The kidney transplant program at UK Transplant Center provides kidney transplants for adults and children with end-stage kidney disease, also known as renal failure.
The UK Kidney Transplant program has been a leader in advanced kidney failure since 1964 when we completed our first live-donor kidney transplant. We've been saving lives ever since: more than 2,500 kidney transplants have taken place at UK Transplant Center since our program was founded.
In this segment, listen in as Thomas H. Waid, MD., explains that the UK Kidney Transplant program has been a leader in advanced kidney failure since 1964 when we completed our first live-donor kidney transplant. We've been saving lives ever since: more than 2,500 kidney transplants have taken place at UK Transplant Center since our program was founded.
Learn more about UK Kidney Transplant program
Learn more about live-donor kidney transplant
Health and Survival Benefit from Kidney Transplantation
From the Show: UK HealthCast
Summary:
Air Date: 8/20/17
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Kidney transplants are the most common organ transplanted in the United States. Kidney transplantation which improves health related quality of life and survival compared with dialysis; is the treatment of choice for end-stage renal disease. My guest today is Dr. Thomas Waid. He is the Medical Director in Renal and Pancreas Transplantation Program at the University of Kentucky Healthcare. Welcome to the show Dr. Waid. What are some conditions that can lead to kidney failure and a possible need for transplant?
Dr. Thomas H. Waid, MD (Guest): Well there can be a lot of different causes of kidney disease. One of the major ones that we deal with right now and perhaps the major one is type II diabetes mellitus, which becomes more and more prevalent as obesity becomes more of a problem. And so that is onwards of almost 50% of what we deal with in terms of patients and the causes of kidney disease. Less frequent is type I or so called juvenile diabetes mellitus, but it still can cause over a period of time, kidney failure due to diabetic nephropathy. We also have uncontrolled hypertension, also that goes with changes with obesity. That is more prevalent in African Americans than it is in white Americans, but nevertheless, it is still an issue and also obesity just by itself, can put a lot of stress on the kidney and cause changes leading to renal failure and those are some of the causes of what is called focal glomerular sclerosis. So, at any rate, there are a number of different causes. The more prevalent ones right now that we are dealing with is associated with the epidemic of obesity in this country.
Melanie: So, if someone is suffering from FSGS or a form of kidney disease, diabetes, whatever it is, obesity, and their kidneys become damaged, they are starting to fail, they have been on medicational intervention and now they are looking to dialysis. Life on dialysis is not easy is it, so when does dialysis become the consideration for getting on that transplant list?
Dr. Waid: Well anybody who is on dialysis or approaching dialysis can certainly be evaluated potentially for a kidney transplantation. That’s not to say that everybody has a right to a kidney transplantation, because not everyone is suitable for transplantation and organs are in very, very short supply. If you go back to 2013, for example, there were about 93,000 patients on kidney transplant lists and about one in five of those patients was transplanted. If you Segway to the current day, there are about 102,000-103,000 patients on the kidney transplant list and again only about 20% of those patients can get the deceased donor kidney transplantation. For that reason, it’s very important that we look for potential live donors within a patient’s family or even patients who have potentially no donor within the family can also perhaps find a friend or even sometimes an altruistic donor which would give the patient a living unrelated kidney transplantation. We also have patients who are not compatible with potentially one donor but maybe with another donor and therefore we can do what is called paired donation where we match up the compatible pairs and transplant patients in that way. So, everyone gets a kidney transplantation that is potentially compatible even though it may not be within the family. So, it’s something that we have done here for the last few years. We have actually done as many as five pairs at a time, but usually two pairs or three pairs are more logistically feasible and usually what occurs at this institution.
Melanie: So, if somebody does get lucky enough to get on the list and get a deceased donor or even lucky enough to get a living donor transplant; then what do you look for as far as rejection and patient selection criteria. You know after a kidney transplant are there certain patient characteristics that you are looking for Dr. Waid?
Dr. Waid: Well not so much patient characteristics as there are perhaps hard stops for not being medically suitable or not being suitable for transplantation from a psychological or social aspect. We basically, screen these people very, very closely and look for any type of problems which we think might arise which would relate to the patient not being able to come to clinic for their follow ups, not being able to afford or take their medications, you know potentially any type of substance abuse which might get in the way of being able to follow up with their physicians, follow up with their medications, being able to afford their medications, etc. All of that would be a potential deterrent to moving forward with transplantation. We want to make sure that the patients have the best chance of surviving with a functioning kidney graft or a pancreas graft for the longest time possible. And organs being in very, very short supply, it’s optimal that we preserve the function of the first organ transplant for as long as possible.
