1. PD, Catheter Exit Site Options

3. PD catheters : lap vs open

5. Pre-sternal PD catheter

7. Chronic Perm Cath Patients Possible Solutions Second Surgical Opinion Second Surgical Opinion Imaging Imaging Unusual Access Procedures: Fem Grafts, Necklace Grafts Unusual Access Procedures: Fem Grafts, Necklace Grafts PD PD HeRO catheters HeRO catheters

8. HeRO cath-graft right central vein occlusion

9. Kidney Transplantation Not for everyone !

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

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

13. 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

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

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

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

17. Compatibility Testing Step #1ABO Testing Determination of blood type Require blood typing on two separate blood draws ABO Compatibility Recipient Blood TypeDonor Blood TypeO AO, A BO, B ABO, A, B, AB

18. Matching Donors & Recipients ABO group ABO group HLA (Human Leukocyte Antigen) HLA (Human Leukocyte Antigen) Proteins located on surface of white blood cells Proteins located on surface of white blood cells Inherited from parents. Inherited from parents. PRA (Panel Reactive Antibody) PRA (Panel Reactive Antibody) Measurement of anti-HLA antibodies Measurement of anti-HLA antibodies Crossmatch Crossmatch Donor lymphocytes mixed with recipient serum Donor lymphocytes mixed with recipient serum

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

20. 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

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

29. Immunosuppression Medicines to prevent rejection of new organ Medicines to prevent rejection of new organ Medicines are taken every day Medicines are taken every day These medicines are needed for the rest of your life! These medicines are needed for the rest of your life! Side effect of increased risk of infection and cancer Side effect of increased risk of infection and cancer

31. Immunosuppression Immunosuppression Triple Regime Triple Regime Prednisone Prednisone Cellcept/ Mycophenolate Mofetil Cellcept/ Mycophenolate Mofetil Prograf/ Tacrolimus Prograf/ Tacrolimus

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