Starting October 1, 2025, Sentara will participate in the Centers for Medicare and Medicaid Services (CMS) Increasing Organ Transplant Access (IOTA) Model. This partnership will enhance care for chronic kidney disease.
The IOTA Model's goal is to boost access to kidney transplants and raise the number of these procedures, enhancing health results for those with end-stage renal disease.
The goal is to enhance coordination of care for people seeking a kidney transplant evaluation for those already on the waiting list and to improve the quality of outcomes for transplant recipients.
Renal and Pancreas Transplant Candidate Selection Criteria
Suitable Kidney and Simultaneous Pancreas Kidney/Pancreas After Kidney(SPK/PAK) candidates:
- Psychologically stable
- Capable of understanding the risks and benefits of transplantation, both in the short term and long term
- Potential Pancreas recipients: Diabetes with End Stage Renal Disease and require dialysis or expect to require dialysis within one year.
- On Insulin (total dose <1 unit/kg/day not to exceed 100 units/day) and has BMI < 30
- Age ≤ 55 years
- Clearance from EVMS Endocrinology
- Fasting C Peptide <12 ng/mL
- PAK only: Acceptable function of kidney transplant
- Creatinine clearance ≥ 40 mg/dl in the presence of calcineurin inhibitors
- Creatinine clearance ≥ 55 mg/dl in the absence of calcineurin inhibitors
- Demonstrated compliance with post kidney transplant regimen
Absolute Contraindications for Kidney/SPK/PAK:
- Incurable Malignancy
- Multiple Myeloma
- For Kidney-age greater than 70 with co-morbidities
- For SPK and PAK-age greater than 55
Relative contraindications for Kidney/SPK/PAK candidates: (the presence of one of the conditions should not preclude referral to the transplant center for evaluation)
- Active psychopathology-not controlled/managed through medication and/or therapy
- Inadequate psychosocial support as defined by the transplant program including the absence of confirmed caregiver for the immediate post-transplant period
- Active alcohol and drug abuse (excluding marijuana use) see KP Transplant Substance Abuse policy (at least one year of abstinence required before reconsideration with negative random screenings)
- Un-reconstructable coronary artery disease or refractory congestive heart failure
- Chronic liver disease with established bridging fibrosis/cirrhosis
- Albumin < 3 g/dl in the absence of nephrotic proteinuria
- Active GI bleed
- Active infection
- C3 glomerulonephritis
- Active glomerulonephritis
- Active lupus
- Positive HBV-DNA
- BMI ≥ 40 for kidney transplant
- BMI ≥ 30 for pancreas transplant
- Obesity-by individual assessment and at the discretion of the Patient Selection Committee
- Proven medical non-compliance with medication and/or prescribed treatment(s)
- Chronic hypotension requiring daily treatment with medications
- If made not a candidate by the transplant center due to no shows, patient must wait three months before being re-referred
- Potential PAK recipients- demonstrated failure to comply with post kidney transplant regimen
- Potential SPK/PAK- tobacco smoking
- Severe pulmonary disease/need for home oxygen
- Refractory pulmonary hypertension with pulmonary arterial pressure > 45
- Open wounds
- Ejection fraction ≤ 35%