1 / 50

Abdominal Organ Transplant Program Mayo Clinic Arizona 2006 Review

Abdominal Organ Transplant Program Mayo Clinic Arizona 2006 Review. Annual Report to CPC / Board of Governors David D. Douglas, MD Raymond L. Heilman, MD David C. Mulligan, MD Pamela L. Gillette, MPH, RN Todd E. Wilkening / Duffy Suba / Susanne M. Gauthier. Presentation Outline.

uyen
Download Presentation

Abdominal Organ Transplant Program Mayo Clinic Arizona 2006 Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abdominal Organ Transplant Program Mayo Clinic Arizona2006 Review Annual Report to CPC / Board of Governors David D. Douglas, MD Raymond L. Heilman, MD David C. Mulligan, MD Pamela L. Gillette, MPH, RN Todd E. Wilkening / Duffy Suba / Susanne M. Gauthier

  2. Presentation Outline • Overview and History • Academic/Research Activity • Liver Transplant Program • Kidney/Pancreas Transplant Program • DSS Financial Analysis for 2005 • Strategic Plan and Targets for 2007

  3. Mayo ClinicLargest Transplant Entity in U.S. 1469 Total Transplants in 2006 717 446 306

  4. MCA Abdominal Organ Transplant HistoryThen and Now • Liver Transplant Program • Deceased Donor Liver Transplantation (1999) • Living Donor Liver Program (2001) – 1st in AZ • 2006 – 7th largest in the US • Kidney Transplant Program • Living Donor Kidney Program (1999) • 2006 – 15th largest in the US • Laparoscopic Donor Procedure (1999) • First in the Foundation & Arizona • Pancreas Transplant Program • November 2002 UNOS Certified • First K/P Transplant in July 2003 • 2006 – 7th largest in the US

  5. 2006 Overview Summary • Total Annual Transplants Decreased by 6%* • 2005 – 238, 2006 - 224 • Transplant Annual Evaluations - 15% Increase* • 2005 – 548, 2006 - 630 • Waitlist Growth Increased in Kidney, Pancreas and Liver Transplant • Program Quality Maintained • Graft and Patient Survival Rates Exceed Expected • Patient Satisfaction in PRC Survey • 80.2% in Overall “Top Box” Score in 2006, up from 2005 73.9% • Market Distinction • Leader in Living Donor Liver Transplant • Heart Transplant data removed for separate presentation

  6. MCA Abdominal Transplant ProgramNational & Regional PresenceAcademic & Research Activity

  7. MCA Abdominal Transplant ProgramNational / Regional Leadership • AASLD and ILTS Journal “Liver Transplantation” • Co-Editor: Dr. Rakela • Associate Editor: Dr. Vargas, Dr. Kusne, Dr. Mulligan • AASLD • Chair, Education Committee • Dr. Vargas • ASTS • Chair, Standards on Organ Transplantation Committee • Dr. Mulligan • AST • Liver and Intestinal Committee member • Dr. Douglas • Kidney Pancreas Committee member • Dr. Heilman

  8. MCA Abdominal Transplant ProgramNational / Regional Leadership • United Network for Organ Sharing (UNOS) • Councilor Region 5, Board of Directors • Chair, MPSC Workgroup for Organ Allocation • Dr. Mulligan • Region 5 Liver Transplant Regional Review Board • Dr. Douglas • Region 5 Transplant Administrator / TAC • Kevin Paige • Region 5 Finance • Pam Gillette • Donor Network Arizona • Board of Directors • Dr. Mulligan

  9. MCA Abdominal Transplant ProgramNational / Regional Leadership • Intermountain End-Stage-Renal-Disease Network • Board of Directors • Dr. Heilman • American Liver Foundation, AZ Chapter • Board of Directors • Pam Gillette • Arizona Coalition for Transplantation • Board of Directors • Kevin Paige • Pam Gillette • Arizona Transplant House Board of Directors • Victoria Miller-Cage, Todd Wilkening, Tom Byrne, Paul Hottenstein, Mandy Impson, Susan Misztal, Kevin Paige

  10. MCA Abdominal Transplant ProgramPublications, Presentations and Research • Publications By Transplant Program* • 2006 Unique Peer Reviewed Journal Articles - 36 • 2006 Authored Book Chapters - 3 • Presentations at National Meetings 2006 • ATC - 4 Oral and 6 Poster Presentations • ILTS – 3 Oral and 2 Poster Presentations • AASLD - 3 Oral and 9 Poster Presentations • UNOS Administrator's Forum 2006: 1 Oral and 3 Poster Presentations • AGA - 6 Poster Presentations • Research Activity • 30 Ongoing Protocols * MCA Librarian Database

