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Clinical Management of the HIV Infected Transplant Recipient:

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?

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Clinical Management of the HIV Infected Transplant Recipient:

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  1. Clinical Management of the HIV Infected Transplant Recipient: How to Balance the Needs of the Patient and the Health Care Team

  2. 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?

  3. 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* Transplant Study Team

  4. Purpose of Communication • 1. Information Dissemination • 2. Patient Scheduling • 3. Decision Making

  5. Communication Challenges • 1. Delays in response • 2. Lack of consensus • 3. Shared decision making • 4. Identify primary decision maker • 5. Integrating theoretical information into practice • 6. Access to pertinent information

  6. Communication Goals • 1. Facilitate discussion • 2. Opportunities for interdisciplinary education • 3. Shared decision making • 4. Timely and efficient process • 5. Positive patient outcomes

  7. Limitations to Transplant • 1. Selective study inclusion criteria • 2. HCV co-infection • 3. Economic barriers • 4. Only 14 centers transplanting the HIV infected individuals • 5. Geographic proximity to transplant center?!

  8. 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??

  9. Challenges Posed by Distance • 1. Variabilites between labs • 2. Delays in receiving and reviewing labs • 3. Delays in decision making • 4. Patient management without direct assessment • 5. Negotiating care plan with patient • 6. Primary provider is HIV MD not Transplant MD

  10. Who Should Comprise the Study Team? • 1. Transplant Surgeon • 2. HIV Consultant • 2. Transplant Nephrologist/Hepatologist • 3. Pharmacologist • 4. Study Coordinator

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