Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses three different areas of advances in transplantation including xenografts, islet cell transplants, and microbiotics. 

Xenograft

Organ supply remains the number one unmet need in transplantation. Pigs are the most appropriate donor animal for xenotransplants. These types of transplants have been performed on patients who are brain dead and cannot donate their organs. Because they are technically deceased, the FDA doesn’t weigh in on this kind of research, so the data can be used to justify future clinical trials in living humans. 

At NYU, a genetically modified pig kidney was put into such a patient to study how it would initially function in the human body. After 50 hours, there was no evidence of inflammation or rejection. In addition, two recipients received heart transplants from genetically modified pigs. Because of these recent experiments, interest has reignited for xenotransplantation, which is on the cusp of successful pig to human life-altering transplants.

So how are the pigs genetically modified? There are a number of companies that are gene editing the germ line, which means that the pigs have human genes permanently in their bodies and their offspring will as well. From this point, they can be easily bred for research purposes. They look like normal pigs; the only differences are that their cells produce some human proteins. 

Unfortunately, with xenotransplantation, there will still be need for immunosuppression therapy, because the human body has an even stronger immune response to the transplanted pig organ than another human. There is some research investigating how the immune response can also be modified genetically to reduce the response. 

Islet Transplantation

In pancreas transplantation, while the success rate is about 90%; there is risk of bleeding and other surgical complications. In order to reduce that risk, islet cell transplant was developed. This process involves taking the pancreas from the deceased donor, then taking the islet cells and infusing them into the liver of the recipient. They stay in the liver and produce insulin and modulate glucose levels. This type of transplant has been optimized for 20 years. Islets can provide long term insulin independence for patients however, immunosuppression for the patient is required.  

Researchers are attempting to develop a way to make islet cells out of embryonic stem cells to have a greater supply of cells for transplant. Some companies are engineering islets from human stem cells, but there is limited success. Islets engineered from human stem cells would provide an unlimited supply, but would require the same immunosuppression therapy as normal transplant. 

To circumvent the need for immunosuppression, using a pouch to immunoprotect the cells from the body of the recipient may avoid the need for immunosuppression. There is research being done in this space as well. 

The outcomes for islet transplant are about the same as whole pancreas transplant, with about 60% of patients being insulin independent after 5 years but, the surgery requires experience from physicians and requires patient’s adherence to be successful as any other transplant. 

Currently, the FDA has not approved islet cell transplant, so it is not reimbursable through insurance. Thus, often they are not able to be performed for patients. This issue requires legislative action to push FDA to approve islet transplant as the same as any other organ transplant to allow for insurance payments. The United States is the only country that is regulated in this way. 

Microbiotics

In intestinal transplant the microbiome in the gut has been shown to be tied to rejection episodes. The intestines are full of bacteria, both commensal (good bacteria), and pathogens, (bad bacteria). There are bacteria that are vital to our survival; some of which help us break down foods, and some release chemicals that are necessary for the body’s functioning. This ecosystem of bacteria is called the microbiome. The interplay between the microbiome and the immune system is tied because an imbalance of the microbiome can cause an increase in immune cells or T cells, causing the body to be in an inflammatory mode versus a regulatory mode. One area of recent research is trying to determine whether rejection is due to the change that occurs in the gut bacteria populations when they are introduced to the recipient’s body’s gut bacteria. 

There are immune cells that are specific to the bacteria that live in the gut and, when the immune cells die off along with the bacteria from the donor’s gut, in the recipient’s body, this can cause an imbalance and lead to rejection. This has been studied in liver transplant. 

An overall decrease in diversity of bacteria, meaning fewer different types of species, is associated with inflammation. Rejection can be potentially modulated by restoring the balance of good and bad bacteria. It must be a targeted treatment of introducing certain foods and compounds that foster the growth of certain bacteria, which can then change the body’s immune response. 

The next webinar session will focus on research into biotechnology and artificial organs with experts in the field. 

Listen to the full webinar and learn more about these conversations and further research and information about life with transplant. This, and future webinars can be found on transplantLyfe.com/webinars.  

Panelists

  • Dr. Griesemer, professor of Surgery and Transplantation at NYU, Head of Pediatric Renal and Liver Transplant 
  • Dr. Piotr Witkowski, Director of the Renal and Pancreas Islet Program at University of Chicago
  • Dr. Joshua Weiner, Assistant Professor of Surgery at Colombia, Head of Intestinal Transplant and an expert on microbiosis

Moderators

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses an overview of identifying the gaps and unmet needs in innovation, and although science is on the verge of significant advancement, efforts are needed in advocacy, regulatory and financial strategies, and formalizing observational studies to trigger innovation, funding, and research. 

