The multi-faceted Journey to Transplantation with Dr. Beje Thomas

Dr. Samra sits down with Dr. Beje Thomas, the Medical Director of the Kidney and Pancreas Transplantation program at the Medical College of Wisconsin, Froedtert Hospital . 

They discuss, how the team at Froedtert has been able to grow the program by placing the patient at the center of their care while also utilizing the lens of entrepreneurship and business principles. 

They share some great anecdotal stories. Remembering that the journey to transplantation is not always a simple straight line. Sometimes there are can be multiple stops along the way. Its important to embrace them and to continue to self advocate for yourself.

https://www.mcw.edu/find-a-doctor/thomas-beje-md. 

Please note this is not medical advice. It is meant for entertainment purposes only. 

Transcript

SPEAKER_00 0:02

Hello, everyone. Welcome to another episode of Totally Transplant. This is your host, Dr. Munfried Samra. We have a very special guest with us today, Dr. B. G. Thomas. I had the pleasure of meeting Dr. Thomas about three years ago, and I instantly knew that he was a very dynamic physician. And he has shown us that as his current role as the medical director of the kidney and increas program at Freighter and the Medical College of Wisconsin. Dr. Thomas, if you could please introduce yourself to the audience.

SPEAKER_01 0:38

Sure. Thank you. First of all, thanks for letting me come on your podcast, Dr. Sam Raman Tree. You know, this is a wonderful opportunity, and I love connecting with you a few years ago. We did. And I think we're kin spirits in all of this and really have a passion for transplant. And it's great having like-minded folks to work with and discuss all these things with. So, yep, I'm Dr. BG Thomas. I'm a transplant nephrologist. I'm the president of the medical director of the Kidney Packers Transplant Program at MCW Freighter Hospital at MCW in Milwaukee. I moved here about three years ago. Prior to this, I finished my training at the University of Clinic where I did my general nephrology fellowship. And then I was fortunate to do transplant nephrology at the Melchizedek, South Carolina in warm Charleston, and then moved to the University of Maryland. I was at Georgetown, and now here in uh Milwaukee. It's a really nice, fortunate trip for me to be able to work at all these wonderful programs and meet many colleagues throughout the country along the way, wonderful mentors. And you know, the that there's that phrase when you stand on the shoulders of giants, and I really feel that way. You're fortunate who you meet and you come into contact with that inspire you. So very excited and look forward to our conversation today.

SPEAKER_00 1:40

This actually segues perfectly into what brought you into the field of transplant.

SPEAKER_01 1:46

So this is kind of a funny story. When you go to school and you're like my dad in the car, we're like, What do you want your career to be? Every time we were driving to my high school, I was like, I don't know, you know, I guess medicine or something along those lines, but parents are both in medical care. Anyway, so then, you know, I went on my journey and became a physician, was very fortunate and uh blessed to do that. And then uh I when I went to internship, I was like, oh, I ought to be a critical care physician, but I ended up not really liking procedures and uh per se. And then so I love nephrology because everybody talks to nephrologists, whether in the hospital, when they're outside the hospital, seems like everybody has to talk to the nephrologist. So anyway, so it was very interesting. Then I think the other part is whenever you have fantastic mentors in a field, you tend to gravitate towards those attendings. So that definitely happened for me at UConn, University of Connecticut. So my second year of neprology fellowship, I was like, you're still used to training, and next year you're going to the next year, the next year, the next year. And now I was like, I have to look for a job. What's that? Right. And then I was like, man, I'm gonna think of my, I always heard them say, like, you know, I'm gonna do like a liberal arts year or take a gap year in a sense. And I thought, what do I do? You know, and my parents like, what are you gonna do? You're gonna like move back home, what's going on here, right? So I actually thought of the, oh, I'll do transplant for years, but I didn't want to do critical care, but I don't like procedures so much per se. And then so I said, I'm gonna do transplant nephrology is my liberal arts year in a sense. And then I don't mean to send anybody that's the arts. I was just taking it as my like first two years of college where I'm trying to find my way. So I did this uh year of uh transplant nephrology. I was very fortunate to be able to interview at several places. I was blessed to be at the Medical Industry of South Carolina, a wonderful experience. And what I realized there as time went on, and I had a one on faculty there, was the impact the transplant nephrology team, transplant surgery, all of us had in the transplant field helping these patients. You know, when they come to you, they're on dialysis and the observational nephrology colleagues take wonderful care of them. But for them to be able to return to uh really quality of life, having that one more holiday with their family off dialysis and these types of things, seeing the change in their life was so impactful that I thought this would be a great way to go forward in my career. And then as I stumbled along in my career, I really saw this increased the need for increased access to care. That's a very common theme used these days. And I think I'm gonna tell you a small story, which I always think of when I went into transplant nephrology. When I was in first grade, my dad picked me up from school and he said we have to go get a doctor's note from a physician so that you know the because one of his friends had to call up from work that day. You know, our parents immigrated here in the 70s, so you know, we're living in uh North Philly, that's where I grew up, you know, of the Eagles stand go birds, but uh but we grew up, I grew up there. So we're going to this doctor's office, you know, and I was in kindergarten first grade. And I just remember seeing all these people there. And you know, being a little kid, you're like, why do I have to be here? I want to go to the playground. And I just remember that one impression is that now being older and being a physician, that physician probably saw so many patients that day. He was working in an underserved area, and he and you know, he wrote this doctor's note for my friend. And I just thought of like the fact that these patients were there until 6 p.m., 7 p.m. 8 p.m., you know, like that, not everybody has that access. And even that is difficult for people, right? So, how can we, in our transplant world, make something super complicated much easier for the patient and much easier for them to get along the way? So we're really like, I want to say the guardian angel trying to get them to transplant and transplant. You're, you know, my pre, there's that very interesting figure, that subway figure that we talked about, transplant. And like, why can't we make that an express train from point A to point B and point B to point C as opposed to having several exits on the way? That is that is life, that's the way it is. But we try to make it as easy as possible.

