Kidney Transplantation

Patient Care

Goals & Objectives

  1. Interpret the results of focused clinical evaluations (history, physical examination, laboratory data) performed on patients undergoing assessment for kidney transplantation to
    1. Identify patients who are candidates for kidney transplantation
    2. Identify the findings that constitute contraindications to proceeding with kidney transplantation.
  2. Perform clinical evaluations on patients being assessed for kidney transplantation 
  3. Assume primary responsibility for the postoperative management of kidney transplant patients
  4. Interpret the results of focused clinical evaluations (history, physical examination, laboratory data) performed on patients undergoing assessment for kidney transplantation to construct a risk benefit analysis including
    1. Cardiac risk factors
    2. Infectious risk factors
    3. Rejection risk factors
  5. Interpret the results of focused clinical evaluations (history, physical examination, laboratory data) in postoperative kidney transplant patients to identify and develop treatment plans for the following postoperative changes
    1. Decreased urine output
    2. Decreased/ Increased blood pressure
    3. Chest pain
    4. Shortness of breath
    5. Hyperkalemia in a patient with renal insufficiency
    6. Fever
  6. Determine an appropriate evaluation plan for patients with a functioning kidney transplant who develop deterioration of renal function. 

Responsibilities and Expectations

  1. Write admission and inpatient orders under the supervision of the fellows, NPs or attendings
  2. Be present at morning attending rounds, prepared to present patients in an organized and succinct manner.
  3. Update sign out
  4. Implement the clinical decisions made by the team (on rounds, during the day) in a timely manner
    1. Arrange consultations
    2. Check orders
    3. Schedule diagnostic tests
    4. Schedule therapeutic procedures
  5. Notify the fellow/NP if unable to implement the clinical decisions
  6. Communicate the results of consultations, diagnostic tests, and therapeutic procedures to the fellow in a timely manner
  7. Write discharge summaries and discharge orders

Medical Knowledge

Goals & Objectives

  1. Describe the evaluation process, including medical and psychosocial components, for the
    1.  Live kidney transplant donor
    2. Kidney transplant recipient
  2. Identify immunosuppressive medication
    1. Classes
    2. Mechanisms of action
    3. Toxicities
  3. Describe the immunology of rejection including
    1. T cell and B cell involvement
  4.   Risk assessment methods
    1. HLA testing, the role of PRA
    2. Cross-matching
    3. Diagnosis
    4. Treatment
  5.   Describe the anatomy of the kidneys including
    1. Kidney
    2.  Renal artery and vein
    3. Iliac arteries and veins
    4.  Ureter
    5. Bladder
  6.   Describe the major steps involved in performing the following procedures
    1. Kidney transplant
    2. Donor nephrectomy
    3. Transplant nephrectomy
  7. Have a working knowledge of clinical application of dialysis
    1.  Interpret the results of clinical evaluations to identify the patient who requires acute dialysis
    2. Compare access methods for dialysis
    3. Assess the risk of dialysis complications
  8. Compare common opportunistic infections in transplant recipients in terms of
    1. Presenting signs and symptoms
    2. Treatment
    3. Prevention

Practice-Based Learning and Improvement

Goals & Objectives

  1. Analyze the causes of common complications of kidney transplantation

Responsibilities and Expectations

  1. Participate in the weekly Transplant Morbidity and Mortality conference to review and analyze treatment outcomes
  2. Document patient outcomes by maintaining a log of patients treated and their clinical results
  3. Meet with the education representative at least 3 times during the rotation (beginning, midpoint, exit) to review goals & objectives 

Interpersonal and Communication Skills

Goals & Objectives

  1. Communicate effectively as a member of the multidisciplinary team that rounds together
  2. Communicate effectively with patients and families.

Responsibilities and Expectations

  1. Counsel and educate patients and their families regarding pathology of illness
  2. Communicate daily plan of care with RN, PT, OT and nutrition.
  3. Communicate plan of care to transplant coordinator and outpatient providers as needed. 

Professionalism

Goals & Objectives

  1. Describe the ethics of organ donation, brain death, withdrawal of support, and the separation of the transplant team from the team caring for the patient who is a potential donor
  2. Describe the ethics of living donation, considering donor health and well-being.
  3. Discuss the ethics of compensation of donor families or living donors.
  4. Discuss the ethics of various organ allocation schemes, emphasizing utility, efficiency, justice.
  5. Discuss the conflicting interests of individual transplant patients vs. the waiting list as a whole

Responsibilities & Expectations

  1. Attend at least one kidney transplant selection conference

Systems Based Practice

Goals & Objectives

  1. Compare the overall healthcare costs of dialysis with the costs of renal transplantation
  2. Describe the payment system and include the role of MedicareAnalyze barriers to renal transplantation for different patient populations
    1. dialysis
    2. renal transplantation

  3. Analyze barriers to renal transplantation for different patient populations

Responsibilities and Expectations

  1. Attend at least one kidney transplant selection conference
  2. Attend twice-weekly multidisciplinary rounds 

Determine an appropriate evaluation plan for patients with a functioning kidney transplant who develop deterioration of renal function. 

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