What Areas Are Being Addressed? 

Some particular areas in transplantation where there exist unmet needs are antibody mediation and inhibiting antigen development, as these are common causes of organ rejection, and for which there are no preventative or treatment therapeutics available. Transplant medications for suppressing the immune system are far from perfect, often causing numerous side effects and long term, almost inevitable organ rejection. Medications that can effectively offset these two significant issues are desperately needed. Delayed graft function, the condition in which the transplanted kidney doesn’t work immediately, occurring in about 20-50% of deceased donor kidneys, requires patients to be on dialysis after the transplant for some time. This significantly affects quality of life and there is an unmet need for prevention of this issue as well. 

From an industry perspective, the areas of focus for transplant innovation fall into the categories of incremental improvements in daily quality of life, including developing less toxic immunosuppressives, less frequent dosing requirements, and fewer and less severe rejection episodes. Immunological innovations are another area of focus, with the developments in better organ matching through the use of genetic testing, machine perfusion to allow for the organ to be outside the body for long for better testing and diagnostic, and lastly, the expanded use of non-human/xenotransplants using stem cells and 3D organ printing. 

What Are the Hurdles in Transplantation Research?

There exist numerous hurdles in conducting research in the transplant population. From drug developers’ perspectives, transplant patients typically have various health issues and there is concern about the inclusion of transplant patients skewing data to affect the approval of a drug for a larger patient market. Often, once a drug is approved for other indications, the research in transplant stops, especially when transplant is not the pharmaceutical companies primary target. For this reason, transplant drugs are often used off-label for transplant patients. Since drug companies want to also recoup costs of research and development, drug prices are quite expensive, so insurance companies don’t want to pay for off-label use. 

There are regulatory hurdles as well in developing and then getting validated surrogate endpoints approved. There are appreciable opportunities here, for example, currently the focus for measuring the success of a drug is on the rate of rejection and patient survival but rate of kidney function loss is a more precise endpoint to be measured.  

How Can A Patient Contribute to Research in Transplantation?

From a collaborative advocacy perspective, transplants occur as a result of a variety of diseases, so many patients are associated with the disease they had before transplant, yet they don’t have those diseases anymore so there isn’t a “home” community for the transplant community. This makes advocacy as one group pushing for innovation, policy change, and funding that much more difficult. Nonetheless, patient advocacy is important, for unmet needs and public campaigns make a difference for early research which leads to innovative therapies down the road. 

A focus on developing what are called enrichment trials, allows more information and research to be gathered from a population that did benefit from the drug, even if the drug didn’t meet its endpoints in trials. In addition, giving companies or academic institutions grants to do exploratory studies using a drug that may be approved for another indication, could be beneficial in transplant. However, overall, pulling a drug from another indication won’t be a huge innovation as they still have similar side effects and transplant rejection rates. 

Listen to the full webinar and learn more about these conversations and information about life with transplant. This, and future webinars can be found on transplantLyfe.com. 

Panelists  

  • Dr. Llyod Ratner, Chief of Kidney Transplantation at Columbia
  • Dr. David Cohen, Medical Director of Transplantation Service
  • Dr. Syed Husain,  Transplant Nephrologist
  • Kevin Kovaleski,  Pharmaceutical Industry Expert

Moderators

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses an overview of pancreas transplant and how patients can prepare for a transplant. Questions for discussion were curated from the patient community. 

Pancreas Transplant Surgery

When a person receives a pancreas, the person’s own pancreas remains in the body. The role of the pancreas is to manage blood sugar levels by making insulin and making digestive enzymes to break down food. The pancreas does not stop making these enzymes, so when the original pancreas is disconnected and the new one is placed in, these enzymes have to be sent somewhere for elimination from the body. It used to be connected to the bladder, from which it is easier to test for rejection from urine, but it is very uncomfortable as patients got inflammation of the bladder and significant pain. It is now done as a bowel drainage to help digest food. Originally, pancreases were not hooked up anywhere to eliminate the enzymes and this also caused serious inflammation in the gut. 

Regarding the risk of transplant with a pancreas, surgical issues used to be the primary risk, but now it is the possibility of rejection – both in the shorter and longer term – that is paramount. Over time, the pancreas does fail and patients revert to needing insulin. The average life of a pancreas is between 7 to 15 years.

