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UAB Med Cast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA category 1 credit. To collect credit please visit www.uabmedicine.org/medcast and complete the episode’s posttest.

Melanie Cole (Host):  The UAB Comprehensive Transplant Institute is establishing a growing network of outreach clinics in order to provide patients throughout Alabama with convenient access to state of the art treatment options for patients with complications of chronic liver and kidney disease with treatment provided by physicians who are nationally recognized as experts in their field. Today, we’re talking about the liver and kidney transplant and outreach clinics. In this panel discussion I have with me Dr. Mohamed Shoreibah. He’s an Assistant Professor and a Hepatologist and Dr. Guarav Agarwal. He’s an Assistant Professor in Nephrology and they are both with UAB Medicine. Dr. Shoreibah, I’d like to start with you. Please tell us about the UAB Comprehensive Transplant Institute if you would.

Mohamed Shoreibah, MD (Guest):  So, the Comprehensive Transplant Institute, the CPI is a multidisciplinary entity where providers take care of patients that require organ transplant evaluation and management after the process is completed. So, we assembled there a great team of care coordinators, specialized clinical providers and we provide organ transplant service for liver, kidney, heart and lungs. The Institute completed so far 15,000 successful organ transplants since 1968. And we average on yearly 400 transplants. We have the largest comprehensive program in the southeast.

Now in terms of liver transplant in particular, we are one of 20 nationally ranked programs that perform 100 or more liver transplants per year. And we have excellent survival rates that actually supersede the average nationally and the big benefit that we are able to streamline that comprehensive service under one umbrella, assembling a great team of providers and administrators.

Guarav Agarwal, MD (Guest):  I would just like to add that it gives us a great opportunity for collaboration and research and deeper understanding of immunosuppression. We also have the ability to invite speakers from around the US and other countries to share their expertise in transplants so we can learn the similarities and differences of these programs and improve our patient care and outcomes.

Host:  Well thank you for that. So, Dr. Agarwal, along those lines, those synergies and the multidisciplinary approach, how has this energized your transplant communities?

Dr. Agarwal:  So, at UAB we are about nine nephrologists that work together along with five kidney transplant surgeons and we have a very strong collaborative team. We all get together at least once a week or sometimes even more frequently and have a very synergistic and comprehensive approach to patient care.

Host:  Dr. Shoreibah, tell us about the outreach clinics at UAB. Why did you see a need for these types of clinics and how did it come about?

Dr. Shoreibah:  Sure. We’re very grateful for a great network of dedicated providers in the region who do not spare any effort in caring for their patients. And equally important to patients and their families for the faith and trust that they put in the services that we provide here. but we really wanted to make sure that we are accessible to patients who are ill and cannot travel to come and see us here at the UAB. Sometimes, those patients need to be fast-tracked into the process of organ transplant evaluation and at times, it’s very difficult for them to get to us here.

And we would like to be able to provide those relevant consultations in a timely manner in a way that’s convenient to providers and patients. It is really a vital part of our mission and I think the big benefit of doing the outreach also is to spread the message about organ transplant and how life changing of a procedure it could be, that it can be a cure for an end-organ disease.

Host:  Well that is so important. What an amazing service you both are providing to the community and while we’re talking about services, Dr. Agarwal, what types of services do you offer? Tell us about the physician services for patients with complications of chronic liver and kidney disease. As I said in my intro, that this is giving them access to state of the art treatment options for patients. Tell us how that works.

Dr. Agarwal:  So, we are currently having one outreach clinic in Mobile Infirmary where we have seen post-kidney transplant patients. We are in the process of expanding our reach with opening a facility in Huntsville very soon. We are also looking into expanding to Montgomery soon. The outreach clinics are a great boon to the patients. They reduce their travel time and we are able to identify problems earlier in these patients. One of the common complaints that we get from these patients is why I have to drive all the way to Birmingham to see someone when everything is fine, and you are just telling me so.

So, with outreach clinics, when we can review their medical records, we can ensure that their medications and labs are up to date. We can also review any problems that they may have and identify these patients to come to Birmingham for higher level of care. Sometimes we are able to intervene much earlier by seeing the patients locally. The patients are always concerned about their transplant and they want our opinion even when the things are not related to their kidneys. So, for example, they are undergoing back surgery or some other surgery; but they would want our opinion to make sure they are safe from the transplant standpoint and we can provide this easily in our outreach clinic.

I also understand that some of the region – some of the institutes in our region are also doing outreach clinics. So, this has become very important part of care for chronic kidney disease and care for our transplant patients.

Host:  Dr. Agarwal, is Telemedicine playing a part in this endeavor?

Dr. Agarwal:  So, Telemedicine is definitely a part of our outreach. We are currently having difficulty in reaching patients that live in rural areas and they have to sometimes travel long distances just to see either us or even their primary care physicians. So, we are partnering with local health authorities that the patients can go there, and we can see them via Tele-Health. So, I think Dr. Clifton Kew from kidney transplant is going to talk about it in more detail. But definitely Telemedicine has increased our outreach efforts quite a bit.