SPEAKER_00 5:20

That really sums it up and also takes us kind of to the next part in increasing access. You know, as we talked about before we started recording, there's this like non-binary journey that we're gonna talk about today that we want to highlight for patients. And I think as we do this, we're also gonna do exactly what you just described, simplify this complicated thing.

SPEAKER_01 5:44

Right. Thank you. It's a great question. So starting from the basics, right? So when I now aging myself, when I was a resident, the staging for chronic kidney disease was coming into play, right? Now it's been around so 20, 20 years now or so, whatever it is, right? But it wouldn't exist before. It was just kidney failure, right? The fact that staging came up, the reason for that stage when your doctor, when a patient here, you're in stage eight, one, two, three, four, five, whatever caveats you want to throw in, we'll just keep it simple, is to say that this is where you're at, and this is what we need to do. We can't do anything about the past. You are where you're at, but we can do things in the future. And the goal is really that you prevent the decline in your function so you don't need dialysis. Hopefully you don't need a transplant. You know, and that's hopefully we catch you early enough. So that's the beginning of the journey when you're seeing your primary care physician getting screening, right? That's very early on, and that's important, I would say, also for the children of the folks that listen, like even with having good pediatric care, right? It's all important. Moving to transplant, when can you get listed for a transplant? Some basic questions we should answer, right? So you can get listed when your GFR or your kidney function is 20 CCs per minute. An easy way to remember that is, or when you talk to your physician, say, what percentage is my kidney function? And that could be 20% or below. And then the next question I get is so doc, when am I going to start dialysis? Most patients will start their dialysis when their function is around 10%, right? Or less, or around there or less. The thing is, we have a gap between that 20 and 10%, if not if you're referred a little bit earlier. And that's when you want to we call ideally in our world, get transplanted before you ever touch dialysis. The fancy terminology is pre-emptive transplant. But trying to get you do not submits the bus, you don't need to be on the house to get a transplant and hopefully get listed to that early part. And now I think coming to the journey part to summarize, right? So when I see we see a patient, they might have three or four reasons, or one reason, that they are not the ideal transplant candidate that day. But patients to understand that it's a journey, right? In the sense that you are in a car and you're driving from point A to point B. Sometimes you need to fill the car with gas, sometimes you need to stop along the way to get some food, and that's exactly what this is. So if you come and I'll give just a classic example that I always think of is there was a patient that had to lose some weight prior to getting the transplant. So instead of saying to them, you know what, we're just gonna deny you, you know, and that's it. We say, look, today we can't transplant you. You're not ideal. We're not doing you any favors by transplanting you tomorrow because it might not work very well, might be multiple complications. But how can we get to you? How can we be in your corner to get to that place? So just like that car, just like you're training for an Olympic event or a fighter training for the ring, how do we give you the homework to go home, do what you need to do, and come back? So I will tell patients, you know, this is what you're gonna hear. And it's gonna sound scary, but forget the letter. What I want you to do is call me back in three months, get another referral, and we're gonna call you and check on you. And we're gonna see, like, hey, did you lose that 10 pounds you need to lose? And that's how we want to coach you. I think that's the problem is it when you say binary, it's like, no, you're not a candidate, that's it. But it should be you're not a candidate today, but you have the potential that we want, and how do we get in there? And it is true, not everybody will be a transplant candidate, but but I think telling the patient and for other patients that are listening to understand, it's a journey. This is just one of the stops along the way.

