Transcript Title goes here

Clinical Management of the HIV
Infected Transplant Recipient:
How to Balance the Needs of the Patient
and the Health Care Team
Clinical Management Questions
 1. What are the challenges of facilitating communication among
the numerous members of the study team?
 2. Is it acceptable to limit access to transplantation due to
geographic proximity to the transplant center because of the
complex nature of the treatment involved?
 3. Given the complex clinical nature of this undertaking and the
busy schedules of all involved, what are the minimum
components of an appropriate transplant team for the study?
Transplant Study Team
 1. Primary HIV provider*
 2. Referring Nephrologist or
Hepatologist
 3. Transplant Surgeons* (7)
 4. HIV Study Consultant*
 5. Transplant Hepatologists
(7), Nephrologists (4)
 6. Pre/Post Transplant
Coordinators (11)
 7. Study Pharmacologist*
 8. Patient/family
 9. Study Coordinator*
Purpose of Communication
1. Information Dissemination
2. Patient Scheduling
3. Decision Making
Communication Challenges
Delays in response
Lack of consensus
Shared decision making
Identify primary decision maker
Integrating theoretical information into
practice
6. Access to pertinent information
1.
2.
3.
4.
5.
Communication Goals
1.
2.
3.
4.
5.
Facilitate discussion
Opportunities for interdisciplinary education
Shared decision making
Timely and efficient process
Positive patient outcomes
Limitations to Transplant
Selective study inclusion criteria
HCV co-infection
Economic barriers
Only 14 centers transplanting the HIV
infected individuals
5. Geographic proximity to transplant center?!
1.
2.
3.
4.
Is Distance a Factor?
8 people transplanted
4 in SF area, 4 in Southern California
Patients in SF area =no rejection, no
hospitalization, no SAEs
Patients out of area = all hospitalized, many
complication, 2/3 rejection
Coincidental??
Challenges Posed by Distance
Variabilites between labs
Delays in receiving and reviewing labs
Delays in decision making
Patient management without direct
assessment
5. Negotiating care plan with patient
6. Primary provider is HIV MD not Transplant
MD
1.
2.
3.
4.
Who Should Comprise the Study
Team?
1.
2.
2.
3.
4.
Transplant Surgeon
HIV Consultant
Transplant Nephrologist/Hepatologist
Pharmacologist
Study Coordinator