nephrologist junaid ahmed
By Junaid Ahmed, MD - Nephrologist at Florida Kidney Physicians

Kidney transplantation, whether using organs from deceased or living donors, has been well established as the optimal management for patients with end stage renal disease (ESRD).

Unfortunately, it is not as widely available as it should be. The OPTN recorded 5,811 living kidney donor transplants, 14,038 deceased donor kidney transplants and 789 kidney/pancreas transplants in 2017. Only 20% of the half million dialysis patients

make it to the transplant waitlist and, of those, 5000 die each year while waiting. Chronic kidney disease (CKD) is on the increase, with an estimated 25 million Americans affected (the rate being three times higher in African Americans).

Although the rate for deceased-donor kidney transplants is improving, the rate for living donations has not changed since achieving its highest level, over a decade ago. Dialysis should be considered a bridge to transplant, with emphasis on finding a living kidney donor for as many ESRD patients as possible.

Unfortunately, only half of American adults are registered for deceased organ donation. Concerted efforts to increase education regarding kidney donation would certainly increase transplantation.

Live kidney donation from a family member or a friend is one of the most reliable ways to improve the lives of patients with advanced kidney disease and those on dialysis. One does not need a good match or to be a family member to donate a kidney.

A donation from an unrelated individual, even with a different blood group, can be performed with a paired-kidney donation.

This kind of donation involves a kidney swap between donor-recipient pairs who can’t donate a kidney directly to their relatives or friends. A donor who is well selected can lead a normal life; In fact, those who donate a kidney have a longer life expectancy than the general population. This is because only the healthiest individuals are selected to donate a kidney, and most kidney donors tend to take better care of their health after kidney donation. Anyone can be an organ donor. It simply starts by individuals letting their family know their wishes, registering with the states Organ Donor registry or by selecting ‘Yes” to organ donation when applying for a driver’s license.

As we celebrate Donor Day this month, we thank all the unsung heroes who give the ultimate gift of life to others by donating their organs while alive or upon their death. Save lives!

Register to be an organ donor today!

 

keeny the kidney


19/Feb/2019

Meet Kenneth. Ken was moving through his life like most of us. In some cases, even better. He developed the early productive belief on to find out “love what you do and figure out someone to pay you to do it.” He was a technician in the theater business for about 25 years, currently at the Broward Center for The Performing Arts. Like many of us, he was in the flow of his routine, without the weight of a burden he was about to carry with him everywhere he would go.

Kidney Disease

Ken was working an unusually long day at the theater, running a show for close to 17 hours. When Kenneth returned home, he was so drained he couldn’t lift his arms above his head. This was not normal, he thought. He made an appointment and visited his doctor to immediately investigate what was going on. What they found was profound. Kenneth’s kidneys were failing. He needed a kidney transplant.

Ken, the diligent man he is, kept working the job he loved. He would arrive at 5am at the clinic for dialysis and hemodialysis so he could work his full day. In that early shift he met Dr. Cassaretto, one of our doctors. They connected immediately, rooted in a healthy sense of humor and energy for life. They could crack each other up at the drop of the hat. A great ally in such an emotionally draining life experience. Ken had found his doctor, his friend. The feeling was mutual and Dr Cassaretto worked and advocated for Kenneth to get the care he deserved and needed. Ken was floored, he felt the importance of his own life through another. A real gift.

As we all know though, the kidney disease can rear its ugly head in any moment. About a month into dialysis Ken had a rupture in his peritoneal sac. A very dangerous prospect. Nephrologist Dr. Cassaretto and his partner Dr. Parham Eftekhari, worked tirelessly to ensure Ken’s safety. Eventually guiding him out of that existential threat. Ken responded in kind, kickstarting his recovery. Ken credits everyone at the hospital, including the nurses, dietitians, and the social workers.  Gratitude overwhelmed his experience, grateful for a doctor that would look him in the eye in every conversation, and be honest. Honest about what he needed from Ken for his recovery to be successful.

 

 

Kidney Transplant

Ken is a Stage Four kidney patient. Neither kidney works. He is on a kidney transplant list. These are all things that can send anyone into an emotional spiral. But with gratitude and humor, next to a good doctors, a friend, supporting his recovery, Ken is ready, ready to fight, ready to thrive, ready to live. We are all Ken, and Ken is us.

Learn more about our Kidney Transplant Services, offices and team: Kidney Transplant Tampa , Kidney Transplant Fort Lauderdale


kidney-treatmentnews.jpg
19/Feb/2019

Researchers analyzed data from thousands of transplants and developed a scoring system for donor kidneys that they hope might expand the pool of available organs in two ways.

With over 120,000 patients in the United States waiting for a kidney transplant, scientists and physicians are constantly looking to expand the pool of available organs through increasing donation and optimizing allocation. Researchers from Thomas Jefferson University analyzed data from thousands of transplants and developed a scoring system for donor kidneys that they hope might expand the pool of available organs in two ways. They published their findings in the Annals of Transplantation.

“The gift of life is so precious. It’s imperative that we use each and every organ in the most efficient way for our patients, donors and their families,” said Cataldo Doria, M.D., Ph.D., MBA, Nicoletti Family Professor of Transplant Surgery and Director of the Jefferson Transplant Institute. “We decided to look closely at dual kidney transplantation and found that there may be ways to optimize their use by a scoring algorithm.”

Dr. Doria and his team retrospectively analyzed United Network for Organ Sharing (UNOS) data for 1,547 dual kidney transplants (DKT) and 26,381 expanded-criteria single kidney transplants (eSKT). Dual kidney transplants use two marginal donated kidneys in one recipient, increasing the amount of nephron mass and blood cleansing capability. Expanded-criteria single kidney transplants use kidneys from older donors or those with other certain risk factors. Thirteen donor variables were found to be significantly associated with graft survival including age, gender, body mass index, history of diabetes, hypertension, smoking and certain laboratory tests. Based on these criteria, the team developed a singular score for the donated organs which showed strong correlation with better survival in dual kidney transplants.

The scoring system could help expand the pool of available kidneys in two ways. First, by identifying which donor organs would be best transplanted together. The algorithm identified a score range where donors transplanted as dual had 70 percent greater median graft survival when compared with matched donors transplanted as single. Sometimes, kidneys with marginal function are offered to surgeon after surgeon as a single, who turn them down in the hopes of a better kidney in the future. This wastes precious time and sometimes the kidney isn’t used. If both kidneys are offered at the same time earlier in the process, a surgeon might be more willing to take them for their patient as the amount of functional kidney cells is increased. Jefferson researchers theorize that better identifying dual transplant kidneys at the start of the donation process will prevent some kidneys from not being used.

Second, the researchers’ score might also increase the amount of available organs by identifying which donors should not be offered as dual, because these donors did not demonstrate any improved median survival when compared with matched donors transplanted as single. “According to our matched samples, the 77 percent of dual kidney transplants with middle or low range scores had no better or worse media graft survival than matched single transplants,” said first author Adam Johnson, M.D., M.P.H. “This suggests that those transplants may have been better used by two recipients or not at all.”

Future prospective studies will be needed to demonstrate the external validity, but researchers are hopeful that the score may help standardize organ allocation for dual kidney transplantation in the future and save additional lives.

Reference:

Provided by Thomas Jefferson University: Thomas Jefferson University. “New score seeks to expand pool of kidneys available for transplant.”


Copyright by Florida Kidney Physicians.