Author: Shaheed Merani, MD, PhD, FRCSC, FACS

1) Deciding on when to list a patient for intestinal transplant

2) Classical indications for listing for intestinal transplant

3) How listing patients for intestinal transplant has changed with time

4) Outline of additional workup required

ASTS gratefully acknowledges Natera for providing education to our members. 

ASTS gratefully acknowledges CareDx for providing education to our members. 

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."

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

Over a third of adults in the United States have limited health literacy and it impacts healthcare utilization
and patient outcomes, particularly among kidney transplantation (KT) candidates. Recent work suggests
that limited health literacy is a salient mechanism in access to KT and is associated with an increased risk
of waitlist mortality. Yet, few centers screen for limited health literacy. This activity will help increase the
awareness of limited health literacy in KT candidates among transplant specialists.

Learner Objectives
1. Become familiar with a tool to measure health literacy
2. Identify the prevalence of and risk factors for limited health literacy among kidney transplant
candidates
3. Understand the consequences of limited health literacy for kidney transplant candidates

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

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.