Chapters Transcript Video Kidney/Pancreas Transplant Patient Education Please review video education and complete Acknowledgement Consent, that has been emailed to you, after the video is viewed. If there are any questions, contact us at 757-388-3906. Today, we will review the introduction of staff and contact information evaluation process, medical evaluation. Multidisciplinary committee, waitlist and living donors, transplant and post transplant care. The Centra Kinney Pancreas Transplant Center is located at 600 Gresham Drive Norfolk, Virginia 23507. The main number to the transplant center is 7573883906. Nursing staff, contact numbers two intake RNS, two evaluation coordinators, two waitlist, coordinators, outreach RN and senior coordinator, prescheduled weightless scheduler, medical assistant, three financial coordinators, two social workers and transplant dietician. Today is the start of your transplant evaluation. Every step of your evaluation is done to ensure that it is safe for you to receive a transplant. The transplant evaluation process includes an RN visit including a triage and education, a surgeon assessment, financial coordinator, education and assessment, social worker assessment. You need to complete all of your required cancer screenings and medical evaluation. Specialty consults may be needed. A cardiac evaluation, dietician review, pharmacist review, a transplant nephrologist assessment. Once all of these steps are complete, we will then present your case at our multidisciplinary committee for a full team decision about your candidacy towards transplant. It is your responsibility to have current routine cancer screenings as recommended by the American Cancer Society. In order to proceed with your transplant evaluation, all females are required to have current pap smear or pelvic exam and continued follow up as recommended by their physician. All females at age 40 or earlier. If there's an abnormal history are required to have a current mammogram. All patients over the age of 45 or earlier with a family history of colon cancer will be required to have a current colonoscopy. The transplant candidate is responsible for scheduling any required cancer screenings. Your evaluation will be closed if they are not completed within three months from today. Testing evaluation includes blood work EKG of your heart, chest x-ray or CT scan of your chest echocardiogram, stress test, ultrasound or ct of your abdomen, completing an evaluation does not guarantee that you will be approved to be a transplant candidate at our facility. Any abnormal testing found during your evaluation may require further testing or an evaluation by a specialist. There's a chance that your medical evaluation could reveal conditions that may make you not a candidate for transplant and that the Centra transplantt team must report to governmental authorities such as HIV or certainly sexually transmitted diseases diseases. Cardiac evaluation is required with a cardiac catheterization or a cardiac CTA also called A CCTA for all patients with diabetes. All patients over the age of 50 all patients with risk factors in their medical history and all patients with abnormal heart testing. A stress test is required for those candidates 40 years or less and are non diabetic stress tests can include exercise, stress tests, diamine stress tests or nuclear stress test. This will be scheduled by the transplant center. Some high risk cardiac patients will also require a stress test in addition to their cardiac CT A or heart catheterization. Cardiac CT A is required for all patients over the age of 50 all diabetics. It's scheduled by the transmit center and can be completed currently at Centra heart hospital, Centra Lee hospital and Centra care hospital. A heart catheterization is required for patients with a history of heart failure, coronary artery disease and or pulmonary hypertension. We will refer you to a heart doctor called a cardiologist for an office visit. Then the cardiologist will schedule your cardiac catheterization. Basic testing ordered by the transplant center will be paid for by the transplant center, contact the financial coordinator at the transplant center. If you receive any bills related to your evaluation for transplant, initial physician consults recommended by the transplant center will be paid for by the transplant center. Any follow up appointments, interventions and treatments for pre existing conditions are your responsibility and will be billed to your insurance. Basic cancer screenings, as previously discussed are the responsibility of the patient financially and will also be required to be updated while you're on the waitlist. Dental evaluations could also be required. They will be reviewed at a later appointment with the transplant nephrologist. If that will be a requirement for you. Hepatitis B is a serious liver disease that results from an infection with Hepatitis B virus. It is spread when blood semen or other body fluids from an infected person enters the body of someone who is not infected. The best way to prevent hepatitis B is by getting vaccinated. The Hepatitis B vaccine is given by a series of three shots over a period of six months. If you have not received the Hepatitis B vaccine, please discuss this with your dialysis unit or your primary care provider. It is recommended by the CDC and the US Public Health Service that you have completed the series before being transplanted. For more information, you can