Immunosuppressive Therapies

The immunosuppression treatment regimen after transplantation is the same for pancreas as other organs like kidney transplant. Immediately after surgery, it is given intravenously, and then maintenance oral anti-rejection meds are dosed. The same medications are used independent of the organ that was transplanted. Across the country, different transplant programs make different decisions on which medications they prescribe the most. In more rural areas for example, there may be more infrequent access to care and follow up, so the use of long-term steroids is more common but reducing the amount of steroid being used is the goal of most centers.  

The follow up care for pancreas transplant is longer than for organs like kidneys. In addition, renal immunosuppression can be reduced over time, but for pancreas this is riskier, especially if the patient received both a pancreas and kidney transplant from different donors, the risk of rejection is higher than getting either a kidney or pancreas by itself. 

Pancreas Supply and Demand

Selection of pancreas donors is based on age, which significantly impacts how successful a transplanted pancreas will be. Donors also tend to be lean individuals with healthy lifestyles. Pancreas transplant is very selective and has to be a high-quality donor. And because of lifelong immunosuppressive medications requirements, pancreas transplants aren’t performed on younger people often because of the abbreviated average length of time a pancreas works successfully after transplant.

In addition to deceased donors, living donor pancreas transplants can be performed, where a partial pancreas is placed in the patient, however, this procedure is no longer commonly performed because of numerous complications, for the patient and for the donor as well. 

As an alternative, islet cell transplant is a simpler procedure, but there is often a shortage of donor cells. It would require two separate donors, because there is an inflammatory reaction when the islets are injected into the liver, so a majority of the islet cells die quickly and there needs to be excess put into the body to account for the loss. The best results have 70% conversion of diabetes within 8 years because the cells get scarred and immune suppression is still required.

There are some clinical trials for using pig islet cells or growing them artificially – which is called induced pluripotent stem cells. Islet transplant surgery can also happen when they take the pancreas out from a person due to disease, and during surgery, remove the islet cells and put them into the kidney. This is called auto transplant and does not require immunosuppression since its cells emanate from the person’s own body. 

Future webinars will cover transplant innovations in new drugs and what research is being done in xeno (non-human) organ transplant, and upcoming cell and organ repair therapies. 

Listen to the full webinar and learn more about these conversations and information about life post-transplant. This, and future webinars can be found on transplantLyfe.com/webinars.  

Panelists

  • Dr. Geoffrey Dube, Nephrologist and Medical Director of the Pancreas Transplant Program
  • Dr. Casey McCune, Surgical Director of Pancreas and Kidney Transplant Programs
  • Gretchen Boyd, RN, MSN, CCTC, Chief Coordinator Kidney Transplant 

Moderators

  • Mark Hardy, Professor of Surgery at Columbia University 
  • Dr. Karin Hehenberger, CEO of Lyfebulb and Visiting Associate Researcher at Columbia
  • Brian Runge, Senior Coordinator of Donors 

June 22, 2022

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses an overview of pancreas transplant and options that exist for patients. 

Pancreas-Only vs Kidney-Pancreas Transplantation

Dr. Hehenberger shares her experience getting both a kidney and pancreas transplant. Being a person with diabetes for many years, and struggling with some of its complications, she was evaluated for a pancreas transplant. During evaluation, it was clear she needed both because she would be on dialysis within a year without getting a new kidney. She was able to receive a kidney from a living donor, which she received first and, 9 months later, received a pancreas. For patients who require both, she states that it may be ideal to get the kidney first because it eliminates some symptoms and she was able to be in better physical condition going into the pancreas transplant. 

Some people receive both a kidney and a pancreas transplant at the same time or the kidney transplant happens first for the patient to be able to get off dialysis and then receive the pancreas transplant. 

Sometimes, the kidney does not need to be transplanted and a patient can have a pancreas transplant alone. This is a patient who has atypical diabetes, which causes symptoms and impairments leading to issues beyond just insulin dependence such as hypoglycemic unawareness. A pancreas transplant candidate usually has comorbidities associated with their diabetes, such as heart disease, retinopathy, or neuropathy, so it is important to perform a benefit and risk analysis prior to deciding if transplant is right. It has to be determined that the patient is fit to undergo the surgery and will ultimately have a benefit from it. 

