Successful Kidney Transplant Management

For Healthmap Solutions (Healthmap), the goal of our Kidney Health Management program is to improve the lives of people with chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aim to optimize renal replacement therapy (RRT) for patients with ESRD by empowering them with improved education and accessibility to RRT options, regardless of whether they are receiving dialysis treatments or have begun the process of kidney transplant evaluation. While our program supports both choices, we believe that a kidney transplant, if appropriate for the patient, is the better long-term option.

While kidney transplantation is not always possible or appropriate for all ESRD patients, it has become the “gold standard” of treatment as a result of a better understanding of the human immune system, the development of more effective immunosuppressants, and advancements in surgical techniques, such as high-precision robot assistance. According to the United Network for Organ Sharing, ¹ more than 25,000 kidney transplants were performed in 2022, an average of 70 per day.

For the patient, a kidney transplant offers a number of important benefits, including a better long-term survival rate. A 2022 study² published online in the Journal of the American Medical Association (JAMA) “... followed target trial emulation methods to quantify life expectancy gain for kidney transplant recipients compared with patients eligible for transplant who were receiving long-term dialysis across all ages and conditional on time on waitlist. [The study] found a survival benefit for patients who receive a kidney transplant regardless of time spent on the waitlist and for all ages of adults who are candidates for kidney transplant.”

In addition, kidney transplant recipients generally enjoy an improved quality of life compared to remaining on dialysis as they can usually return to a more normal lifestyle with fewer dietary restrictions. Kidney transplantation can also improve a patient’s overall health, for example, by helping to control high blood pressure and reducing the risk of cardiovascular disease compared to remaining on dialysis.

For providers and health plans, kidney transplantation is significantly more cost-effective in the long run compared to hemodialysis and peritoneal dialysis. A study³ published in the Annals of Transplantation showed that “the annual costs per patient connected to kidney transplantation were approximately 2.5 times less compared to the costs connected to peritoneal dialysis, and 3 times less compared to the costs of treatment with hemodialysis.”

A 2021 report⁴ by the Council of Economic Advisors provides a startling contrast in Medicare expenditures for kidney transplants versus dialysis:

The value of kidney transplant was recognized in Presidential Executive Order 13879, ⁵ “Advancing American Kidney Health,” issued in 2019. One of its stated goals is to increase access to kidney transplants by modernizing the organ recovery and transplantation systems and updating outmoded and counterproductive regulations.

How can providers successfully manage kidney transplant patients?

Because the number of available donor organs remains well below the number of transplant candidates, all patients interested in kidney transplant must undergo a thorough evaluation led by a multidisciplinary care team. In addition, the patient will need to make some lifestyle modifications before and after transplant, such as adopting a healthy diet, avoiding certain medications and supplements, minimizing exposure to infectious diseases, and staying up to date on vaccinations. Throughout the process, the patient’s provider will need to ensure that they are following up with the patient regularly and providing ongoing education. Transplant management typically involves numerous steps and procedures both before and after the transplant, which will vary depending on the individual patient’s condition. Here are some general guidelines:

Before Transplant

Recommended steps include:

• Patient evaluation: Patients undergo a comprehensive medical evaluation to determine their suitability for the procedure. The evaluation should include a complete review of their medical history, physical examination, blood and urine tests, imaging studies, and cardiac evaluation to assess the patient’s organ function and identify any underlying conditions. Blood and tissue samples from both the recipient and any potential donors should be analyzed to determine compatibility.
• Donor evaluation: All interested donors are similarly evaluated (medical evaluation, blood and urine tests, blood type, tissue type) to ensure a suitable match. In addition, donors must first and foremost be healthy themselves to ensure that a kidney donation would not adversely affect their own health in the future.
• Education: Patients receive complete information on the transplant process, including the risks and benefits, medications, follow-up care, and potential complications. Emphasis is placed on the importance of adhering to their post-op treatment regimen, including medications and medical visits, and communicating any challenges or concerns to their care team.
• Pre-op preparation: Patients need to be medically optimized before surgery to ensure that any underlying conditions, such as high blood pressure and blood glucose levels, are well-managed.

After Transplant

• Post-operative care: The patient will require close monitoring in the hospital following surgery, including vital signs, fluid/electrolyte balances, and kidney function. The patient’s reaction to immunosuppressives (medications that lower the immune system so that the new organ is not rejected) must also be monitored.
• Follow-up care: After discharge, the patient will need regular follow-up appointments with their transplant team. This should include frequent blood tests to gauge kidney function, monitoring medication management, and watching for potential complications.
• Transplant management: The transplant team must continue to closely monitor the patient for signs of potential complications, such as infections, organ rejection, and the side effects of immunosuppressive medications. Early detection and management of complications are crucial to a successful transplant.

Healthmap’s Approach

Healthmap’s Kidney Health Management Program is designed to facilitate the fully integrated care and follow-up required for successful transplants. We emphasize the benefits of transplants to our advanced CKD and ESRD patients and help them get on the list for a donor organ if they (and their care team) decide it’s the right choice.

Our Care Navigation nurses work directly with patients to help educate them about transplant, identify any social barriers to care to ensure they do not preclude them from engaging in the transplant evaluation process, and support them through necessary medical appointments crucial to long-term success. Similarly, our Quality Practice Advisors work with providers to ensure they are kept abreast of any progress their patients are making, whether related to transplant knowledge assessment scores or as they navigate the evaluation for kidney transplant.

We Are Passionate about optimizing renal replacement therapy for patients with advanced CKD and ESRD. We Are Healthmap! Learn more at www.healthmapsolutions.com.

resource links:

1 https://unos.org/news/in-focus/new-milestone-kidney-donation-and-transplant/

2 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797181

3 www.ncbi.nlm.nih.gov/pmc/articles/PMC6524555/

4 https://www.govinfo.gov/content/pkg/DCPD-201900464/pdf/DCPD-201900464.pdf

5 https://trumpwhitehouse.archives.gov/wp-content/uploads/2021/01/CEA-Kidney-Transplant-Report1.8.211.pdf

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