New Transplant Center Initiatives Improve Efficiency, Effectiveness and the Patient Experience

Owen, pediatric transplant patient As a national leader in pediatric solid organ transplantation, the Pediatric Transplant Center at the Children’s Hospital of Philadelphia (CHOP) is committed to providing patients and families with the best care. We have recently instituted a number of new initiatives focused on improving the efficiency and effectiveness of care and supporting the long-term health of our kidney transplant recipients.

Centralized vaccine administration

Vaccine preventable infections remain a common cause of morbidity and hospital admissions after transplant. During their transplant evaluation process, patients meet with Infectious Disease providers who give recommendations on ways to decrease the burden of infections after transplant. These recommendations include optimizing vaccinations prior to transplant so that patients can achieve optimal vaccine response and be protected from vaccine-preventable infections before they receive immunosuppression. We are currently working to develop a centralized, on-site vaccine administration clinic to enable patients to receive their recommended vaccines at the time of their transplant evaluation. This initiative will expedite kidney transplant listing and saves families time and travel to their primary care pediatrician to receive necessary immunizations. We believe this program is unique among other transplant centers across the country.

Streamlined transplant evaluation process

Many of our kidney transplant candidates have underlying urological conditions which require high-level urologic expertise to ensure successful voiding after transplant. We have identified dedicated pediatric urologists to collaborate with the transplant team during the transplant evaluation process, allowing for better care coordination and surgical planning to optimize bladder readiness for patients with complex urological conditions awaiting transplant. Improved communication with urology allows us to apply innovative pre-transplant approaches, such as bladder cycling in children with very small bladder capacity. Bladder cycling can potentially eliminate the need for surgical bladder augmentation in some of our patients. Our collaborative efforts have enabled us to transplant several children with success, avoiding surgical procedures, reducing risks of infection, and optimizing transplant function.

Enhanced living donor coordination

CHOP is one of only a few pediatric transplant centers in the country involved with the National Kidney Registry, a national paired-donor exchange program primarily for adults. The program allows families with living donors who do not match their recipients the opportunity to pair with living donors around the country, increasing access to transplant for multiple patients. We recently added a dedicated living donor coordinator to our transplant evaluation process. The coordinator provides education to families on the benefits of living donation and serves as a liaison for our pediatric program with the living donor evaluation program at our adult partner hospital, the University of Pennsylvania.

Supporting the transition to adulthood

Adolescent patients who are transitioning to adult care are at highest risk for transplant rejection. Their parents also often struggle during this time of transition. Our dedicated multidisciplinary transition/teen clinic supports this high-risk population and their families by addressing issues of healthcare self-management, identifying barriers and facilitators of treatment adherence, and helping prepare patients and their caregivers for transfer to adult care. We also partner closely with our neighboring adult transplant centers to support smooth transfer of information.

Screening for early rejection

Finally, we recently started a kidney protocol biopsy program. The latest scientific evidence suggests that pediatric kidney transplant recipients often develop subclinical injury after transplant that is often unrecognized and undertreated. Protocol biopsies allow for improved understanding of kidney transplant health and enable the early diagnosis of transplant injury, allowing for intervention before damage becomes permanent.

Conclusion

In summary, our multidisciplinary kidney transplant team includes nephrologists, nurse practitioners, nurses, transplant surgeons, pharmacists, social workers, psychologists, dieticians, and financial counselors. The team provides comprehensive care from referral, evaluation, listing, and eventual transplant. We are confident that the initiatives outlined above will continue to improve the efficiency of our transplant process, maximize the patient and family experience, and most importantly lead to outstanding transplant outcomes.

By Sandra Amaral, MD, MHS, Medical Director, Kidney Transplant Program, and Benjamin Laskin, MD, MS, Medical Director of Quality Improvement, Solid Organ Transplant Program.