SPEAKER_00 9:00

Everything that you've said, I'm also as I connect it, you know, you mentioned like we are as the transplant team, as transplant nephrologists, as transplant clinicians, like we are champions for our patients. Like we are on their side. We want to advocate for them as much as we can. Where there, you mentioned guardian angels. I mean, I think that really summarizes it beautifully. And we want to get patients from that point A to that point B. And I think you described it beautifully that sometimes just like a car needs checkups or like an oil check, the same way patients may need that colonoscopy or whatever that additional testing is, so that they can have the best outcome. Along those lines, will you share with us like what do you think we can do as transplant programs, as a transplant society, as a transplant community to increase that access?

SPEAKER_01 9:55

So I would want to add one bit before I answer your question. The other part of the transplant is that is your team is super important. I want the patients to realize there's a social worker, there's finance, there's dietary, the nurse coordinator, the intake person, different coordinators and different of different positions, the pharmacy. We have a transplant psychologist here that we're blessed with. I know the VA also has a transplant psychologist. Yep. We also have specialists like cardiology or eye infection diseases or surges that well, all programs have this. So you have bariatric surgery, endocrine surgery, whatever. So what we try to tell you is I would say this one part. We are a village that everybody has a part in trying to get you to the to the to that goal that you want to get to transplant. So increasing access to care, that's your question.

SPEAKER_00 10:39

Yes. How do we do it? I mean, I know that's such a big question. And so you can take it granularly or at a 10,000-foot level, or both.

SPEAKER_01 10:49

It's very interesting. Coming into a leadership role, you look, you you read different books and look at different kinds of other things to try to learn these leadership concepts, right? Something that I came across that I think is really important is something called survivorship bias. And so there's a story where, you know, in World War II, they had these planes, right? And these planes flew out, many of them didn't come back because they were forced to shot down. So now the the military is like, man, you know, how do we keep these planes from getting shot down? Wherever the bullet holes are, let's put all the armor there, right? And and instead and this mathematician, uh, I think his name is Alderwald, he came up with, he's like, you know, that's not the way we should look at this, right? Why did those planes make it back? Because none of them have bullet holes in their engine. So they were we were looking at the wrong place. So I think, and the real thing was that survivorship bias or asking why a company makes it, what happened to all the companies that didn't make it, right, in that particular field. And that's what I kind of ask myself with our patients is why did this patient with the same issues make it versus this patient that didn't, right? And then when we look at the different qualities, many times it comes back down to, you know, what was their education, even what is their school level, what are your socioeconomic status, what other social factors are involved, right? We can't make everything totally equal for everybody, but that's not being equitable. Equitable is that everybody is that same shot. So I think to increase access to care, we have a lot of traditional ways of looking at this gap, but maybe it's time to take that kind of business way of looking at it, or looking at what are the blind spots that we're missing that are both low ass and high ass. I think that's really important to look at. So when you talk about 30,000 for view, I think it's patient response, it's very important. I just saw a lecture from Dr. Tabor, Dave Tabor, who's an M U S C. And he was saying, he was talking about all the medications that we use in our patients and you know their satisfaction with these medications. And do we really ask our patients, are you happy with the medicines you take? I think to make it equitable is look for our blind spots that we've been missing. What do we really need to attack? And not just the traditional risk factors, I guess, as we could say. Also, the other part is instead of being parental, the where we are dictating to the patient, asking like a focus group, what is it that gives you difficulty? Because I don't live in my patient's shoes, right? Yeah. So when we were we were fellows, right? We went to dialysis. That's probably the first time we've seen someone go to outpatient dialysis and had a feel for what they do from seven in the morning. You go eat lunch, you get to go to lecture, and then you know what, that patient's there through the afternoon, they're exhausted, they're calling you because the patient's hypotensive, and and now that's their normal day. So I think to increase access is to is to really look at the problem. What are we missing? Who do we need to get on board and looking at it in a medicine way, healthcare way, but also maybe a business way, maybe the entrepreneurial way, that type of way of looking at it. So a very long answer for your short question. Sorry.

