Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Bridging the Gap Between Obesity and Kidney Transplant
Danielle
Heyer
, BSN, RN, CCTC
, Transplant Bariatric Coordinator
, Mayo Clinic
The Challenge
In 2021, a review of our waitlist population indicated that 18% of our patients had a BMI of greater than 35, putting them at a higher risk of cardiovascular events post-transplant. 2% of these patients had a BMI greater than 40, making them ineligible for transplant. If these patients took part in weight management services prior to organ transplant they could have better outcomes during their post-transplant course. The objective of this program was to make transplant an option for patients whose BMI would have made them ineligible for transplant. Additionally, it would address risk factors, specifically obesity, to optimize post-transplant outcomes for patients that have a BMI between 35 and 40. Without a specifically identified person to help navigate the newly developed Bariatric Program, the care and management of the patient was disjointed and many times incomplete. These patients are less like to complete the program due to management of complicated chronic conditions involving multiple medical appointments and ongoing coordination. For the patient to be successful, it was critical to have a nurse coordinator develop a process that would guide the patient through the new program.
The Approach
The endocrinology department treats the general obese population rather than focusing on the transplant-specific patient population. Bringing this service into the Transplant Center provided us a greater opportunity to prepare for weight loss efforts for transplant patients and to properly follow up for kidney transplant surgery. The initial team developed for the new program consisted of the transplant surgeon, Nephrologist, Endocrinology (consulting), Psychiatry (consulting), and an RN credentialed Operations Manager, and dietitian. We later brought in a Certified Transplant Coordinator to act in the Role of Bariatric Transplant Coordinator. The program is a multidisciplinary approach that touches on dietary changes, activity, psychological and behavioral therapies, medication therapies, and surgical procedures that can be used to facilitate weight loss prior to being listed for Transplant. After verifying benefits, the bariatric nurse coordinator submits a nurse consult order. Based on the patient’s needs and eligible benefits, the bariatric nurse coordinator will enter orders for Endocrinology and Psychology, transplant bariatric surgeon, and Transplant Nutrition. After all visits are completed, the patient can proceed to a pre-surgical assessment with the transplant bariatric surgeon. Once evaluated, a case request for surgery is created which ensures a holding place for surgery and sends a prior authorization. Once the prior authorization is approved, a surgery date can be scheduled, PAME orders are placed, and all required post-surgery visits are scheduled.
The Results
The results show that we have performed 55 sleeve gastrectomy’s on pre-kidney transplant patients since February of 2021. 22 of them have gone on to receive a kidney transplant. 13 of them are actively waiting for a transplant. 3 of them have been made inactive because their kidney function improved post-sleeve and they are no longer eligible for a transplant, as they are too well. Overall, this indicates a 69% success rate as 38/55 patients who have received a sleeve through our program have gone on to either receive a kidney, are currently awaiting a kidney, or are too well to be listed.
Insights & Lessons Learned
The opportunity for the number of obese patients receiving Kidney organ transplant has increased through this program. The unique needs of the transplant patient were also identified and addressed enabling better outcomes. The scope of the program and lessons learned can be broadly used with other organ groups, not just within our center but across other organ transplant programs.