living donation provides best long-term outcome for recipient

• Pre-emptive

• Living donor transplants provide shorter waiting time

• Lower rate of delayed graft function

• Improved long-term graft and patient survival

• Surgery “donor friendly” with the hand-assisted laparoscopic donor nephrectomy

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Living Kidney Donors

• 18 years of age or older

• Blood pressure under good control

• Cannot be diabetic

• No cardiac disease

• No active infection

• No active cancer

• Overall good health

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Matching Donor to Recipient

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Crossmatch Results

You do not have antibodies

against the donor

Negative Crossmatch

You do have antibodies

against the donor

Positive Crossmatch

Weak Moderate Strong

Positive result Negative result

Transplant Transplant Plasmapheresis

then transplant Incompatible donor

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Kidney Paired Donor Program

• Reasons for KPD:

- Blood incompatible

- Donor specific antibodies

- EBV/CMV mismatch

- Age/size mismatch

- Compatible/altruistic

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Paired Donation

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Surgery

• Your kidneys are not removed

• Donor kidney placed in abdomen

• Surgery lasts 2-4 hours

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At the Hospital

• 3-4 day hospital stay

• Begin taking

anti-rejection

medications

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Post transplant

• Outpatient stay in Rochester for 3-4 weeks post transplant for close follow up

• Labs and medical assessment every 1-2 days

• Intense education focus throughout entire transplant process

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Post Transplant Goals

• Preparation for dismissal to home

• Patient education – critical to assure best outcome

• Partnership – Local physician, recipient, Mayo Clinic

• Best outcomes – compliance with post transplant protocols

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Long Term Follow Up

• Cardiovascular health

• Blood pressure control

• Lipid management

• Nutrition and fitness

• Glucose control

• Compliance with medications/lab draws and appointments

• Protocol biopsy (4 month, 1, 2, 4, 7, and 10 years post transplant)

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Summary

• Transplant is a treatment not a cure

• Includes a lifetime of medical management

• Can improve quality of life

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Thank You

Mayo Clinic Transplant Center

866/249-1648

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Questions & Discussion