ASTS gratefully acknowledges CareDx for providing education to our members. CareDx will be hosting content on a quarterly basis throughout the remainder of 2020.  

Author: Jennifer Vittorio, MD

1. Define health care transition.

2. Review current outcomes following transfer of care for pediatric solid organ transplant recipients. 

3. Identify and discuss barriers to health care transition. 

4. Review the "Six Core Elements of Transition."

ASTS gratefully acknowledges Natera for providing education to our members. Natera will be hosting content on a quarterly basis throughout the remainder of 2020.

Submitted by: Koji Hashimoto, MD 

Cleveland Clinic, Cleveland, OH

Unit Objectives

I. List the indications for kidney transplantation, explain the different disease processes resulting in end-stage renal disease, and describe the treatment options.
II. Outline the basic of principles of donor and recipient selection and deceased donor organ allocation.
III. Describe and perform living and deceased donor kidney transplant procedures;
IV. Explain the basic immunosuppressive strategies used in kidney transplantation, including induction and maintenance therapy.
V. Recognize and diagnose renal transplant rejection, identify basic pathologic findings of rejection, and describe treatment strategies for rejection.
VI. Describe appropriate long term follow-up and be able to identify and treat short and long term complications of kidney transplantation.
VII. Describe the short and long term outcomes of kidney transplantation.
VIII. Outline the basic principles of renal replacement therapy; identify indications for and surgical techniques necessary to place hemo- and peritoneal dialysis access.

Elizabeth M. Thomas, DO

1. Understand the benefits of living kidney donor transplantation

2. Appreciate the risks of living kidney donor nephrectomy to the donor

3. Appreciate the components and importance of the OPTN policy for living kidney donor evaluation

4. Understand that there are dilemmas in living kidney donation and the acceptance criteria for living kidney donors continues to evolve.

Submitted by: Chandra Bhati, MD
Virginia Commonwealth University 

Practice Gap

Opioid analgesics serve an important role in management of acute and chronic pain, but recognition of
an “epidemic” of complications related to the misuse, abuse, and inherent potential toxicity of
prescription opioids is a growing. Concerns about opioid-related toxicity are even greater in patients with
end-stage organ failure due to altered drug protein binding, metabolism, and excretion. This activity will
increase the awareness of transplant professionals of patterns of prescription opioid use before and after
kidney transplantation, and outcomes associated opioid medication use in these periods. Such knowledge
may help practitioners better understand the risk of transplant patients at their center, and direct efforts
to mitigate risk, such as focused monitoring of support of higher risk patients over time after surgery.

Learner Objectives
1. Understand the patterns of prescription opioid use before and after kidney transplantation in
the U.S.
2. Understand relationships of pre- and post-transplant prescription opioid use in the kidney
transplant population.
3. Understand associations of opioid use before and after kidney transplantation with patient and
allograft outcomes.

Accreditation
The American Society of Transplant Surgeons (ASTS) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
ASTS designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate with the extent of their participation in the activity.

Activity Disclosures
The authors of this activity have no relevant financial relationships to disclose.

Instructions for completing ASTS MOC – Education through AJT modules
*Please note, you must hit the “next” button at the bottom left after each step to continue in the
module.
1. Review article.
2. Complete post-test. A passing score of 75% is required to move forward. The test can be retaken
as many times as necessary.
3. Complete the evaluation.
4. Access your AJT MOC certificate(s) and transcript of modules completed under the “My
Learning” tab. 

Practice Gap

Few high-quality data exist on the management of patients with PTDM. In this context of relative
uncertainty physicians are confronted daily with challenging clinical situations that require to integrate a
series of concepts which are the efficacy of immunosuppressive therapy, the immunological risk that is
conditioned by patient characteristics and the moment after transplantation, as well as the metabolic
side effect profile of immunosuppressive medication. In addition, other factors such as age and frailty of
the patient, and the quality of the graft have to be considered in taking decisions about possible
adjustments of the immunosuppressive management.

Learner Objectives
1. Provide immunosuppressive therapy with optimal protection against acute rejection during the
first months after transplantation when the risk of acute rejection is highest.
2. Avoid labeling the patient as having PTDM before attaining the maintenance dose of
corticosteroids and calcineurin inhibitors. This will normally be the case 2-3 months after renal
transplantation.
3. Consider the immunological risk of the patient when adjusting the immunosuppressive regimen
in order to improve glucose metabolism.

Accreditation
The American Society of Transplant Surgeons (ASTS) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
ASTS designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate with the extent of their participation in the activity.

Activity Disclosures
Karl Martin Wissing has received grants, travel support, and honoraria from Astellas, Novartis, Amgen,
Bellco, Roche, and Pfizer.

Instructions for completing ASTS MOC – Education through AJT modules
*Please note, you must hit the “next” button at the bottom left after each step to continue in the
module.
1. Review article.
2. Complete post-test. A passing score of 75% is required to move forward. The test can be retaken
as many times as necessary.
3. Complete the evaluation.
4. Access your AJT MOC certificate(s) and transcript of modules completed under the “My
Learning” tab.

Practice Gap

Many transplant professionals do not currently understand risk factors that may necessitate screening
and prevention strategies for post-transplant hematologic cancers (PTLDs).

Learner Objectives
1. Describe the magnitude of increased risks for various hematologic cancers after organ
transplantation
2. Understand the known relationships between viral infection, immune surveillance and
immunosuppression as mechanisms of cancer pathogenesis
3. List the prevention and treatment strategies that have been explored for PTLDs

Accreditation
The American Society of Transplant Surgeons (ASTS) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
ASTS designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate with the extent of their participation in the activity.

Activity Disclosures
Vikas Dharnidharka, MD is a consultant for Bristol-Myers Squibb and Atara Biotherapeutics.

Instructions for completing ASTS MOC – Education through AJT modules
*Please note, you must hit the “next” button at the bottom left after each step to continue in the
module.
1. Review article.
2. Complete post-test. A passing score of 75% is required to move forward. The test can be retaken
as many times as necessary.
3. Complete the evaluation.
4. Access your AJT MOC certificate(s) and transcript of modules completed under the “My
Learning” tab.