Totally Transplant

Improving access to Transplantation and Adolescent to Adult Transition Clinics with Dr. Basu

Enjoy this converation between Dr. Basu and Dr. Samra. They discuss what ignited their interest in Transplant Nephrology and their path since. How much they enjoy practicing Transplant Nephrology and making a meaningful difference in patients lives. They then discuss Dr. Basu's focus on the vulnerable population. Pregnant women and the use of Belatacept 'bela'. The older adult population and access to transplant, avoiding arbitrary age cut-offs. The importance of utilizing race modification/race neutral formula. All these efforts have been to improve access to transplant for those populations that have historically been at a disadvantage. They then discuss an Adolescent to Adult Transition clinic that was started in concert with pediatric Transplant nephrologist, Dr. Roshan George. At age 18, transplanted patients start to visit the adult Kidney Transplant Clinic so as to start to feel comfortable and safe in this new space while remaiing under the Childrens Transplant Clinic umbrella. They continue this from age 18 to 21 such that by the age of 21 they are now familiar with the adult Transplant Clinic and have built a rapport with the adult Transplant Nephrology Team. Dr. Basu intentionally formed a multi-disciplinary team formed of social workers, physicians, transgender specialists. They identified unique challenges in this population and while addressing those, created a holistic, collaborative and personalized clinic. Improving compliance by utilizing telehealth in follow up visits being one such example. They then discuss Belatacept, a long term immunosuppressant that is un ique in that it is administered intravenously at 4-6 week intervals. At Emory, this is used as a primary immunosuppressant unless there is a contraindication. It has been shown to have better allograft and patient survival, cardiac outcomes and less post transplant diabetes mellitus when compared with calcineurin inhbitors as shown inthe BENEFIT trial. Belatacept cannot be used in those patients who are EBV(epstein barr virus ) positive. They then discuss the gap that older patients have to access to transplant. Some transplant centers have an arbitrary age cut off which we discussed doesnt pertain to all individuals. Further, we discussed the need for guidelines for older adult post transplant management including but not limited to frailty and cognition. We are all in the center of the continous innovation happening in the world of transplant medicine. The future of transplantation is exciting, inlcuding the recent gene edited Xenotransplantation. Increasing the number of transplants performed and aiming for one transplatn for life will be what we strive for as a community.  Dr. Arpita Basu is a Transplant Nephrologist at Emory University.