The Pancreas Transplant Procedure

Pancreas transplant takes about 4-8 hours. 1 in 20 transplants fail because of clotting of blood vessels. These risks need to be understood by the patient. To receive a pancreas transplant, the patient has to be healthy overall. During surgery, the old pancreas stays in the body and subsequently, it continues to make the digestive enzymes produced to help break down food that is consumed. The pancreas has an exocrine component, producing digestive enzymes that help digest food. Typically, patients do not have digestive issues for this reason. For those patients who didn’t have proper enzyme production before transplant, they would see an improvement in the digestive system once they received a new pancreas that was producing sufficient enzymes for digestion. 

Receiving a transplant can halt the worsening of other comorbidities and complications by improving in sensation of nerves, stop worsening of eye disease, and stop the progression of kidney disease. 

Monitoring for Rejection

After transplant, detecting rejection in the pancreas is not as easy as taking a biopsy of the kidney. There are, however, ways to monitor the function of enzyme production in the blood. Elevated enzyme levels over the course of a few weeks can indicate rejection and then Imaging and a biopsy are used to confirm. Rejection can be asymptomatic, but imaging can show inflammation and swelling. 

Limiting Factors

One may ask, why aren’t more pancreas transplants being done? Selection of pancreas donors is based on age, which significantly affects how successful a transplanted pancreas will be. Donors also tend to be lean individuals with healthy lifestyles. Pancreas transplant is very selective and has to involve a high-quality donor. And because of lifelong immunosuppressive medication requirements, pancreas transplants aren’t performed on younger people often because the average length of time a pancreas works after transplant before rejection occurs is about 10 years.  

Future webinars will cover how to prepare for pancreas transplants as well as transplant innovations in new drugs and what research is being done in xeno (non-human) organ transplant, and upcoming cell and organ repair therapies. 

Listen to the full webinar and learn more about these conversations and information about life post-transplant. This, and future webinars can be found on transplantLyfe.com/webinars.  

Panelists

  • Dr. Dube, a nephrologist and medical director of the pancreas transplant program
  • Dr. Casey McCune, surgical director of pancreas transplant programs
  • Dr. Sandoval, kidney and pancreas transplant physician and director of the chronic kidney program.

Moderators

June 1, 2022

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses what happens post transplantation surgery and how to navigate life afterward and get back to a normal as much as possible. There are medical concerns regarding resuming certain life activities. However, in general, the purpose of transplant is not only to enable survival, but also allow people to thrive. 

Avoiding Rejection

After getting a transplant, there are a few precautions that must be taken to avoid rejection and infection. In the first 3 months, the recipient shouldn’t be in public much due to getting infection from others who could be sick. After about 6 months, recipients are allowed to go back to normal activities and live fulfilled lives of travel, work, spending time with friends, and more. Since COVID 19, the recommendations are to be masked at least for the first 3 months and vaccination is important prior to transplant. Those that are post-transplant can receive Evushield. 

Physical Activity

Physical activity after transplant is important. Some contact sports should be limited but, in general, due to the likelihood of developing diabetes and weight gain from transplant medication, consistent, moderate-level activity is suggested. 

Mental Health Post Transplant

There can be some psychological implications after transplant as both a kidney recipient and a kidney donor. Recipients that have some psychiatric histories are followed by social workers and psychologists. Sometimes, ongoing psychological support can be helpful. Patients who express need or those that are determined to need support through the evaluation process are monitored. For some recipients, there can be feelings of guilt associated with taking someone else’s kidney, sometimes fear can take over and lead to reticence about going through with the transplant, or treatment requirements after transplant can be overwhelming. It is also common that parents do not want to take a kidney from their child donor. A psychologist is consulted for each donor as well.

Medication Assistance

Managing and planning for the cost of medications after transplant long-term requires considerable attention. There are medication assistance programs through mail order pharmacies or other prescription drug benefits. Patients with end stage renal disease are entitled to Medicare that currently extends 36 months post-transplant. Starting in 2023, lifelong coverage through Medicare will be enacted into law. Through that prescription drug plan, other drugs that are required for transplant, besides rejection medications, are eligible for coverage as well. 

Pregnancy

Pregnancy is a possibility after transplant for women of child bearing age. It is recommended to wait at least a year out to get pregnant to minimize the occurrence of rejection because medications need to be altered due to the toxicity to a child. Changing immunosuppressive medications could lead to organ rejection episodes. Educating recipients on the alternative means of having a child, like through surrogacy, can be invaluable. 

Connecting with other patients experiencing similar issues is vital pre and post-transplant. There are a number of resources – support groups through hospitals, online social media groups through Facebook and other platforms, and Lyfebulb’s TransplantLyfe.com. Often, the transplant coordinator facilitates a connection between donors and recipients at a particular center to share their experiences. 