Melanie: So what kind of lifestyle changes do you want someone who has received a kidney transplant to make and what about even well visits afterwards and their general practitioner and just kind of maintaining that healthy lifestyle. What do you want them to know about what they should do after that type of surgery?
Dr. Waid: Well certainly. We want to make sure that they don’t do anything which would harm their health either before or after transplantation. A perfect example is smoking. Smoking has a risk of cancer, not only of the lung but also the esophagus, the bladder, the kidney and other places in the body and when we immunosuppress a person to keep them from rejecting their kidney; we also knock down or stun the immune surveillance of the body which detects cancer cells early and essentially eliminates them before they start to grow. When you immunosuppress a person, then that part of the immune system is suppressed and if patients continue to smoke, or continue in some cases large amounts of alcohol which is a risk for esophageal cancer, then they can potentially develop a malignancy or a cancer sooner than would be otherwise the case if they were not immunosuppressed. We like to try and keep them out of the sun as much as possible because of risk of sun cancers which is significant. We tell them to wear sun blocking clothes and hats and wear sunscreen etc. But additionally, because it is so prevalent now we try and get these patients to lose weight. That basically decreases the amount of undue stress on transplanted organs particularly the kidney because there can be recurrent diseases like focal sclerosis after transplantation. It decreases their risk of developing diabetes which is probably 30-35% of all kidney transplant patients over a 15-year period even if they are not diabetic prior to transplantation. So, adding additional weight just increases the risk of that and of course with the new onset of new diabetes, comes more stress on the kidney transplant. So, those are some of the changes that we really try and impart to our patients to try and keep them with good kidney function and a good overall health for as long of a period as is possible. Transplantation actually imparts probably two and a half times more remaining life years than if the patient stayed on dialysis. So, in this particular case, we want to make sure that they optimize their chances of as many life years as possible by keeping a good kidney transplantation functioning. Hypertension is another thing we try and keep that in control because of the risk of hypertension and actually transplantation may improve overall control of blood pressure which is very, very significant in kidney failure and again this would improve overall health benefits and decrease cardiovascular risks after transplantation. Dialysis has about a 9.9% per year mortality from cardiovascular complications. If you transplant a patient with a good functioning kidney transplant that reduces from 9.9% per year to 0.9% per year. So, it is a tenfold decrease in cardiovascular risk after a successful transplantation.
Melanie: That’s such great information Dr. Waid. And so, in just the last few minutes, give us your best advice for preventing kidney disease, keeping healthy kidneys and then tell us about your team at the University of Kentucky Healthcare.
Dr. Waid: Well, right now I mean there are some things that obviously, we can’t do anything about with regard to kidney disease, polycystic kidney disease, secondary diseases that cause kidney failure that come on a person like an autoimmune disease of something like that. But in terms of things that we can control; hypertension, blood pressure is one of them, obesity is another, if you are diabetic, keep your diabetes in as good a control as possible and just basically exercise, eat a good diet, maintain your weight, and those are about the best things that I can say in terms of overall control of the factors which can produce kidney failure that we really have or that the patient really has an ability to control themselves.
My team here at the University of Kentucky, I have an associate transplant nephrologist Dr. Ana Leah Castellanos who has kind of been with me now for 12 years. We have a new person, Dr. Hassin Fattah who is starting in September coming from the Virginia Commonwealth University in Richmond Virginia. We have four transplant surgeons, Dr. Gedaly, Dr. Malay Shah, Dr. Jonathan Berger, and Dr. Michael Daily who also do pancreas transplantation and some do liver transplantation as well. And let’s not forget that I have an excellent group of transplantation nurses who follow patients very, very closely both for kidney and for pancreas and also many ancillary staff, people who do our scheduling, make things run seamlessly, our administrators who basically, keep an eye on quality control and all of our statistics and I think it is just a very well-run institution.
