PD, Catheter Exit Site Options
PD catheters : lap vs open
Pre-sternal PD catheter
Chronic Perm Cath Patients
Possible Solutions
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Second Surgical Opinion
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Imaging
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Unusual Access Procedures: Fem Grafts, Necklace
Grafts
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PD
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HeRO catheters
HeRO cath-graft
right central vein occlusion
Kidney
Transplantation
Not for everyone !
Transplantation versus Dialysis
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Treatment option and not a cure
Quality of Life
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time constraints of dialysis
return to work
Life Expectancy
Cost
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dialysis cost remains constant
transplantation cost reduces after first year to 1/3 cost of
dialysis
Notable Breakthroughs
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Immunosuppressant Drugs
Tissue typing
Organ recovery & preservation
Surgical techniques
Non-traditional donor sources
Post 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 Members
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Transplant Coordinator
Nephrologist
Transplant Nurse Practitioner/ Physician Assistant
Surgeon
Social Worker
Dietician
Financial Coordinator
Psychologist
Evaluation Overview
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Meet all team members
Review medical and social history
Answer questions
Determine plan for further testing
Health screening
 Cardiac, Pulmonary, Urologic, Anatomic
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Consent Forms
Your Responsibilities
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Be active in your evaluation
Keep all of your appointments
Recommend stop smoking
Limit alcohol intake
No illegal drug use
Ask questions
Compatibility Testing

Step #1
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ABO Testing
Determination of blood type
Require blood typing on two separate blood draws
ABO Compatibility
Recipient Blood Type
O
A
B
AB
Donor Blood Type
O
O, A
O, B
O, A, B, AB
Matching Donors & Recipients
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ABO group
HLA (Human Leukocyte Antigen)
 Proteins located on surface of white
blood cells
 Inherited from parents.
PRA (Panel Reactive Antibody)
 Measurement of anti-HLA
antibodies
Crossmatch
 Donor lymphocytes mixed with
recipient serum
Sources of Antibodies
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Previous transplant
Blood transfusions
Pregnancies
Viruses
Vaccinations
Unknown factors
Approximately 30% of patients on the kidney
transplant list are sensitized
Benefits of Living Donation
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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
What if my Donor is not a Match?
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Paired Kidney Exchange
When donor and recipient are incompatible
Incompatible blood type
 Positive Crossmatch
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Uses a computer optimization program to match
incompatible pairs
Immunosuppression
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Medicines to prevent rejection of new organ
Medicines are taken every day
These medicines are needed for the rest of your life!
Side effect of increased risk of infection and
cancer
Immunosuppression

Triple Regime
Prednisone
 Cellcept/ Mycophenolate Mofetil
 Prograf/ Tacrolimus
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Making the Choice
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Complicated process
Make sure that transplant is right for you
Weigh the risks and benefits
Another form of kidney therapy, not a cure