Future webinars will cover transplant innovations in new drugs and what research is being done in xeno (non-human) organ transplant, such as pigs and other animals, and upcoming cell and organ repair therapies. 

Listen to the full webinar and learn more about these conversations and information about life post-transplant. This, and future webinars can be found on transplantLyfe.com/webinars.  

Panelists 

  • Dr. Ilona Weiner, Assistant Professor of Psychiatry at Columbia
  • Dr. Hilda Fernandez, Assistant Professor of Medicine for Pediatric Kidney Transplants
  • Ms. Catherine Sioson, Supervisor for Financial Coordinators
  • Brian Runge, Chief Coordinator of Donors at Columbia University Transplant Program

Moderators

Post-Transplantation Surgery: How Do I Manage My New Kidney?

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses what happens post kidney transplant surgery and matters relating to patient follow-up.

What Follow Up Should I Expect After a Transplant?

After transplant, patients are frequently seen at the transplant center. Follow-up appointments begin twice a week for the first month, then once a week for the second month and, starting in month three; it is once a month for a few months after that. The first week of appointments can take up to a couple hours each; requiring blood work and physician/doctor appointments. Then, blood work is done every week, once a week and, eventually, once a month for the first year. 

During the first few months, blood tests need to be performed at the transplant center but, after that, may be done locally. 

If a patient is doing well and lives far away from the transplant center, arrangements can be made for them to be followed by a nephrologist in the city where they live. But, for the first few months, they must stay near the transplant center. This schedule does require a significant amount of flexibility on the part of the patient and their caregiver(s).

What Drugs Are Given Post-Transplant?

Post-transplant, a person will be required to take a number of immunosuppression drugs as well as others to minimize infections. There is a common virus called CMV that most people have in their bodies and, after transplant, once someone is immunosuppressed, this virus can become active if not treated with a medication called Valcyte. Pneumonias and fungal infections after transplant are common and require preventative medications. Over time, immunosuppression is lowered so there is less need for these other medications and about a year after transplant patients are on fewer medications and lower doses. However, it is always essential to measure the levels of these immunosuppressive medications in the blood, to ensure someone is being treated with the correct dose for appropriate immune suppression. 

The medications a person is on, change whether they are pre or post-transplant. For example, blood pressure is easier to manage after transplant, so someone won’t need as much medication for that condition, but something like cholesterol or diabetes doesn’t change so those treatments will continue. Fortunately, drug manufactures are helping patients with medication costs and gaps in coverage by providing patient assistance programs. By 2023, those on government insurance will have lifelong immunosuppressive drugs covered.  

What Complications Could Arise?

Though transplantation has significantly advanced over the years, there are surgical complications with which to contend. Some of the most common issues are related to the blood vessels, specifically when they bleed after kidney transplant. Around 5-15% of patients have to go back into surgery for bleeding complications. This occurs usually in the few days subsequent to surgery and those on blood thinners are at elevated risk, however, it is not considered a major issue. Clotting is a more dire concern that can cause stroke, and patients are monitored closely for this. 

Delayed graft function (colloquially referred to as “sleepy kidney”) occurs in about 50% of deceased donor kidneys which means the kidney does not start working quickly. It normally takes a few days to a week to start working properly and, in less than 1% of cases, the kidney does not start working at all. A viable quality kidney will have less problem with delayed graft function. If it doesn’t begin working, the patient will need another transplant but they will stay at the top of the list for getting another one. A few other complications related to the lymphatic system occur in about 5% of cases, where fluid builds up in the abdomen, but this can be remedied by drainage.

Post-Transplant Precautions

After receiving a transplant, there are a few precautions that must be taken to avoid rejection and infection. In the first month, the recipient should not be in public much due to getting infection from others who could be sick. There are some foods that should be avoided, like pomegranate and grapefruit, because of drug interactions, and sushi, raw meat, and shellfish because of high bacteria levels. After about 6 months, recipients are allowed to go back to normal activities and live fulfilled lives of travel, work, spending time with friends, and more. 

April is Donate Life Awareness Month! Encourage living and deceased donors! 

Listen to the full webinar and learn more about these conversations and information about life post-transplant. This, and future webinars can be found on transplantLyfe.com/webinars. 

