Another banner year for the Kidney Transplant Team
The multi-disciplinary Kidney Transplant Center at Cincinnati Children's has been in existence since 1965, and has performed over 500 kidney transplants in children. Recent years have seen an explosion of activities, thanks to novel protocols that optimize the care of children with the most complex malformations, antibody-mediated rejection and BK virus nephropathy. Despite the complexity, Cincinnati Children's kidney transplant program, directed by Dr. Jens Goebel, continues to achieve patient and graft survival rates that are at or above the national benchmarks, while the lengths of stay for the initial transplant surgery are shorter than the national average. These successes have now established our program as one of the premier transplant centers in the Midwest, and more than half of our patients come from distant cities and states. We now perform 20-25 kidney transplants each year, which places us within the top five busiest pediatric kidney transplant centers in the country. During the past year, we performed our first combined heart-kidney transplant successfully, with an excellent outcome. We also performed successful kidney transplants for several fetal care center “graduates” who had prenatal interventions for severe developmental anomalies of the kidneys and urinary tract. In addition, Dr. David Hooper has led the transformation of our kidney transplant program to comprehensively track and improve outcomes for our patients. We have standardize the measurement, reporting, and classification of blood pressure by RN’s and MD’s across 6 clinic locations in addition to prototyping, refining and implementing a sophisticated visit planning process that includes decision support. We also started the first dedicated kidney transplant clinic. These interventions have contributed to an increase in the percentage of patients in our population with controlled blood pressure from under 50% to nearly 70%.
A continued surge of infants at the Dialysis Center
The Dialysis Unit at Cincinnati Children's, directed by Dr. Rene Vandevoorde, is among the 10 largest in the country. By far the most challenging and complex dialysis patients are infants. Over the past couple of years, this extremely demanding population has exploded, and we now care for several infants on home dialysis. The majority of these infants have come from outside the Cincinnati area, many referred via our Fetal Care program and others because of lack of complex dialysis expertise at their home institutions. The care of these infants is optimized through a coordination of services orchestrated by the dialysis unit, bringing together their medical, surgical, nutritional, developmental, and psychosocial needs. New policies for aggressive feeding, hormonal, and dialytic treatments have already resulted in improved physical and mental development, and earlier kidney transplantation. Such initiatives have assured optimal care and set best practice care standards for this unique dialysis population.
An enormously successful year for the new Center for Acute Care Nephrology
The incidence of acute kidney injury has reached epidemic proportions globally, afflicting one third of critically ill children and often resulting in death or chronic kidney disease. Stemming the tide requires a concerted effort to develop optimal care for patients with or at risk for acute kidney injury. These urgent needs led to the launch of the Center for Acute Care Nephrology (CACN) in 2010, a collaborative effort between Nephrology, the Heart Institute, and Critical Care, directed by Dr. Stuart Goldstein. Our clinical accomplishments have included launching the first in-house consultative acute Pheresis Service, implementation of early proactive peritoneal dialysis in children at risk for acute kidney injury after cardiac surgery, development of intra-operative plasmapheresis for Heart Institute patients with high antibody sensitization undergoing heart transplantation, and implementation of the Nephrotoxic Medication Associated Injury Negated by Just In Time Action (NephroNINJA) project which has led to the avoidance of 900 days of nephrotoxic medication associated acute kidney injury days annually.
Expert and unique care for children and adults with Tuberous Sclerosis
We have now established the largest referral center for the management of kidney manifestations of tuberous sclerosis in the country. Under the leadership of Dr. John Bissler, we perform innovative embolization techniques for renal angiomyolipomas that complicate tuberous sclerosis, and have pioneered the use of steroid therapy to minimize post-embolization complications.