  11. MCA Abdominal Transplant ProgramEducation Programs • Hepatology MD Fellowship Program (1999-Present)* • Hepatology PA Fellowship Program (2003-2007) • Both Programs AASLD Funded • Hepatobiliary & Liver Transplant Rotation • General Surgery Residents, Internal Medicine Residents, Gastroenterology Fellows • Social Worker Internship Program • ASU Collaboration • Liver Transplant CME Course: 1995, 1997, 1999, 2001, 2003, 2005, 2006 and 2007 *Pending initial ACGME accreditation 2007

  12. Liver Transplant Program2006

  13. MCA Liver Transplantation Program • 1999 to 2006 Volume Data • Liver Transplants - 345 • Living Donor Transplants - 64 (18%) • 2006 Volume Data • Liver Transplants - 43 (Target 73) • 8 of 43 Transplants - Living Donor • 2006 Outcome Data* • 1 Year Patient Survival • 91.85% Actual vs. 88.18% National Avg (Combined) • 1 Year Graft Survival • 89.41% Actual vs. 84.43% National Avg (Combined) * SRTR National Data Base - January 2007 Release

  14. Mayo System and National Comparison % 1 Year Patient and Graft Survival SRTR National Data Base - January 2007 Release Deceased Donor Only for Appropriate Comparison

  15. Mayo System and National ComparisonMedian Length of Stay Post Transplant SRTR National Data Base - January 2007 Release Median LOS for Deceased Donor

  16. Liver Waitlist & Transplants2001 - 2006 Wait List Size as of Last Day of Year

  17. Etiology of Liver Disease * Liver disease transplanted Q1 2007 Q1 2007

  18. Cold Ischemia Time (hours)Cumulative • Average CIT 6.02 hrs • MedianCIT5.75hrs • Range1.5 -23 hrs Q1 2007

  19. Benchmarking: National Centers of ExcellenceUNOS Patient Survival Data(7/01/03 - 12/31/05 w/ 1 Mo. & 1 Yr. Cohorts; 01/01/01 - 6/30/03 w/ 3 Yr. Cohort) Q1 2007

  20. Benchmarking: National Centers of ExcellenceUNOS Graft Survival Data(7/01/03 - 12/31/05 w/ 1 Mo. & 1 Yr. Cohorts; 01/01/01 - 6/30/03 w/ 3 Yr. Cohort) Q1 2007

  21. The Impact of Gender Mismatch on Living Donor Liver Transplantation Kristin L. Mekeel, Adyr A. Moss, David D. Douglas, M.E. Harrison, Hugo E. Vargas, Thomas J. Byrne, Vijay Balan, Elizabeth J. Carey, Jorge Rakela, Kunam S. Reddy and David C. Mulligan Divisions of Transplant Surgery and Hepatology Mayo Clinic Arizona

  22. Background • In liver transplantation • Gender mismatch has been associated with decreased graft survival, especially female to male transplantation. • In adult living donor liver transplantation • The ratio between graft size and recipient weight (GRWR) has been shown to be essential to graft function, preventing small graft for size syndrome.

  23. Purpose • The combination of smaller graft size and gender mismatch could lead to inferior results for female to male LDLT. • The purpose of this study is to compare the outcomes of female to male LDLT with male to female and gender matched transplants.

  24. Methods • This is a retrospective study 70 living donor liver transplants completed at our institution between January 2001 and April 2007. • All grafts were right lobes, preserved with custodial HTK after the 15th transplant.

  25. Methods • GRWR was estimated pre-operatively with CT volumetry and the graft was weighed after resection to determine actual GRWR, which is used for this presentation. • The right paramedian sectoral vein was routinely preserved starting after the 26th transplant.

  26. Methods • Analyses of variance were carried out to assess differences between groups on the continuous variables. • Kruskal-Wallis tests were used for non-parametric continuous variables. • Chi-square analyses were used to assess differences between groups on the categorical variables.