SPEAKER_00 13:37

Oh no, that that's fantastic. That also reminds me. So when I do my pre-transplant evaluations, an important question I've started incorporating to my patients is why do you want a kidney transplant? Yeah. And doesn't that get to the heart of all of it?

SPEAKER_01 13:56

Absolutely. I think telling our teams, the folks that we work with as when we're leaders, saying to them, you know, because of you, seeing that patient today in eval, they got transplanters. Because they got that transplant, this next New Year's, they'll be around to have New Year's with their family. That's the biggest thank you, I think, we can get. And then that's what patients tell us. I think when you ask them, their patient's response is is quality of life, not always quantity, but they do want to live longer, of course. We all do. But it's really like I want to spend more, I want to see my I want to spend more time with my family. I have some things I need to take care of or to do. I want to go back to work, you know, I want to finish grad school, whatever it might be. But that's why I think patient response has not always been taken into how we look at things. When we go to DC and you ask for a payment for immunosuppression, a lot of times about finances and this and that. But then, and and they do include patient stories, but really, like, you know, if you're not in their shoes, it's different, you know. And then when you see movies when someone switches bodies and they get experienced when you don't when you walk in that other person's shoes for a day, for two days, for three days, it changes how you look at it.

SPEAKER_00 14:56

It really does. And I think you've touched upon something so important that as clinicians, you know, empathy is such a big piece of all of this. And that also takes me to a really important question. And right along the lines of the conversation we've been having is that a few years ago, Freder Hospital and the Medical College of Wisconsin, you were doing about 50 transplants a year. You have now crossed like 180, 188 transplants. And clearly everything you've talked about, increasing that access, you have implemented and you have shown the results, right? And so if you could please share anything else that we did not talk about to get you there. And if you could also share the coveted award that was given to you guys by Interlink.

SPEAKER_01 15:42

Oh, yeah, we won the, we were very fortunate to win their 2026 Chairman's Award, Ritualink, for being the top program for the outcomes in their network. And we are very blessed, very humbled by it. So all the programs are fantastic. Everybody's working hard to do great things, and so we really appreciate it. But again, we learn from each other all the programs too, just like me and you collaborate. We ask other medical directors how to do these things. I think that's also really important that everybody helps each other. So that's very, very key to doing it. So I think coming to this program and seeing, you know, how there are some easy things you can do to always make a program grow. But the thing is, what is your goal? Right. So I think something really important that I learned is that goals are wonderful, you know, but that but they also limit your creativity in a sense, in a sense that that that boxes you into something, right? So you have to think of what other ways to look at it. And coming back to the story I mentioned about the military planes, like what things am I missing? What have other programs have missed? What have caused problems? So, you know, you try to learn from those things and bring them in, right? Because systems, I really believe systems make the make things much better. Our only goal is to do 500 transplants this year. Yeah, that's a great goal, right? But now, a year from now, how does that affect those 500 patients? Because your goal is just to get to 500 transplants, right? You've done that. But now, how does that help those patients five years from now? So I think for me, my personal goal being in a transplant for all is not probably for many of our dogs, all of our dogs is we want to get you to transplant. We want you to be successful at keep this transplant as long as you can keep it. And we want to push the envelope. And when people say why this person is not able to get a transplant, we want to ask why not? How can we push it? You know what a classic story is actually is myeloma patients. So I recently did a talk for us on myeloma and um Dr. Chris Bossman out in what's share what myeloma is. So one myeloma is a blood uh plasma cell disorder, blood cell disorder. And these patients unfortunately don't have a long life course when it's fully blown, to keep it very simple. Um, and and so, you know, probably again, you know, 10, 15 years ago, if you look at the number of patients referred with myeloma, very, very small numbers, like double digits. Today, this has changed to where these patients are referred more and more. And about five, six thousand patients every year that are end up on dialysis have this disease. The bias is when you hear this on their diagnosis on the intake, when you're trying, you're like, oh, they're not gonna be able to get transplanted. It's gonna reoccur, they're gonna pass away. But take a step back. What is the mortality of dialysis? You know, roughly that population flips every 68% every year, you know. So 40-50% of the population has a high chance of dying or bad things happening over five to seven years. What if I transplant them? Yes, maybe the might won't recur, but now there are new treatments. So knowing about that, collaborating with them really helps build what we can do. So coming back to your original question, I think when you grow the program, you you want to know what your gaps are and what biases have held you back that might be true, or you should revisit them and they might not be true so you can push the envelope. The other thing is you have to realize that at the end of the day, your partners are so important. They're referring practices, right? So the dialysis units, they're referring neurogenal neurology practices and making them really your partners. And I think a part of that is educating them on transplant, being open to questions, and uh being accessible is really key. And then once they have faith in you, they'll make the referrals. There's weird fortune in our part of the country to have several programs that are fantastic. And I think each of the programs also so good that they'll say, Hey, look, you live in this part of Chicago, you're best to go to this program. That's a very good program. Let me talk to them for that person get you there. So I think you know, I did what says is how using things we didn't necessarily learn in medical school, yeah, to to help to not customer acquisition, but having the patient come to us, then asking ourselves, what are we doing for this patient so that they're happy? Not that I'm meeting metrics, not that I'm meeting uh certain numbers, or what am I doing to make sure these patients are happy so that if I were to retire tomorrow, that'd be good.