Dr. Shoreibah:  And if I may add, in the field of the hepatology also, we are looking into doing that in the future. So, we would like very much to utilize Telemedicine for that intake season, that quick access point that we need for our patients to get them the access they need to their transplant evaluation and listing here at UAB. So, we’re very excited about that and we’re definitely exploring it as an option too.

Host:  Well that’s a great point and Dr. Shoreibah as we talk about how this care model improves the way patients receive their care; how does that all work together if they are going to have some other procedure done or they do have diabetes or comorbid conditions; how is this improving that whole care model by bringing it together so that everybody knows what everybody else is doing?

Dr. Shoreibah:  Sure. So, transplant patients are a unique population to deal with and right after the transplant and even that starts early on during the evaluation process; each and every patient is assigned a transplant coordinator that has a high level of training and expertise in that area in particular, the management of the immunosuppression medications, what to do before surgery or any needed procedures and that serves as a great quick access point for all of our patients. Not only this, but we utilize also the patient portal which allows patients to send us message that we can respond to in a timely manner. So, to maintain that success and good outcome after transplant; we really depend on a very strong dedicated team that maintains that communication between us and the patients and also us and the other providers that are taking care of the organ transplant recipients.

Host:  It’s such an amazing program as I said already, and Dr. Agarwal talk about patient outcomes a little bit for us. Why is this continuum of care so important for the success of transplant patients?

Dr. Agarwal:  So, one of the unique things that we provide to our patients is we follow them for the life of their organs, and this is very important. Because these patients as Dr. Shoreibah is saying that they are unique. They need to be followed for long term to improve their outcomes. So, we do that. Not all the programs in the country follow their patients for a long term. So, we feel that it has really improved our outcomes, both short and long term outcomes and we continue to do everything we can both locally and in our outreach clinic to do everything we can to improve the survivability of both the patients and allograft.

Host:  Dr. Shoreibah, give us some future plans for the clinic. What’s your vision? What are you hoping will include when you are evaluating patients with renal failure, assessing their needs? Tell us a little bit about what your vision is.

Dr. Shoreibah:  Sure. I think that to broaden even the discussion about the vision for organ transplant; I want to share some numbers with you. In the year 2019, there were more than 113,000 patients listed for organ transplant in the US. And if you look at the number of patients that were transplanted in 2018; about a third of that number received organ transplant. So, I think our vision and future challenges that we have probably two important points. The access to the specialized care, how can we get those patients quickly to be evaluated for liver transplant and outreach is a vital part of that and we will continue to do it. But also, how to fill in the gap on the deficiency in the organs there because 20 patients on the list for organ transplant die everyday without getting what they need.

So, while you look at the population here in the US, 95% of the adults approve of organ donation and have positive opinion about it but only 58% actually signed up as organ donor. So, what can we do to bridge that gap and make sure that we have more organ availability? Probably more education and outreach to the community to make sure that people understand the importance of that.

The other thing that we are working on and pushing really forward with is trying to modify nonhuman organs to be transplanted to humans in the future. And this is a very unique concept and we really hope that it becomes successful in the future and that’s what we call xenotransplant. So, we have a very strong research program now that we are hoping to see the fruits of in the near future.

Dr. Agarwal:  I agree with Dr. Shoreibah. We are moving tremendous – we are making tremendous stride in terms of xenotransplant in terms of possibly obtaining pig organs for kidney. In terms of having more accessibility for organ donation; these outreach clinics will help us find suitable candidates who have living donors and sometimes because of the slow process of evaluation; these donors are not being able to be tapped or reached because they sometimes tend to lose interest as the process lingers on. So, with this outreach, we are trying to see if we can quickly identify suitable candidates and identify living donors to improve the number of transplants that we can do every year.

Host:  Well it is fascinating, and listeners can listen to a podcast on xenotransplantation from the experts at UAB Medicine on the website podcast page. Because we have done one and it is amazing what you are all doing there. So, Dr. Agarwal, I’d like to start with you. Do you have any final thoughts? Anything you’d like to leave other providers with that will give them more information about the liver and kidney transplant and outreach clinics available through UAB.

Dr. Agarwal:  So, I would just like to say that we are working very hard to provide great care to our patients. We are trying to provide – reduce the wait time for the patients who are referred to us. We are trying to increase our outreach, so the patients don’t have to wait as much or travel as much to UAB and they are better served and are more satisfied with their care.

Host:  Dr. Shoreibah, last word to you. What would you like the listeners to take away from this very important comprehensive approach to treatment of organ failure and transplant?

Dr. Shoreibah:  Sure, I agree with everything my colleague Dr. Agarwal mentioned. I would like to add to our referring providers that the mission that we are trying to accomplish here in the CTI would not happen and won’t be a success without their efforts there. And we are ready to help and give any opinion at any point of time. So, no hesitation picking up the phone and talking to us about any patient that we need to take care of, and we value the effort that they do out there in the community. They are really on the frontlines.

Host:  Well thank you gentlemen both of you for all that you are doing and for coming on this podcast today and sharing your incredible expertise. Thank you again. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. This concludes this episode of UAB Med Cast. For more information on resources available at UAB Medicine, please visit our website at www.uabmedicine.org/physician. And please remember to subscribe, rate and review this podcast and all the other UAB podcasts. I’m Melanie Cole.