New Ways to Tackle a Growing Health Care Dilemma - ESRD J. Keith - - PowerPoint PPT Presentation

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New Ways to Tackle a Growing Health Care Dilemma - ESRD J. Keith - - PowerPoint PPT Presentation

Jun 02, 2023 47 likes •473 views

New Ways to Tackle a Growing Health Care Dilemma - ESRD J. Keith Melancon, M.D., F.A.C.S. George Washington University Professor of Surgery Chief, Transplant Surgery and Transplant Institute Thanks to our speaker! Dr. Keith Melancon

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New Ways to Tackle a Growing Health Care Dilemma - ESRD

  • J. Keith Melancon, M.D., F.A.C.S.

George Washington University Professor of Surgery Chief, Transplant Surgery and Transplant Institute

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  • Dr. Keith Melancon
  • Director of the George Washington

Transplant Institute

  • Professor of surgery & the medical

director of the Ron and Joy Paul Kidney Center

  • Internationally renowned expert in

paired kidney exchanges, ABO incompatible kidney transplantation, pancreas transplantation, and immunologic desensitization for organ transplants

  • On four occasions set the world’s

record for largest paired kidney exchange

Thanks to our speaker!

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  • Apollo
  • Dionysis

Nietzsche – “The Birth of Tragedy”

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Why ESRD?

  • Diabetes
  • Hypertension
  • Obesity
  • Increased rates in minority population
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Obesity

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Hypertension

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Diabetes

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Where is ESRD?

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Who is ESRD?

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Addressing Disparities

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Community Outreach

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Community Health Delivery Models

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CKD Increasing

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Incidence ESRD

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Cost of ESRD

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Cost of ESRD vs Transplant

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Outcomes for first-time wait-listed patients three years after listing in 2008, by age, race, & PRA Figure 7.5 (Volume 2)

Patients age 18 & older listed for a first-time, kidney-only transplant in 2008; transplanted patients may have subsequent

  • utcomes in the three-year follow-up period.
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Survival Difference: Transplant vs. Dialysis

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Number of Kidney Transplants

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Incidence of ESRD by Race

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Graft Survival by Race

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Apol1 in Black Patients Nejm raj 2013

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African Ethnicities

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Middle Passage

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Current Issues in Kidney Transplantation

  • Access
  • Graft survival
  • Sensitization
  • Increasing organ numbers (DD and LD)
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Addressing Kidney Transplant Issues

  • Access – outreach, education
  • Sensitization- PKE (paired kidney exchange),

desensitization

  • Graft survival- novel immunosuppressive

protocols, tolerance

  • Donors – sign up potential donors, educate

potential living donors

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Paired Kidney Exchange

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Desensitization

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Addressing Crisis – Increasing Organ Availability

  • DCD/ECD organs
  • Increasing living donation/ Altruistic donation
  • ABO incompatible transplantation
  • Desensitization protocols
  • Paired kidney exchanges
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ABO Incompatible Transplantation

  • Must know and reduce ABO titer incompatibility

(Antibody therapy, plasma exchange)

  • Oftentimes better option than sensitized

transplantation and timing better than PKE

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Desensitization Protocols

  • Must have luminex single bead technologies to

isolate Antibody specificities and then tract titers during reduction therapy (Antibody therapy, plasma exchange, immunoglobulin therapy)

  • Best fitted for living donor transplantation
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Paired Kidney Exchanges

  • Utilize computerized matching algorithms to
  • ptimize organ utilization schemes in local,

regional, and national organ exchanges

  • Can be combined with ABO incompatible

transplant and desensitization

  • Domino exchanges can be fashioned to multiply

successes

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Disparities

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Paired Kidney Exchanges

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Results

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Results

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PKE (Paired Kidney Exchange)

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The Bonds that Tie

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Paired Exchanges

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World’s Largest Kidney Exchange

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Questions?

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Join us for next month’s webinar!

Unique Strategies for Improving the Effectiveness of Exercise Training in Patients with Kidney Failure

Join us to learn about:

  • Research regarding exercise in

hemodialysis and transplant patients (What has worked, and what has not)

  • Strategies for improving outcomes from

exercise training interventions (How much and what type of exercise is recommended)

  • Strategies for improving patient

compliance with exercise and physical activity programs

  • Dr. Ken Wilund
  • Associate Professor in the

Department of Kinesiology and Community Health and Division of Nutritional Sciences at the University of Illinois at Urbana-Champaign

Go to www.KidneyFund.org/webinars to learn more and register!

Tuesday, January 17 1-2 p.m. (ET)