donor transplants last about 8-10 years on average, where living transplants can average over 15-year longevity. Data from the Scientific Registry of Transplant Recipients (SRTR) registry are displayed in the two figures below. This first figure shows the 5-year (60-month) graft survival for DDRTs. You can see it ranges from about 70% in diabetic kidney disease to about 80-85% in patients with glomerulonephritis (GN) or cystic kidney disease (CKD); grafts placed in patients with hypertensive ESRD fall in the middle with about a 75% 5-year graft survival. Figure 1: Graft survival among adult deceased donor kidney transplant recipients, 2011, by diagnosis. OPTN/SRTR 2016 Annual Data Report. HHS/HRSA. [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 2 The next figure shows the 5-year (60-month) graft survival in living donor transplants (note the scale is different from the graph above). You can see 5-year graft survival is somewhat better: 80% for diabetic kidney disease, 88-90% in patients with GN and CKD; patients with hypertension as their cause of ESRD fall in the middle with about 85% 5-year graft survival. Figure 2: Graft survival among adult living donor kidney transplant recipients, 2011, by diagnosis. OPTN/SRTR 2016 Annual Data Report. HHS/HRSA. Patient survival is somewhat better than graft survival, as patients can return to dialysis and in many cases be eligible to receive a second (or even third) transplant. It is important to note that patients with living donor transplants have somewhat longer graft survival, as well as patient survival. However, in general, eligible patients undergoing any kind of kidney transplant have better survival and quality of life than those remaining on dialysis, regardless of the cause of kidney failure. The dialysis unit is an important part of the transplant team. The dialysis team is required by the Centers for Medicare and Medicaid Services (CMS) to educate patients about renal transplantation. Patients are referred for transplant from the dialysis unit, if they have not already been referred. The team can help patients complete the steps needed to be placed on the waitlist by encouraging and helping the patients finish required testing, such as colonoscopies, PAP smears, mammograms, and outpatient cardiac testing. Not only can the dialysis team arrange the patient’s dialysis schedule to be able to visit the transplant center and complete the testing, but also can help by giving the patients vaccines and by sending timely blood samples to the HLA lab. The dialysis clinic can give the transplant center important feedback on a patient’s social situation, drug or alcohol use, or lack of adherence to medical therapy, which can impact their candidacy for transplantation. Once on the waitlist, the dialysis clinic can help make sure the patient maintains a stable state of health, and can notify the transplant center if the patient develops a change in their medical condition with a severe illness, such as cancer, chronic severe infection, or congestive heart failure which will affect their transplant candidacy, and also notify the transplant center when the illness has resolved, so that the patient can be activated on the list again. They can let the transplant center [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 3 know if the patient’s social situation becomes unstable – for instance if they become homeless, go into a nursing home, or lose their transportation – which would impact their ability to have a successful transplant. We don’t know the percentage of patients in a dialysis unit who are eligible to receive a kidney transplant – this may vary based on the location, demographics, and medical profile of a given dialysis clinic. However, evidence suggests that over 50% of dialysis patients are actually eligible to receive a transplant. The best data we have, from the Southeastern US, reveals that only about 25% of ESRD patients are referred for a kidney transplant in their first year on dialysis. As mentioned above, only 16% of dialysis patients are on the kidney transplant waitlist. Recently CMS has directed the ESRD networks to develop quality improvement programs for dialysis units with the goal to increase the number of patients who are referred for transplant and placed on the kidney transplant waitlist. The quality initiatives have usually involved dialysis clinics with low referral and transplant waitlisting rates. This transplant toolkit was developed in order to provide information regarding kidney transplantation that will be useful for dialysis clinic staff. The chapters are written for clinical staff who are trained in dialysis but are not trained in transplant medicine. We also believe nephrologists will also find the chapters informative. It is not a comprehensive textbook on transplantation, but a series of chapters that covers basic information; this information should be beneficial to those helping patients prepare for receiving a kidney transplant. We hope you find this toolkit useful and welcome your feedback for ways we can improve it in the future. [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 4 Chapter 1: Selecting Patients to be Referred to a Transplant Center and the Transplant Evaluation Author: Carlos Zayas, MD Despite modern improvements in healthcare, Chronic Kidney Disease (CKD) currently affects approximately 14% of the American population. In some patients, progression