visit www dot CDC dot gov backslash hepatitis, the Centra transplant team and the American Society of Transplants strongly recommend all transplant candidates receive a COVID-19 vaccination series prior to receiving a transplant studies have shown that transplant patients who have received the vaccine after a transplant do not develop a full antibody response. Ideally, you should be fully vaccinated at least two weeks before a transplant to give your immune system time to respond effectively to the vaccine. Even if you have previously had a COVID-19 infection, you should still get vaccinated. For additional information. Please visit the American Society of Transplant website after you have completed all testing and appointments required for your evaluation. You will have an appointment with the transplant nephrologist. The nephrologist will review your entire work up for transplant and complete an assessment at this visit. We will further discuss your candidacy for transplant donor KDP I scores A two, a two B transplants, acceptance of hepatitis B and hepatitis C positive organs and acute donor risk factors. At the conclusion of the evaluation process, all of the information will be presented to the transplant team who will make the final decision about your candidacy for transplant. A transplant nurse will notify you of the multidisciplinary team's decision. And in writing after the meeting, you will either be approved as a candidate deferred pending additional testing or consults or declined as a candidate at our facility. Each transplant facility creates their own policies on candidacy here at Centra. You will be made not a candidate if your age is greater than 70 for a kidney transplant or 55 for pancreas. If your body mass index or BM I is greater than 40 for a kidney transplant or greater than 30 for a pancreas transplant patients that are close to this cut off do have the option to participate in weight management program with our transplant dietician if you're psychologically or have financial problems that cannot be resolved timely, if you have inadequate support or transportation, medical noncompliance, current illegal drug use will require one year of abstinence, chronic hypotension requiring medications active infections, current wounds, if you have a diagnosis of multiple myeloma or if you have active medical problems requiring clearances from specialists, we also have a no show policy. And if you miss three or more appointments during your evaluation, you'll be made, not a candidate and no longer considered, you will be eligible for rereferral in three months. You will be responsible for any charges associated with a no show for a specialty visit. Please make sure you call and reschedule your appointments with us if you're unable to make it at 3883906. Another reason you could be made on a candidate if you fail to get your cancer screenings that we have talked about previously today, done within three months of the start of your evaluation. Physicians of the Centra Transplant center strongly recommend that if you smoke or use nicotine products that you stop doing. So, smokers have a high risk of complications at the time of surgery and their long term health is affected by smoking or using substances with nicotine. Nicotine smoking is a contraindication for pancreas transplant and random screenings will be required prior to being placed on the wait list. The only alternatives to advanced kidney disease is hemodialysis, peritoneal dialysis, living donor, kidney transplant, deceased donor, kidney transplant, multiple listings for transplant and no treatment and death. Waitlist and living donors. The wait list is divided by blood type, blood type A bab and O the average wait time in Virginia for a transplant is about 3 to 5 years. The wait time for a pancreas or a kidney and pancreas may be shorter. Your wait time is calculated by the start of dialysis or for patients that are not on dialysis. It's the date that you were placed on the wait list. Candidates are seen by the transplant center annually while on the waitlist, contact the transplant center with any of the following change in phone number or address. If you start or change your dialysis information, if you have a change in your insurance change in medical condition, hospitalization, illness or wounds, pre dialysis patients or preemptive patients need blood work every month while they're on the waitlist. Call the transplant center the day before you're going for blood work so we can register you in our system. You can get this blood work drawn at any Centra lab patients who are on dialysis will have their blood work sent to us monthly by their dialysis facilities. Re evaluation testing will be repeated annually. Once you are closer to the top of the list, you may also need additional cardiac testing such as a cardiac CT A or heart catheterization. The transplant center will contact you and schedule this testing for you after your testing has been completed, we will schedule you for annual visits with our multidisciplinary team and transplant providers. Please remember that your cancer screenings must be kept up to date as directed by your physicians while you're on our waitlist. Multiple listings is a great option for transplant candidates being listed at multiple centers can increase your chances of receiving a transplant. You must have your follow up care at the same transplant center that does your transplant. Please check with your insurance provider