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PD, Catheter Exit Site Options

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.

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PD, Catheter Exit Site Options

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  1. PD, Catheter Exit Site Options

  2. PD catheters : lap vs open

  3. Pre-sternal PD catheter

  4. Chronic Perm Cath PatientsPossible Solutions • Second Surgical Opinion • Imaging • Unusual Access Procedures: Fem Grafts, Necklace Grafts • PD • HeRO catheters

  5. HeRO cath-graft right central vein occlusion

  6. Kidney Transplantation Not for everyone !

  7. Transplantation versus Dialysis • Treatment option and not a cure • Quality of Life • time constraints of dialysis • return to work • Life Expectancy • Cost • dialysis cost remains constant • transplantation cost reduces after first year to 1/3 cost of dialysis

  8. Notable Breakthroughs • Immunosuppressant Drugs • Tissue typing • Organ recovery & preservation • Surgical techniques • Non-traditional donor sources

  9. Post Transplant Success UNOS, 2009

  10. Transplant Team Members • Transplant Coordinator • Nephrologist • Transplant Nurse Practitioner/ Physician Assistant • Surgeon • Social Worker • Dietician • Financial Coordinator • Psychologist

  11. Evaluation Overview • Meet all team members • Review medical and social history • Answer questions • Determine plan for further testing • Health screening • Cardiac, Pulmonary, Urologic, Anatomic • Consent Forms

  12. Your Responsibilities • Be active in your evaluation • Keep all of your appointments • Recommend stop smoking • Limit alcohol intake • No illegal drug use • Ask questions

  13. Compatibility Testing • Step #1 ABO Testing • Determination of blood type • Require blood typing on two separate blood draws • ABO Compatibility Recipient Blood Type Donor Blood Type O O A O, A B O, B AB O, A, B, AB

  14. Matching Donors & Recipients • 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

  15. Sources of Antibodies Previous transplant Blood transfusions Pregnancies Viruses Vaccinations Unknown factors Approximately 30% of patients on the kidney transplant list are sensitized

  16. 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

  17. What if my Donor is not a Match? • Paired Kidney Exchange • When donor and recipient are incompatible • Incompatible blood type • Positive Crossmatch • Uses a computer optimization program to match incompatible pairs

  18. Immunosuppression • 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

  19. Immunosuppression • Triple Regime • Prednisone • Cellcept/ Mycophenolate Mofetil • Prograf/ Tacrolimus

  20. Making the Choice • Complicated process • Make sure that transplant is right for you • Weigh the risks and benefits • Another form of kidney therapy, not a cure

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