  27. Patient Demographics Demographic GM (32) MF (16) FM (22) P-value Age 17–68 (49) 30–66 (49) 30–67 (55) 0.27 GRWR 0.8–1.5 (1.19) 0.8–1.9 (1.42) 0.7–1.2 (0.94) 0.0001 Donor age 19–46 (33.3) 21–54 (36.8) 18–56 (41.7) 0.02 MELD 8–22 (14.3) 6–20 (11.7) 7–22 (14.1) 0.11 % HCV 48% 37.5% 50% 0.89 Operative time 3:25–10:17 (5:13) 2:52–6:59 (4:40) 3:26–8:09 (5:10) 0.3732 CIT (min) 150–285 (214) 150–270 (196) 150–285 (208) 0.35

  28. Results Outcomes GM (32) MF (16) FM(22) P-value LOS (days) 5–17 (7.84) 4–22 (9.88) 2–23 (8.9) 0.47 FU (months) 0.7–64.2 (24) 0.3–62 (19.9) 0.3–63.5 (20.4) 0.16 Acute rejection 3 (9.6%) 2 (12.5%) 1(4.5%) 0.59 HAT 4 (12.9%) 3 (18.75%) 6 (27.3%) 0.42 Bile Leak or 18 (58%) 10 (56.3%) 12 (54.5%) 0.95 Stricture Re-transplant 2 (6.5%) 2 (12.5%) 1 (4.5%) 0.63 Pt Survival 27 (87%) 12 (75%) 20 (91%) 0.37 (actual)

  29. Results Causes of Death GM (4) Recurrent hepatocellular carcinoma (2) Fungal sepsis after biliary leak (1) Hepatic artery thrombosis and graft failure (1) MF (4) Recurrent hepatitis C virus (2) Systemic aspergillosis (1) Hepatic artery thrombosis, re-transplantation and graft failure (1) FM (2) Intra-operative cardiac arrest after re-perfusion (1) Fungal pneumonia and sepsis (1)

  30. Conclusions • Despite a lower graft to recipient weight ratio, female to male LDLT recipients do not have an increased risk of complications or diminished graft or patient survival compared to gender matched or male to female cohorts • Gender should not be a factor in determining suitability for living donation.

  31. Kidney / Pancreas Transplant Program2006

  32. MCA Kidney Transplantation Program • 1999 to 2006 Volume Data • Kidney Transplants - 705 • Living Donor Kidney Transplants - 367 (53%) • Pancreas Transplants - 65 • 2006 Volume Data • Kidney Transplants - 152 • Living Donor Kidney Transplants - 81 (53%) • Pancreas Transplants - 27 • 2006 Outcome Data Kidney Transplant* • 1 Year Patient Survival • 96.13% Actual vs. 96.47% Expected • 1 Year Graft Survival • 92.83% Actual vs. 93.34% Expected * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

  33. Mayo System and National Comparison % 1 Year Patient and Graft Survival * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

  34. Mayo System and National ComparisonLength of Stay - Time on Wait List SRTR National Data Base - January 2007 Release LOS for Deceased Donor, Wait Times Includes Both Living and Deceased Donor Transplants

  35. Kidney Waitlist & Transplants2001 - 2006 Wait List Size as of Last Day of Year

  36. Donor Source (N=654)Cumulative Living Related Donor 238 Living Unrelated Donor 154 Deceased Donor 262 Q1 2007

  37. Pancreas Transplantation at MCA

  38. Pancreas Transplants at MCA by type of transplant

  39. Type of Surgical Procedure

  40. MCH Patient/Graft Survival for KP Txs (Kaplan-Meier)

  41. MCH Patient/Graft Survivalfor PAK & PTA (Kaplan-Meier)

  42. Thymoglobulin Prograf MMF Long-term steroids Campath Prograf MMF Rapid steroid taper Immunosuppression

  43. Acute Rejection during the first year • Kidney-Pancreas : 17% • Solitary Pancreas: 32%

  44. Kidney-Pancreas : Steroid Avoidance • 37 patients • Patient survival 100% • Graft Survival • Kidney 97% • Pancreas 95% • Acute Rejection 11%

  45. Historical Total Transplant Volumes 2001 to present

  46. Support for Organ Donation in AZ • Active Mayo Participation in Multiple Organizations • AKF, ALF, ACT, DNA • DNA, ACT and Mayo Collaborations • AZ Medal Ceremony for Donors • Active Participation in National Donor Week • Continue Participation in National Collaborative • Bronze Level Sponsor of Team AZ at Transplant Games

  47. Program Summary • High Quality Transplant Program • Distinguished by • Mayo Model of Care • Living Donor Liver Transplant • Controlled Growth • Strong Education Focus • Strong Research Focus • National and Regional Presence • Financial Enhancement to MCA

  48. Conclusions • Strong clinical academic solid organ transplant practice with complete conversion from UW to Custodial HTK in 2003 without any negative effect • Improved outcomes using Custodial for Living Donor Liver Transplantation • Recommendation for HTK for DCD donors to improve outcomes

More Related