Kidney Week Educational Symposia-Partners for Life: Optimizing Collaboration of Community and Transplant Nephrologists

Video Transcription

Video Summary

The session discusses improving collaboration among community nephrologists, dialysis providers, and transplant centers to enhance kidney transplant access and long-term outcomes. Ben Hippen outlines how siloed care, inconsistent candidacy criteria, fax-based referrals, poor tracking, and limited communication lead to late or lost referrals, poorly managed transitions (including return to dialysis after graft failure), and avoidable costs—estimated at $1.38B annually from premature graft failure and suboptimal dialysis restarts. He argues that AAKH models (ETC and KCE) incentivize waitlisting and short-term post-transplant outcomes but are misaligned with transplant-center financial and regulatory pressures. Proposed solutions include clearer division of responsibilities across the “renal lifetime,” standardized referral and evaluation timelines, shared communication platforms, surveillance systems, telehealth, and aligning metrics and payment models to prioritize true transplant access and long-term graft survival.<br /><br />Dr. Singh reviews long-term allograft survival trends: major early improvements, but modest gains at 5–20 years. Late failure is driven by death with graft function (about 50% of failures), mainly cardiovascular disease, plus cancer and infection; and death-censored graft loss, increasingly linked to antibody-mediated rejection and transplant glomerulopathy, often associated with nonadherence. Traditional cardioprotective strategies have underperformed in trials; SGLT2 inhibitors are promising but need larger transplant-specific studies.<br /><br />Dr. Malone reviews noninvasive monitoring, focusing on donor-derived cell-free DNA tests (AlloSure, Prospera) to detect rejection and reduce reliance on biopsy, acknowledging varying performance and evolving evidence.

Asset Subtitle

Moderators: Benjamin Hippen

Speakers:

Introduction – All Together Now: Post-Transplant Care in the Age of AAKH - Benjamin Hippen
Going the Distance: Challenges to Long-Term Allograft Survival - Sunita Singh
Art and Science: Noninvasive Allograft Monitoring Methods - Andrew Malone

Meta Tag

Date 11/4/2021

Pathway 1 Transplantation/Immunology

Session ID 408689

Session Type ES - Educational Symposium

Keywords

kidney transplant access

care coordination

community nephrologists

dialysis providers

transplant centers

AAKH models (ETC, KCE)

long-term allograft survival

donor-derived cell-free DNA (AlloSure, Prospera)

antibody-mediated rejection