to see if they allow multiple evaluations. You can also transfer your primary wait time points to another transplant center. If you are considering this, you should ask the transplant program, how they handle this process? The National and transplant Program specific outcomes can be found at the scientific registry of transplant recipients known as S RT R. They have a website found on your screen. We have also provided you a letter today with our current one year post transplant survival and one year post transplant graph survival rates of the centric kidney pancreas transplant program. And how these rates compare to the national average. A combination of factors including blood and tissue type, medical urgency, body size, distance between the donor and transplant hospital and time spent waiting for a transplant are all used in the current organ allocation model. The distance between the donor and transplant hospital is important because the less time the organ must be preserved outside the donor's body. The better chance that it will function when transplanted. For this reason, the matching system will often consider candidates at transplant hospital close to the donor location before other candidates at hospitals farther away, more educational materials were provided to you today. In your folders including you know, pamphlets on organ allocation compatibility is important. You must be blood type compatible and tissue type compatible. A negative cross match means the recipient's blood does not react to the donor's blood. A reaction would mean that recipient has antibodies to the donor's blood compatibility can also change over time due to pregnancies, blood transfusions and previous transplants. Recipients may be able to receive a transplant from someone with a certain level of antibody living donation. Anyone can be a living donor. They do not have to be related to you but they do have to be medically suitable. Potential donors must fill out a screening form at Sentra dot donors screen dot org. The living donor team will contact the potential donor after they have completed the screening form to discuss the next steps. Living donors are required to go through a donor evaluation including a full medical work up. Having an identified living donor can shorten your wait time for transplant, shorten, post op length of stay and have better outcomes. When compared to deceased donor. Transplants. Cards with the above website were given to you today to help assist in your search for a suitable living donor. Living donors can be a directed donor to identified candidate on our transplant wait list or a non directed donor, which is also called an anonymous donor to the transplant, deceased donor waitlist or through the National Kidney registry. The National Kidney registry assists with living donor swaps domino chains and have programs for advanced kidney donation. We also have a living kidney donor seminar to help you find a donor. Please discuss this workshop with your nurse today. Before you leave, there are two separate teams in the Centra transplant program. One for the transplant recipients and the other for living donors. Our teams must keep confidentiality and will not discuss living donors and work up with transplant recipients. Transplant recipients cannot contact a living donor team due to HIPA and privacy rights. If you have questions about your work up, please call your evaluation coordinator to discuss transplant and post transplant. The pertinent facts about the medical and social history. Approximate age of the donor and condition of the organ will be discussed with you at the time. A kidney and or pancreas transplant is offered. Potential donors are also screened for acute risk factors according to the public health service or PS guidelines and extensively tested for infections of all types of malignancy or cancer. There's a rare chance that with the current testing today HIV hepatitis C virus, hepatitis B virus cancer or other illnesses could be transmitted from the donor to the recipient. You have the right to withdraw consent any time during the transplant evaluation or prior to transplant surgery. The reason or reasons for your decision will remain confidential and not be disclosed without prior consent. You may have your physician rerefer you for evaluation in the future and will be required to start the evaluation process from the beginning. A successful kidney transplant will eliminate the need for hemodialysis or peritoneal dialysis and can eliminate waste and excessive chemicals from your blood. The transplanted kidney will be placed in your lower abdomen. This placement is preferred because your own or native kidneys are not removed unless they are causing you problems. A successful pancreas transplant will eliminate the need for insulin and hopefully stop the progression of complications from diabetes. Pancreas transplants can be performed alone or in conjunction with the kidney transplant. The pancreas is very fragile and produces insulin and enzymes. The pancreas is joined to the blood vessels and intestines which allow the pancreatic enzymes to flow into the bowel. A simultaneous pancreas kidney transplant is a treatment for patients with kidney failure and insulin dependent diabetes. After you receive a transplant, you'll receive post-op care in the vascular intensive care unit or V IC U for one day. Then you are transferred to nine Kauffman or intermediate care for 2 to 3 days. The average