pd, catheter exit site options
DESCRIPTION
PD, Catheter Exit Site Options. PD catheters : lap vs open. Pre-sternal PD catheter. Chronic Perm Cath Patients Possible Solutions. Second Surgical Opinion Imaging Unusual Access Procedures: Fem Grafts, Necklace Grafts PD HeRO catheters. HeRO cath-graft right central vein occlusion. - PowerPoint PPT PresentationTRANSCRIPT
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
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