Kidney Transplantation
Tufts Medical Center has become one of the leading medical institutions in the country for kidney transplantation since its program began in 1971. As of 2007, Tufts Medical Center's transplantation services have performed more than 1051 living-related, living-unrelated and deceased donor kidney transplants.
The Kidney Transplantation team (from left)– Scott Gilbert MD, Jeffrey T. Cooper MD, Ronald D.Perrone MD, Richard B. Freeman MD, Richard J. Rohrer MD
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Outstanding patient survival statistics underscore Tufts Medical Center's success. Graft survival at one year is currently 96% for the Medical Center's living donor kidney transplants, and 92% for deceased donor kidney transplants.
Success means recipients have returned to a normal quality of life following transplant surgery-returning to any occupation of their choosing, pursuing any sport or exercise, traveling freely world wide, or making plans for having or increasing a family.
Transplantation Options
Patients with kidney failure may be treated with either dialysis or transplantation. For most patients between six months and 70 years of age, kidney transplantation offers opportunities for greatly improved quality of life compared to dialysis-higher energy levels and greater freedom from restrictive schedules. With a functioning transplanted kidney, recipients must take medications every day to prevent attack from their own immune systems, but otherwise carry on normally with their life as it was before dialysis became necessary.
Each type of kidney transplant has varying levels of expected success simply because of the source of donation. Some family members may have exceptionally good tissue matches with their recipients, thus resulting in outstanding long term success notes. Transplants from other living donors also give excellent function because the transit time from donor to recipient is so rapid that there is little injury to the kidney, and thus less rejection. With kidneys donated from deceased donors there is less chance of a good match and longer preservation time, but there is still a very reasonable hope for long-term success.
Referrals
Patients, their primary care physicians, specialists or insurers can initiate referrals for kidney transplantation with a single call to Tufts Medical Center's Division of Transplant Surgery at 617-636-5592.
Evaluations
Patients are encouraged to undergo as many baseline tests as possible close to home and deliver the results to Tufts Medical Center prior to evaluation. Patients spend two half days being evaluated at the Medical Center, where they visit with the members of the transplant team: a transplant nephrologist, transplant surgeon, social services worker and transplant nurse coordinator.
Waiting period
Waiting times for kidney transplantation vary widely. The typical living-donor transplant can take place quickly. Surgery can be scheduled more or less at the donor's convenience-often only a few weeks or months after initial evaluation. However, the wait for a deceased donor kidney can be as long as four years. The list of patients in New England who are in need of kidney transplants is long and growing.
Recovery
The hospital stay after surgery is usually five-to-seven days for recipients of living-donor kidneys; seven-to-ten days for deceased donor kidney recipients. While the transplant procedure is much the same, the difference in recovery time relates to how readily the transplanted kidney starts working. |
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Outpatient Care
Initial follow-up after kidney transplantation is conducted at weekly intervals, but is lengthened over time to monthly intervals. In addition, every effort is made to coordinate home-based follow-up care through referring physicians. One year after a transplant, clinic visits become progressively less frequent, until they reach a once or twice yearly follow-up schedule.
Several medications are required to prevent a transplanted kidney from being attacked by the recipient's immune system. At present, most kidney transplant recipients at Tufts Medical Center receive “prednisone-free” immunosuppression. This spares them from the most common drug side effects seen in the past, while maintaining excellent outcomes. All medication and dosage combinations are carefully tailored to each patient, and these medicines must be taken for life. If medications are stopped for even a few days, the transplanted kidney can be damaged or lost.
Most cases of rejection can be brought under control, although some long-term, slow forms of rejection may not be manageable. Such "chronic rejection" is the main cause of kidney transplant loss over time.
About Kidney Donors
The three types of transplants are named for the donor of the kidney:
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Living-related-the donated kidney comes from a close, directly related family member such as a parent, sibling or child who is healthy, willing and able to donate one kidney.
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Living-unrelated-the kidney is donated by someone who is alive, but not closely related such as a spouse, aunt or uncle, or a friend.
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We offer laparoscopic nephrectomy (removal of kidney) as well as the traditional open approach for all live kidney donors.
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Deceased donor – the donated organ comes from someone who has died. Typically the donor suffered a brain injury, and passed away with either neurologic or cardiac death.
Each year, approximately 50 percent of Tufts Medical Center's kidney transplants come from deceased donors, 30 percent from living-related donors and 20 percent from living, unrelated donors.
At Tufts Medical Center, during the evaluation process patients are offered a unique "extended family" meeting with members of Tufts Medical Center's transplantation team including a nephrologist, surgeon, nurse, and a social worker. This group reviews the entire process-from dialysis through long-term transplant follow-up-for all interested family members, partners and close friends. The potential for using a living donor is discussed at a later stage.