UNIVERSITY OF UTAH SCHOOL OF MEDICINE Donor Management Goals:

Slides:

Advertisements

Similar presentations

Maximizing the Yield from the Liver Donor Pool A.Joseph Tector MD PhD Department of Surgery Indiana University School of Medicine.

Advertisements

Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index American Journal of Transplantation 2006; 6: 783–790 S. Fenga, N.P.

30-Year Retrospective on Organ Transplant Immunosuppression in the Era of Calcineurin Inhibitors Herwig-Ulf Meier-Kriesche, MD Professor of Medicine Department.

Superior outcomes in HIV-positive kidney transplant patients compared to HCV-infected or HIV/HCV co-infected recipients Deirdre Sawinski MD, Kimberly A.

Moderator: Thomas Nakagawa, MD, Wake Forest Baptist Health Presenters: Darren Malinoski, MD, Cedars-Sinai Medical Center Breakout Session A: Optimizing.

Turning Questions into Trials: Innovation in Surgical Oncology Jennifer E. Rosen MD FACS Assistant Professor of Surgery and Molecular Medicine Boston University.

Women and Alport Syndrome Michelle Rheault, M.D. Assistant Professor Division of Pediatric Nephrology University of Minnesota, USA.

Donor Organ Selection Criteria: What is Ideal? A Consensus (?) Discussion.

Extracorporeal Membrane Oxygenation Following Lung Transplantation in Adult ISKANDER AL-GITHMI, M.D., FRCSC, FRCSC (Ts & CDs), FCCP. Assistant Professor.

USRDS Clinical Indicators of Renal Allograft Loss Lawrence Y.C. Agodoa, MD FACP Jon J. Snyder, MS Bertram L. Kasiske, MD Allan J. Collins, MD FACP United.

IL28B in the Era of DAA Therapy: Ten Years Too Late? Donald M. Jensen, MD Professor of Medicine Director, Center for Liver Disease University of Chicago.

Horizon Scanning on organ perfusion

OMICS Group Contact us at: OMICS Group International through its Open Access Initiative is committed to make genuine and.

Kidney Transplant: A Realistic Chance for Elderly Patients Reference: Munnapradist S, Danovitch GM. Kidney transplants for the elderly: Hope or hype? Clin.

Organ Donation in DCD: 10 Year Experience at the University of Michigan A Rojas-Pena, MD; L Sall, BS; K. Koch, BS; E Cooley, RN; M Gravel, RN; R Bartlett,

Comparison of HTK and UW in Abdominal Transplantation Dr. Richard S. Mangus, MD MS Indiana University, School of Medicine.

Why Emergency Physicians Don’t Care about Cardiac Arrest and Should. Robert Swor, DO Professor, Emergency Medicine Oakland University William Beaumont.

AEDs Do Not Improve Survival from In-Hospital Arrest Summary and Comment by Daniel J. Pallin, MD, MPH Dr. Pallin is an attending physician in the Department.

John F. Schnelle, PhD Vanderbilt Center for Quality Aging Professor School of Medicine.

 Exemplary Care  Cutting-edge Research  World-class Education  Raghavan Murugan MD, MS, FRCP Associate Professor Dept. of Critical Care Medicine Clinical.

Setting: The Department of Veterans Affairs Myrtle Beach Community Based outpatient Clinic (CBOC) offers Primary Care services to more than 10,000 veterans,

Barb Supanich, RSM, MD, FAAHPM Holy Cross IP Palliative Care Team November 11, 2010.

5-Azacitidine For Myelodysplasia Before Allogeneic Hematopoietic Cell Transplantation Field T et al. Bone Marrow Transplant 2009:[Epub ahead of print].

MRI as a Potential Surrogate Marker in the ADCS MCI Trial

3 Patrick T Anderson, 2,3 Vivian McAlister, 1,3 Alp Sener, 1,3 Patrick P Luke Divisions of 1 Urology and 2 Surgery, Department of Surgery, 3 Schulich School.

DEFINING A NEW TOOL FOR LIMITING DELAYED GRAFT FUNCTION FOR KIDNEYS IN COLD STORAGE: THE MACHINE PRESERVATION TO COLD ISCHEMIA TIME RATIO Michael J. Goldstein.

Cancer Stem Cells: Some statistical issues  What you would like to do: Identify ways to design studies with increased statistical “power” in clinical.

Welcome and Introduction Lee S. Simon, MD Division Director Analgesic, Anti-inflammatory and Ophthalmologic Drug Products ODEV/CDER.

A 1 Physician’s Perspective: The Impact. A 2 Clinician’s Perspective Bartolome R. Celli, MD Professor of Medicine Tufts University Boston, MA.

EPE C for VE T E R A N S EPE C for VE T E R A N S Education in Palliative and End-of-life Care for Veterans is a collaborative effort between the Department.

Pre-Operative Therapy for Borderline Resectable Pancreatic Cancer: The Potential Role of Chemotherapy Robert A. Wolff, M.D. Associate Professor of Medicine.

Induced Hypothermia After VF Cardiac Arrest Improves Outcomes Summary and Comment by Kristi L. Koenig, MD, FACEP Published in Journal Watch Emergency Medicine.

John A. Kellum, MD, MCCM Professor of Critical Care Medicine, Medicine, Bioengineering and Clinical & Translational Science Vice Chair for Research Director,

EASL view on HCV compassionate use programmes Daniele Prati, MD EASL Governing Board Member Dept. Of Transfusion Medicine and Hematology, Ospedale Alessandro.

