Clinical Management of the HIV Infected Transplant Recipient:

How to Balance the Needs of the Patient and the Health Care Team

Clinical Management Questions

1. What are the challenges of facilitating communication among the numerous members of the study team?

2. Is it acceptable to limit access to transplantation due to geographic proximity to the transplant center because of the complex nature of the treatment involved?

3. Given the complex clinical nature of this undertaking and the busy schedules of all involved, what are the minimum components of an appropriate transplant team for the study?

Transplant Study Team

1. Primary HIV provider* 2. Referring Nephrologist

or Hepatologist 3. Transplant Surgeons*

(7) 4. HIV Study Consultant* 5. Transplant

Hepatologists (7), Nephrologists (4)

6. Pre/Post Transplant Coordinators (11)

7. Study Pharmacologist* 8. Patient/family 9. Study Coordinator*

Purpose of Communication

1. Information Dissemination2. Patient Scheduling3. Decision Making

Communication Challenges

1. Delays in response2. Lack of consensus3. Shared decision making4. Identify primary decision maker5. Integrating theoretical information into

practice6. Access to pertinent information

Communication Goals

1. Facilitate discussion2. Opportunities for interdisciplinary

education3. Shared decision making4. Timely and efficient process5. Positive patient outcomes

Limitations to Transplant

1. Selective study inclusion criteria2. HCV co-infection3. Economic barriers4. Only 14 centers transplanting the HIV

infected individuals5. Geographic proximity to transplant

center?!

Is Distance a Factor?

8 people transplanted4 in SF area, 4 in Southern CaliforniaPatients in SF area =no rejection, no

hospitalization, no SAEs Patients out of area = all hospitalized,

many complication, 2/3 rejectionCoincidental??

Challenges Posed by Distance

1. Variabilites between labs2. Delays in receiving and reviewing labs3. Delays in decision making4. Patient management without direct

assessment5. Negotiating care plan with patient6. Primary provider is HIV MD not

Transplant MD

Who Should Comprise the Study Team?

1. Transplant Surgeon2. HIV Consultant2. Transplant Nephrologist/Hepatologist3. Pharmacologist4. Study Coordinator