We have been transplanting since 1964. That’s only ten years after the first kidney transplantation was done at the Brigham Hospital in Boston, only one year after University of Minnesota started their program and we were the first program in this region to do kidney transplantation. So, I can say with pride that one of our patients had their 50th anniversary for their kidney transplantation on December 6th of last year. So, we have a pretty good track record in transplantation in general and in kidney transplantation in particular.
Melanie: Thank you so much Dr. Waid for being with us today. This is UK HealthCast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I am Melanie Cole. Thank so much for listening.
Melanie Cole (Host): Kidney transplants are the most common organ transplanted in the United States. Kidney transplantation which improves health related quality of life and survival compared with dialysis; is the treatment of choice for end-stage renal disease. My guest today is Dr. Thomas Waid. He is the Medical Director in Renal and Pancreas Transplantation Program at the University of Kentucky Healthcare. Welcome to the show Dr. Waid. What are some conditions that can lead to kidney failure and a possible need for transplant?
Dr. Thomas H. Waid, MD (Guest): Well there can be a lot of different causes of kidney disease. One of the major ones that we deal with right now and perhaps the major one is type II diabetes mellitus, which becomes more and more prevalent as obesity becomes more of a problem. And so that is onwards of almost 50% of what we deal with in terms of patients and the causes of kidney disease. Less frequent is type I or so called juvenile diabetes mellitus, but it still can cause over a period of time, kidney failure due to diabetic nephropathy. We also have uncontrolled hypertension, also that goes with changes with obesity. That is more prevalent in African Americans than it is in white Americans, but nevertheless, it is still an issue and also obesity just by itself, can put a lot of stress on the kidney and cause changes leading to renal failure and those are some of the causes of what is called focal glomerular sclerosis. So, at any rate, there are a number of different causes. The more prevalent ones right now that we are dealing with is associated with the epidemic of obesity in this country.
Melanie: So, if someone is suffering from FSGS or a form of kidney disease, diabetes, whatever it is, obesity, and their kidneys become damaged, they are starting to fail, they have been on medicational intervention and now they are looking to dialysis. Life on dialysis is not easy is it, so when does dialysis become the consideration for getting on that transplant list?
Dr. Waid: Well anybody who is on dialysis or approaching dialysis can certainly be evaluated potentially for a kidney transplantation. That’s not to say that everybody has a right to a kidney transplantation, because not everyone is suitable for transplantation and organs are in very, very short supply. If you go back to 2013, for example, there were about 93,000 patients on kidney transplant lists and about one in five of those patients was transplanted. If you Segway to the current day, there are about 102,000-103,000 patients on the kidney transplant list and again only about 20% of those patients can get the deceased donor kidney transplantation. For that reason, it’s very important that we look for potential live donors within a patient’s family or even patients who have potentially no donor within the family can also perhaps find a friend or even sometimes an altruistic donor which would give the patient a living unrelated kidney transplantation. We also have patients who are not compatible with potentially one donor but maybe with another donor and therefore we can do what is called paired donation where we match up the compatible pairs and transplant patients in that way. So, everyone gets a kidney transplantation that is potentially compatible even though it may not be within the family. So, it’s something that we have done here for the last few years. We have actually done as many as five pairs at a time, but usually two pairs or three pairs are more logistically feasible and usually what occurs at this institution.
Melanie: So, if somebody does get lucky enough to get on the list and get a deceased donor or even lucky enough to get a living donor transplant; then what do you look for as far as rejection and patient selection criteria. You know after a kidney transplant are there certain patient characteristics that you are looking for Dr. Waid?
Dr. Waid: Well not so much patient characteristics as there are perhaps hard stops for not being medically suitable or not being suitable for transplantation from a psychological or social aspect. We basically, screen these people very, very closely and look for any type of problems which we think might arise which would relate to the patient not being able to come to clinic for their follow ups, not being able to afford or take their medications, you know potentially any type of substance abuse which might get in the way of being able to follow up with their physicians, follow up with their medications, being able to afford their medications, etc. All of that would be a potential deterrent to moving forward with transplantation. We want to make sure that the patients have the best chance of surviving with a functioning kidney graft or a pancreas graft for the longest time possible. And organs being in very, very short supply, it’s optimal that we preserve the function of the first organ transplant for as long as possible.