Date of download: 6/24/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Year in Cardiovascular Surgery J Am Coll Cardiol.

STUDY OF THE RISK FACTORS OF ACUTE REJECTION AFTER LIVE DONOR RENAL TRANSPLANTATION:A SINGLE EGYPTIAN CENTER EXPERIENCE Ayman M Nagib¹, Ahmed S Elsaied¹,

How Do We Individualize Guidelines in an Era of Personalized Medicine? Douglas K. Owens, MD, MS VA Palo Alto Health Care System Stanford University, Stanford.

Cadaveric vs Living Donation; Comparing Options

Adnan K. Chhatriwalla, MD Saint-Luke’s Mid America Heart Institute

BUONA FUNZIONE RENALE DEI TRAPIANTI RENALI DA DONATORI ANZIANI VALUTATI CON CLEARANCE DELLA CREATININA SECONDO GAULT-COCKCROFT, CON DATI ECOGRAFICI E CON.

When fluids go wrong: CRRT in fluid overload

Stephen Joseph Galli, MD Journal of Allergy and Clinical Immunology

Kidney Transplantation.

Enterprise | Interest Nothing to disclose.

The FDA Early Feasibility Study Pilot and the Innovation Pathway

Preservation of Renal Function: The Key to Long-term Kidney Allograft and Patient Survival.

KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients 순천향대학교 서울병원 신장내과 R2 김윤석.

Definition of Cancer Screening

DEBATE: Timing of CRRT in Critical Care

Dunleavy K et al. Proc ASH 2015;Abstract 472.

C. Chalklin, C. Colmont, A. Zaidi, J. Warden-Smith, E. Ablorsu

T. Rana, L. Szabo, A. Asderakis, E. Ablorsu

Liver Transplantation: 50 years

The Organ Donation Process

Research at the Intersection of Biomarkers and Causal Inference

ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION for MULTIPLE MYELOMA

The Organ Donation Process

Active Surveillance for Low Risk Prostate Cancer

Steroid-free maintenance immunosuppression in kidney transplantation: is it time to consider it as a standard therapy? Fu L. Luan, Diane E. Steffick,

Liver and Intestinal Organ Transplantation Committee

Kidney and Kidney/Pancreas Transplantation in a Year

Welcome Ask The Experts March 24-27, 2007 New Orleans, LA.

Branford S et al. Proc ASH 2013;Abstract 254.

Kaplan–Meier curves for the probability of a first adjudicated primary end-point event in the AMBITION trial, suggesting that the primary outcome events.

Does equal care give equal outcomes?

Clinical Practice Guidelines: What, Why, Who?

Volume 143, Issue 5, Pages (November 2012)

Representative Light Micrographs of Kidney Sections Illustrating the Histologic Scoring Criteria Giuseppe Remuzzi, et al, N Engl J Med 2006;3354:

Analysis of secreted proteins in the discovery panel.

Robert J. Porte, MD, PhD Professor of Surgery

Presentation transcript:

UNIVERSITY OF UTAH SCHOOL OF MEDICINE Donor Management Goals: A Transplant Center Perspective (as viewed by a practicing nephrologist & researcher) Isaac E. Hall, MD, MS Assistant Professor of Medicine University of Utah School of Medicine Department of Internal Medicine Division of Nephrology & Hypertension

Should transplant centers care about DMGs? More DMGs met associates with: more organs procured from those donors (including “expanded criteria donors”)1-3 less delayed graft function (DGF) in kidney transplants4 Increased utilization of livers5 1. Malinoski et al. J Trauma. 2011;71: 990-6 2. Malinoski et al. Crit Care Med. 2012; 40:2773–2780 3. Patel et al. JAMA Surg. 2014; 149:969-75 4. Malinoski et al. Am J Transplant. 2013; 13:993-1000 5. Bloom et al. J Am Coll Surg. 2015; 220:38-47

There are potential challenges/concerns about transplant centers using DMGs. “Not meeting DMGs” could be a new reason to decline offers “# of DMGs met” at a defined time-point or even “change in # met between time-points” may just represent underlying donor characteristics (i.e., not modifiable) A cause-and-effect relationship between DMGs and allograft outcomes is difficult to prove using observational data

How might the field benefit as a whole? If improvements can be made in meeting DMGs: It might increase the organ pool and number of lives saved by transplant It might prolong allograft survival and reduce the need for re-transplantation

DMG data are available for use by centers Centers can consider ongoing review of recent DMG data during regular quality assurance / process improvement (QAPI) meetings For turned-down offers accepted elsewhere, would we have reconsidered if we knew the # of DMGs met had been increasing? It may be premature to use DMG data in real-time to make yes/no decisions about organ offers now

Centers might want to consider DMGs when deciding about early treatments Adjusted odds ratio of DGF when “DMGs met” (≥7 out of 9 DMGs achieved) was about 0.51 Alternatively, can consider the inverse...if at least 7 DMGs not met, DGF was twice as likely If DGF is likely, may be reason to: Therapeutically pump kidney Shorten cold ischemia time Augment induction regimen Delay intro of CNIs More aggressively support BP Preemptively dialyze post-op Consider other novel therapies 1. Malinoski et al. Am J Transplant. 2013; 13:993-1000

Summary – what should centers do with DMGs? DMGs might be most enlightening during QAPI review Determining how to use new data clinically once we’ve decided we probably should can still be difficult Additional studies are needed to see if “DMGs met” is a reliable surrogate marker for hard transplant outcomes