Living Donor Kidney Transplant Program Ranked Largest in the Country
Kidney transplant program a national leader in techniques to expand the living donor pool
Newly released data from the United Network of Organ Sharing (UNOS) shows that in the past two years (2007 and 2008) Northwestern Memorial Hospital’s living donor kidney transplant program was the largest in the country. In 2007, surgeons performed 142 living donor kidney transplants and in 2008 they performed 166.
“During a time when more than 90,000 people are waiting for a life-saving transplant, Northwestern is leading the country in innovative techniques to expand the living donor pool,” commented Joseph Leventhal, MD, PhD, director of the living donor kidney transplant program.
“The benefits of living donor kidney transplants are well-documented, the kidneys tend to last longer, function better and have fewer complications than kidneys from deceased donors,” said Michael Abecassis, MD, chief of the division of organ transplantation. “We are very proud that our efforts have resulted in Northwestern Memorial’s standing as the largest living donor program in the country.”
“The goal of our program is to make every effort to ensure that a transplant takes place when a medically viable living donor steps forward,” commented Dr. Leventhal. About one third of living donors that come forward end up not being matches for one another due to certain incompatibilities such as blood type and immune system differences. The transplant team is able to offer various techniques to work around those incompatibilities.
Blood Type and Immune Incompatibility
For a transplant to happen, the donor and recipient must share certain compatibilities so that the recipient will not reject the donor’s organ. In the past a blood type incompatibility would have ruled out a donor and recipient pair. Northwestern Memorial is one of only a handful of centers in the country that offers a technique called ABO incompatible transplantation. A week or two before surgery, and a week or two after the transplant these patients undergo a process called plasmapheresis to desensitize and clean out antibodies in the blood. This same process also works for kidney recipients that have multiple antibodies to a donor’s HLA antigens, which are proteins in the blood that help the body’s immune system to recognize its own cells and foreign, harmful substances.
Paired Exchange Program
A paired exchange is a possible solution for donor and recipient pairs that are not compatible with one another. Paired exchange transplants are made possible when a kidney donor who is incompatible with the intended recipient is paired with another donor and recipient in the same situation. Northwestern Memorial has done six paired exchange surgeries to-date, the largest of them being a four-way domino paired exchange that involved four donors and four recipients.
“Paired kidney exchanges are becoming more common and signal a trend in the field of organ transplantation,” said John Friedewald, MD, a transplant nephrologist and member of the UNOS committee working to develop a national kidney paired donation system. “They have the potential to dramatically increase the number of patients who receive transplants, and reduce time spent on the waiting list.”
After transplant surgery anti-rejection drugs for the organ recipient are a must, but with prolonged use can have serious side effects including infections, heart disease and cancer. Northwestern is one of four transplant centers in the country investigating new therapies to help wean transplant recipients off immunosuppression drugs. The protocol of the two studies involves transplanting stem cells from a kidney donor’s bone marrow into the recipient, with the hope of gradually eliminating the need for anti-rejection drugs. If research proves successful, it would mean a dramatic change in the post-transplant quality of life for transplant recipients.
In addition to offering cutting edge techniques and research, the transplant team recognizes the importance of a culturally-sensitive approach to patient care. The Hispanic population represents the largest minority group with the fastest growth in the U.S. and has a higher incidence and prevalence of diseases leading to kidney failure, such as diabetes, hypertension and obesity. The Chicagoland area has one of the largest and most rapidly growing Hispanic populations in the U.S. In an effort to meet the need of this growing population, Northwestern Memorial Hospital has developed a comprehensive Hispanic transplant program that includes many Spanish speaking staff members such as surgeons and hepatologists.
“Seventy-five percent of our Hispanic patients prefer to speak Spanish,” says Juan Carlos Caicedo, MD, director of the Hispanic Transplant Program. “They also want to involve the whole family in discussing their medical care, including their elders, who often are the family decision makers and also most likely speak Spanish. Since we started the program, we have doubled the number of Hispanic kidney transplant recipients per year and increased the living donation rates to 78 percent, which constitutes the highest living donation rate throughout all ethnic groups in our transplant center. When you take language and culture out of the equation, it makes everything easier.”
To learn more about Northwestern’s transplant program, visit transplant.nmh.org.