Melanie: So what kind of lifestyle changes do you want someone who has received a kidney transplant to make and what about even well visits afterwards and their general practitioner and just kind of maintaining that healthy lifestyle. What do you want them to know about what they should do after that type of surgery?
Dr. Waid: Well certainly. We want to make sure that they don’t do anything which would harm their health either before or after transplantation. A perfect example is smoking. Smoking has a risk of cancer, not only of the lung but also the esophagus, the bladder, the kidney and other places in the body and when we immunosuppress a person to keep them from rejecting their kidney; we also knock down or stun the immune surveillance of the body which detects cancer cells early and essentially eliminates them before they start to grow. When you immunosuppress a person, then that part of the immune system is suppressed and if patients continue to smoke, or continue in some cases large amounts of alcohol which is a risk for esophageal cancer, then they can potentially develop a malignancy or a cancer sooner than would be otherwise the case if they were not immunosuppressed. We like to try and keep them out of the sun as much as possible because of risk of sun cancers which is significant. We tell them to wear sun blocking clothes and hats and wear sunscreen etc. But additionally, because it is so prevalent now we try and get these patients to lose weight. That basically decreases the amount of undue stress on transplanted organs particularly the kidney because there can be recurrent diseases like focal sclerosis after transplantation. It decreases their risk of developing diabetes which is probably 30-35% of all kidney transplant patients over a 15-year period even if they are not diabetic prior to transplantation. So, adding additional weight just increases the risk of that and of course with the new onset of new diabetes, comes more stress on the kidney transplant. So, those are some of the changes that we really try and impart to our patients to try and keep them with good kidney function and a good overall health for as long of a period as is possible. Transplantation actually imparts probably two and a half times more remaining life years than if the patient stayed on dialysis. So, in this particular case, we want to make sure that they optimize their chances of as many life years as possible by keeping a good kidney transplantation functioning. Hypertension is another thing we try and keep that in control because of the risk of hypertension and actually transplantation may improve overall control of blood pressure which is very, very significant in kidney failure and again this would improve overall health benefits and decrease cardiovascular risks after transplantation. Dialysis has about a 9.9% per year mortality from cardiovascular complications. If you transplant a patient with a good functioning kidney transplant that reduces from 9.9% per year to 0.9% per year. So, it is a tenfold decrease in cardiovascular risk after a successful transplantation.
Melanie: That’s such great information Dr. Waid. And so, in just the last few minutes, give us your best advice for preventing kidney disease, keeping healthy kidneys and then tell us about your team at the University of Kentucky Healthcare.
Dr. Waid: Well, right now I mean there are some things that obviously, we can’t do anything about with regard to kidney disease, polycystic kidney disease, secondary diseases that cause kidney failure that come on a person like an autoimmune disease of something like that. But in terms of things that we can control; hypertension, blood pressure is one of them, obesity is another, if you are diabetic, keep your diabetes in as good a control as possible and just basically exercise, eat a good diet, maintain your weight, and those are about the best things that I can say in terms of overall control of the factors which can produce kidney failure that we really have or that the patient really has an ability to control themselves.
My team here at the University of Kentucky, I have an associate transplant nephrologist Dr. Ana Leah Castellanos who has kind of been with me now for 12 years. We have a new person, Dr. Hassin Fattah who is starting in September coming from the Virginia Commonwealth University in Richmond Virginia. We have four transplant surgeons, Dr. Gedaly, Dr. Malay Shah, Dr. Jonathan Berger, and Dr. Michael Daily who also do pancreas transplantation and some do liver transplantation as well. And let’s not forget that I have an excellent group of transplantation nurses who follow patients very, very closely both for kidney and for pancreas and also many ancillary staff, people who do our scheduling, make things run seamlessly, our administrators who basically, keep an eye on quality control and all of our statistics and I think it is just a very well-run institution.
We have been transplanting since 1964. That’s only ten years after the first kidney transplantation was done at the Brigham Hospital in Boston, only one year after University of Minnesota started their program and we were the first program in this region to do kidney transplantation. So, I can say with pride that one of our patients had their 50th anniversary for their kidney transplantation on December 6th of last year. So, we have a pretty good track record in transplantation in general and in kidney transplantation in particular.
Melanie: Thank you so much Dr. Waid for being with us today. This is UK HealthCast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I am Melanie Cole. Thank so much for listening.