SPEAKER_00 19:46

Yeah, so well said. I mean, it's it's also like personalized medicine. What I'm hearing is ask the right questions, ask the quality question, and you will get quality answers and quality solutions. I'm hearing. Look at where your gaps are. You need to be so insightful and have a mirror up to the program to make sure you're meeting what the patients need and what your team needs. Because, you know, especially as a leader in the program, you're balancing both of these needs. Um both the patient and for this. Okay, my goodness. We could keep talk talking about so many things.

SPEAKER_01 20:21

That's why the quality meetings are so important that I always cut out when I was a fellow. Now I realize how important they are.

SPEAKER_00 20:27

100%. And along those lines, before we kind of start to conclude, could you shed more light on the quality programs that you have looked at, that you are piloting, that you have found to be most instrumental in this amazing quality outcomes that you have?

SPEAKER_01 20:46

So building the quality team is really important, having good resources for them. So having someone that will collect the data, able to work in Excel sheet, which I can't do, and having others to organize, you know, things such as protocols or guidelines, it's not a one-person job. And there are quality conferences, and you really have to invest in them. And I think when you talk to your team, constantly saying that word quality, quality, quality, the quality team really starts to embed in them, like, okay, what is quality saying? So we, me and my surgical partners, but Dr. Kaidun is our surgical director. So we sit, we go through the PowerPoint, you know, that they're going to present in our quality beam. And for us, when we're going through, we're trying to, what wins have we had? But then where are our gaps? For instance, why is our inactive so much higher ratio so much higher to our active? Why is the referrals maybe not dropping for say, but what why is the number of patients in this quarter not doing so well? Why do we have, you know, we've we've had a high notion rate, and probably many programs have that. How do you fight that? What are people doing in other industries? You know, what are people doing across our own enterprise? I think one of the things I would tell my transform colleagues is like, reach out to your own hospital, the other people, they have the same problems, many of them. And what are they doing to fight those things? But it comes down to being uh Humble enough to ask the right questions, recognizing when something's not working, so you can shift focus. And it really you have to test something and then reassess it and then test it again, reassess it and test it again, and realize we're evolving every part of the program all the time. So what it looks like in 2026 might not be what the programs need in 2030. And so many programs, as you know, McCrease, we just do it this way, this way we've done it for 10 years. That's it.

SPEAKER_00 22:27

No, we can't do it like that anymore. And what is not measured cannot be modified. And we're in right and in a state, we're in a state of con what I'm hearing is that you guys are in a state of constant improvement. And like that PDSA where you're constantly improving. I mean, what I'm also hearing is that you've taken the program from good to great and you won't step there.

