Making the Most at the Margins Improving Organ Utilization and Recipient Outcomes. Jared C Brandenberger MD UNOS Region 6 Educational Forum March 6, 2015.

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Presentation transcript:

Making the Most at the Margins Improving Organ Utilization and Recipient Outcomes. Jared C Brandenberger MD UNOS Region 6 Educational Forum March 6, 2015

© 2014 Virginia Mason Objectives Review current trends in recipient and donor populations. Review donor and transplant trends at Virginia Mason over the past 5 years Review the use of unconventional donors in our program 2

© 2014 Virginia Mason Need As of 07:12AM 03/05/15: –101,585 patients on the kidney waitlist 16,894 total transplants in 2013 –11,161 Deceased donor –5,733 living donor –13,124 Jan-Nov % Dialysis patients die annually Wolfe et al. NEJM, 1999 OPTN data

© 2014 Virginia Mason Need 2011 OPTN Annual Report

© 2014 Virginia Mason Need 2011 OPTN Annual Report

© 2014 Virginia Mason Recipient Age OPTN Data

© 2014 Virginia Mason Expanded Recipient Population Older recipients Recipients with higher immunologic risk Desensitization HIV positive recipients

© 2014 Virginia Mason Need Renal Transplantation is safe –Survival advantage –Quality of life Recipient age and complexity are increasing Organ supply is not Port et al. JAMA, 1993 Russel et al. Transplantation, 1992

© 2014 Virginia Mason 9

Use of Unconventional Donors 10

© 2014 Virginia Mason Use of Unconventional Donors 11

© 2014 Virginia Mason Outcomes 12

© 2014 Virginia Mason ECD/KDPI >85% Donor –67 yo female fall from ladder –KDPI 94% –CDC increased risk - hemodilution –Height 5'5'' Weight 50kg, BMI 18 –Terminal creat 1.4 (Admit 0.9) –Biopsy shows 5-15% sclerosis 13 Recipient –70-year-old female –CPRA 0% –53 kg –CKD V 2/2 DM

© 2014 Virginia Mason ECD/KDPI >85% 2 for 1-Dual grafts 3mg/kg thymo induction Low intensity belatacept protocol (mmf, pred 5) Early BK Nephropathy-Resolved Creat Nadir 1.2 and stable at 1yr 14

© 2014 Virginia Mason ECD/KDPI >85% 15 Hefty et al. Urology, 1998

© 2014 Virginia Mason ECD/KDPI >85% 1.5 to 3 year wait time 98% overall graft survival last 5y 87.0%; 61.7%; 30.5% - 1, 3, and 5 yr survival nationwide Creation of local expedited placement list 16 SRTR Data