Panelists 

  • Dr. John Crew, Assistant Professor of Medicine and a Senior Transplant Physician
  • Dr. Joshua Weiner, Assistant Professor of Surgery and Transplant Surgeon, Director of Intestinal Transplant
  • Shefali Patel, Chief Coordinator of Post-transplant Patients
  • Brian Runge, Chief Coordinator of Donors at Columbia University Transplant Program

Moderators

March 24, 2022

Lyfebulb, in partnership with Columbia University, presents a virtual education series, sponsored by Veloxis Pharmaceuticals, to address key topics of living from late-stage disease through the transplantation process and beyond. Providing informative patient education is key to improving the patient experience, health communications, and health outcomes.

This session discusses the steps involving kidney surgery itself and the considerations for patients in preparation for surgery. 

The Waiting List

While a patient is on a waiting list for a renal transplant, they will attend classes to understand what will be expected when it comes time. A patient must keep up with their primary care team, inform the transplant team of any health changes, testing that has been done, medication changes, hospitalizations, any blood transfusion, illnesses, and changes in contact information. 

The patient and the family of the patient will remain in close contact with the transplant coordinators during the waiting time and they are the primary contact with the transplant team.

The time on the waiting list can be long for patients. Being on a waitlist causes anxiety because of the uncertainty about when the call comes. The educational program helps with answering patients’ concerns and questions and social workers and therapists support the patient and families.  

For each available kidney, the top 5 patients on the list are notified and then based on match, health status and other factors, one is chosen to receive the kidney. When a patient is toward the top of the list, they may be called multiple times before actually receiving a kidney. 

The Surgery

When a kidney is taken out of a donor, it can be stored for 55 hours on ice, but this length of time isn’t ideal. Getting it in the body of the recipient as quickly as possible is important. If it’s a high-quality kidney there is more time – this would be someone that doesn’t have kidney damage or disease and is a young person. A kidney score (KDPI score) is given to each kidney – 85 and above is considered a damaged kidney. There are 10 categories to determine this score but it doesn’t include the biopsy score. 

For the patient that is selected for the kidney they are called to come into the hospital to discuss the surgery. The surgery takes about 3-4 hours and the additional kidney is added and patients’ own kidneys remain in the body. There are many new medications after transplant which require attention to learn the regimen. 

The kidney doesn’t work right away in about 40% of cases from deceased donors. These patients are monitored closely. The living donor works well quickly, but for example, Dr. Hehenberger shares her transplant experience where her living donor kidney did not work for 3 days. 

After transplant, it takes about 2 months to fully recover. In the first month, the patient needs a lot of care-taking because they are fatigued. It’s important to keep exercising to retain good muscle tone – don’t stay in bed and try to resume normal life to progress in recovery. Building muscle is very important to gaining strength as well as a good diet. 

Medications

There are 3 categories of medications – the surgery pills like pain medicine. Anti-infective pills, and anti-rejection meds – the latter must be taken for the life of the kidney. Levels and dosage of medications often have to be adjusted based on the body’s response. 

The side effects of the anti-rejection medication, tacrolimus, can cause damage to kidney and tremors, headache, anxiety, and high blood pressure. The symptoms can start immediately but some symptoms like kidney damage happen over years’ time.  There are alternate options for drugs if one medication doesn’t work for a patient – minimizing side effects is a priority. 

Kidney Function

To determine the kidney’s baseline functioning, an ultrasound of the kidney is done. This compared to future ultrasounds and lab work is used to check for any changes – determining that there is good blood flow and urine flow through and from the kidney. Immediately after transplant, bleeding is a concern, and as more time passes, there is more concern about infection. Biopsies are also performed routinely to examine the kidney function and check for rejection. 

The kidney from a living donor lasts up to  20 years versus about 10 years from a deceased donor. In a living donor transplant, the surgeries of the donor and receipient happen simultaneously usually within the same center so they don’t have to be held on ice for very long, and it begins to function in the body quickly after transplant. If needed, living donor transplants can be done across the country and shipped as well. 

Being prepared physically and mentally for kidney transplant surgery requires a lot of effort and commitment from the patient and families. Don’t be afraid to ask for help from the transplant team and your family, and stay positive because overall, it is a very successful procedure!

Listen to the webinar and learn more about these conversations and educational resources for potential kidney transplant recipients. This, and future webinars can be found on transplantLyfe.com/webinars. 

Panelists

  • Dr. Kasi McCune, Surgical Director of Pancreas Transplant Program at Columbia
  • Ms. Maxine Morris, Chief Coordinator of Kidney Transplantation at Columbia
  • Dr. Chang, Assistant Professor of Medicine and part of nephrology group at Columbia
  • Mr. Brian Runge, Chief Coordinator of Donors at Columbia University Transplant Program

Moderators