Kidney transplant: a pioneering program now 40 years strong
You’d be hard-pressed to find a more eloquent champion for kidney transplantation at Tufts Medical Center than Andrew Levey, MD. He’s not only Chief of the William B. Schwartz, MD Division of Nephrology – he’s also a kidney donor who was part of a life-saving six-person organ exchange at Tufts Medical Center.
In 2009, Levey’s wife – oncologist Roberta Falke, MD – needed a kidney transplant due to worsening polycystic kidney disease. Levey was a willing but incompatible donor. So he and Falke did what Levey had been advising some of his own patients to do – they signed on with the New England Program for Kidney Exchange in Newton. The exchange program helps to increase the pool of potential donors by orchestrating matches among altruistic strangers.
In the fall of that year, Falke was notified of a match. But it didn’t stop there. Levey was a match for a man named Peter Scheibe. Scheibe’s wife Susan wasn’t a match for her husband, but she was a match for a man named Hai Nguyen. And Nguyen’s wife Vy wasn’t a match for him, but she was a match for Falke. And on December 15, in an exquisitely choreographed series of operations at Tufts Medical Center and the Lahey Clinic Medical Center, the three healthy donor kidneys were harvested and transplanted into the three recipients. Today, all six participants in this “circle of miracles” are doing fine.
“I obviously think this is a great place for people to get care for kidney disease,” Levey says with masterful understatement, referring to the medical center where he has worked for 31 years. He directed the dialysis program and was Medical Director of Kidney Transplantation before becoming Chief of the Nephrology Division in 1999. “Of all the places where we could get a kidney transplant, I’d prefer to bring my family here,” he adds.
Tufts Medical Center has a distinguished history in kidney transplantation. The institution’s contributions to the field began in the 1950s, when research into the immune system led Tufts University researchers Robert Schwartz, MD and William Dameshek, MD to the discovery of the chemical 6-mercaptopurine and its immunosuppressive effects.
This breakthrough led to formulation of the drug azathioprine, ushering in the modern era of transplant immunosuppression. The first kidney transplant at Tufts Medical Center was performed in 1971, and more than 1,000 procedures have been performed here in the nearly 40 years since then.
Today, Tufts Medical Center performs about 40 kidney transplants a year, making it a mid-sized program by national standards. Most recently, the kidney disease program was recognized in the 2010 US News and World Report’s “Best Hospitals.”
“I feel our program comes as close as possible to offering the best of both worlds,” says Richard Rohrer, MD, Chief of Transplant Surgery – and the surgeon who harvested Levey’s donor kidney. “We have enough history and experience to take on the toughest cases, yet we’re small enough to get to know our patients and give them personalized attention.”
“We are a great team that works well together,” says Ronald Perrone, MD, Associate Chief of the Division of Nephrology and Medical Director of Kidney Transplantation, referring to the collaboration among surgeons, physicians and transplant coordinators – and including the referring physician. “We’re able to evaluate patients thoroughly, make sure transplantation is the right choice, and cover all the bases safely. As a result, we have excellent outcomes that meet or exceed national norms.”
Rohrer quantifies that: “With live-donor kidney transplants, we consistently have a better than 95 percent success rate,” he says. “With deceased-donor transplants, we see 90 percent success rates. These numbers are equal to the best anywhere,” he adds.
Nationally and particularly in New England, there are still too few donor kidneys, however, for the number of patients who need them. In New England, 2,500 people are on the waiting list for a new kidney, and each year about 168 will die before getting one. Tufts Medical Center has been on the forefront of finding solutions to this problem.
In the 1980s, Levey and Susan Hou, MD, who completed her nephrology fellowship here, wrote about how kidney donation from living unrelated donors could help expand the donor pool. Today, approximately 20 percent of kidney transplants at Tufts Medical Center are from such donors (with 30 percent from living related donors and the remaining 50 percent from deceased donors). Hou, incidentally, went on to become Medical Director of the Renal Transplant Program at Loyola University Medical Center in suburban Chicago and made headlines when she donated a kidney to one of her patients in 2003.
Tufts Medical Center also was a pioneer in advancing the idea of an organ donor exchange, says Rohrer.
“Patients would come in to see about a transplant, and we’d meet with their family and friends who wanted to be donors,” he relates. “When there was no match, we’d end up sending away healthy, willing donors. Sometimes we’d get a donor with blood group A and a recipient with group B, then by chance a month later we’d get the exact opposite. About 10 years ago, a light bulb went off – why can’t we arrange a system to swap them?”
That system – the New England Program for Kidney Exchange – is now managed by the New England Organ Bank. “It’s evolved into different exchanges and chains of donors and recipients,” Rohrer says. “And the rest of the country is coming around to the idea,” he adds, noting that the Washington (DC) Regional Transplant Community and Johns Hopkins have developed programs to register recipients and donors, using computer algorithms to identify potential swaps.
“Now they’re being knitted together as a network to help establish best practices and expand,” Rohrer says. “I’m sure that within three to five years, donor exchanges will be common across the U.S.”
In the meantime, here at Tufts Medical Center, patients and their physicians have access to an exemplary kidney transplantation program that has been fully vetted by someone who’s truly in the know.
“I was very happy with the thoughtful and considerate care shown by the doctors and surgeons, transplant coordinators, the OR staff, nurses, everyone,” Levey says. “They were the same professional and caring individuals I know them to be from working with them.”
“All of us doctors want to help our patients,” he continues. “But it’s rare to get the chance to do anything so direct and meaningful to restore someone’s health. To give a personal gift that you can give only once to another person, it’s a unique confluence of both professional and personal ideals.”