hospital length of stay for kidney transplant is five days. The average hospital length of stay for pancreas transplant is seven days, delayed graph function or dialysis. After transplant is common after deceased donor kidney transplant and happens in over 30% of patients. If you experience any post-operative complications, your recovery time may be longer as with any surgical procedure. There are potential medical and surgical risks that can occur postoperatively including death, respiratory arrest, cardiovascular collapse, brain damage, disfiguring scar paralysis or weakness, loss of function in limbs or organ blood loss, allergic reaction and infection. There are also organ specific surgical risks. The risk for kidney transplant include bleeding, infection, urine leak clotting, such that the kidney has to be removed. This happens in less than 1% of cases, delayed organ function, rejection, problems with the intestines, liver failure, heart attack or stroke. The risk of infection at the surgical incision is significantly increased for patients who are obese specific risk to pancreas transplant. In addition to those listed above include clotting that the pancreas must be removed. This happens in less than 5% of cases, inflammation of the pancreas or pancreatitis, delayed pancreas function and requirement of IV. Insulin, psychological risk associated with transplant may include depression, post traumatic stress disorder or ptsd, generalized anxiety or anxiety due to dependence on others, feelings of guilt, difficulty adjusting to life with a transplant, changes in family relationships and financial difficulty. Long term risk of kidney transplant include infection, rejection and cancer. Since you are required to take immunosuppressive medication for the rest of your life to prevent organ rejection, you are more likely to develop infections. These medications have other side effects which may include finding liver bone marrow and the development of some types of cancer. Your body is smart and can detect that your transplant came from another person. If you stop taking these medications, even for a short period of time or do not take your medication. Exactly how instructed your body will reject your new transplant. After transplants, you will be prescribed three different immunosuppressant or anti rejection medications. These will help prevent your body from rejecting or attacking your new kidney and or pancreas, you'll be required to take these for the rest of your life to help suppress your immune system. Rejection can lead to kidney loss. You'll also be on 1 to 2 different medications to help prevent infection along with some others, your new transplant medications will have to be taken exactly as your doctor tells you to, you'll need to remember the name dose. When you take the medication, why you take the medication and what the common side of after your transplant. You will meet with a transplant, pharmacist, dietician, and social worker during your hospital stay. And in our post transplant clinic as needed, our multidisciplinary team is available to speak with you at any time. After a transplant. After discharge, you can contact your post transplant coordinator anytime with health questions or concerns you will not be able to drive for four weeks after a transplant. There will be no lifting anything heavier than £20 for six weeks, no tub baths or going swimming until your incision is healed. Avoid creams and lotions to your incision and patients can expect to return to work 4 to 8 weeks after a transplant, depending on recovery and physical requirements of their job, you'll have to take your medications. Exactly how instructed we are committed to your lifelong health and safety. We require transplant recipients commitment to follow up weekly for the first month, biweekly for months, 233 monthly, for months, three through 12, you will be re referred back to your community nephrologists after your 12 month visit for continued monitoring and are offered annual labs and an annual visit with transplant center during your anniversary month. It is possible to get pregnant after a transplant. However, you should talk to your transplant team to see if pregnancy is safe for you. Some of the anti rejection medications used are associated with increased risk for miscarriages or loss of pregnancy and birth defects if you are able to get pregnant. It is highly recommended that you either abstain from sexual intercourse or use an acceptable form of birth control while taking these medications. Talk to your transplant team before you stop using birth control and let the team know right away. If you find out you are pregnant. Kidney transplant recipients are eligible for Medicare for inst stage renal disease. Post transplant. Medicare covers 80% of anti rejection medications start planning now for other medical costs and drug copays, please call transplant financial coordinators with any insurance questions or changes. The United Network for organ sharing or UNOS provides a toll free number for patient services to help transplant candidates recipients and family members understand organ allocation and transplantt data. You may also call this number to discuss a problem you may be experiencing with your transplant center or the transplantation system in general. For more information, please feel free to visit the website listed on your screen. Published September 29, 2023 Created by
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