SPEAKER_01 22:51

Yes, it is a village. It's everybody in the program, every person in the program was important. One thing I really learned when I was at Georgetown and bringing here is this idea of a high reliability organization and learning about how airlines did this at first, at least that's what's made it famous. And what a high reliability organization really is that every person has equal vote on the team. See something, say something. If you feel like this can improve, everybody has an equal say to it. It's not a hierarchical system. So frequently I'll go around and ask you this, everyone on our team at different in different positions. What are your obstacles? What are your biases? Because I've many leaders will go to that level. I think when I was at MUSC, they had a gap with leadership. And I learned a lot, you know, being on the granular level of like reviewing all the labs and what were the little things. So I and I think sometimes when you move up, you forget those things. So making sure you keep in touch with that stuff.

SPEAKER_00 23:43

So we know where we've been in transplant. I know where we, right? We've talked about where we are right now. Where do you think the future of transplant is going?

SPEAKER_01 23:52

So this is fantastic. So now when we interview for new faculty, especially new grads, you tell them like your experience at transplant is going to be amazing because there's so many new drugs, so many new things, such an exciting, exciting time, right? It's almost as funny. My my our tornado medicine had Dr. Kevin Brink, Z was the general fraudine, and now he's our tornado medicine. But he like we were talking about IKA recently. He's like, you know, before we used to tonselectomies and fish oil. And I always were like laughing, like, how far have we come? Now like 10 new drugs. Yes. When you ask me about the future of transplant, I will almost it's kind of like our uh phases of immunosuppression, like induction treatment and maintenance immunosuppression. Induction treatment is like this is really going to like shock your immune system. So I think that's kind of like DNA transplantation, you know, this 34 lives, AI, artificial intelligence, and many things like that, right? That are just so they're very stem cell transplant, so hi-fi, you know, the newer treatments for cancers, waiting time shorter, different products from different pharmaceutical companies that follow tumors, so you don't need to wait five years to transplant somebody. These are shocking the system and I think changing the game. Because the goal at the end of the day is yes, ideally, no one will ever need a transplant, nobody, nobody will ever need a transplant, nobody ever needs dialysis. But we do we don't have enough organs for everybody to transplant them. So that it or some or 3D modeling, whatever it is, how do we do that? And then when we do have that, the next part is making medications that allow these organs to last as long as possible. So there's one part is having access to transplant itself, and then part two is having the medications and the the care that we'll we are able to give a patient so that the kidney can last long a long as long as possible, right? And that's probably along with also the maintenance part of it. And I think, you know, and I think this is very undersold, and it's coming more and more to the forefront is you know, we do a lot of pre-transplant testing, and now it's very controversial. Do we really do all that cardiac testing that we do? And there are data coming out that maybe you don't, you know, so so being careful with that kind of things to see if we're giving barriers to the patients. They're post-transplant. There's many ways to monitor patients, being very judicious that way, and those types of things. So I think there's a lot that's going on. I think there's a big technology card to it, and and many more that, you know, there's so many things, normal thermic refusion, different, all kinds of things. Taking organs that are full-time for like over 20, 24 hours. The thing that I would say that I would, I think the only part that I really want to make sure is that remember there's a person involved on the other side, the patient, the recipient, and that whatever we do out as fancy as this is, and we are pushing the science, taking those risks, we still have to remember they're the human recipient at the other end. So I think the future is really bright. And and I I think there's a lot of different technology and different types of things, but I I also hope that we don't make the patient just a number and and that they we do realize they're a person and that you know that and they're coming here for our help.

SPEAKER_00 26:45

I think that's a wonderful reminder and also a reminder for our donors and that constant gratitude for the gift that they give to the recipients across all organs.

SPEAKER_01 26:55

Yeah, I mean, you can't say enough about living donors and those families that have given their loved ones uh organs to folks. We're very thankful for that.

SPEAKER_00 27:03

Yep. Well, Dr. Thomas, thank you so much for being with us today. If you could leave your patients with a piece of advice from yourself, what would that be?

SPEAKER_01 27:16

You have to be your own champion. Don't be discouraged, find a partner in the fight with you, build up your social circle, but be your own champion, you know. And and if you hear no, ask the whys. And if you don't understand, it's okay to keep asking the lies. But I can't explain it to you that it's probably not a good decision.

SPEAKER_00 27:32

Thank you so much.

SPEAKER_01 27:34

Thank you.