Transplant: Kidney Transplant
Guest: Dr. Prabhakar Baliga – Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Prabhakar Baliga who is Chief of Transplant Surgery here at the Medical University of South Carolina.
Dr. Prabhakar Baliga, let’s talk now about one of your areas of expertise which is the transplant of kidneys. Could you tell us the profile of a typical person who is in need of a kidney transplant?
Dr. Prabhakar Baliga: The vast majority of kidney transplant patients are diabetic. That has become the number one cause of end-stage renal disease, or chronic renal failure, over the last few years. So, a typical kidney patient is usually middle aged or a little older who has had 15 to 20 years of diabetes, and usually some hypertension along with that. So, that is the vast majority and, unfortunately, that is in an incident that is going to increase very rapidly with obesity and other problems associated with what we call metabolic syndrome.
Dr. Linda Austin: Now, will most patients have been on dialysis before they go to transplant?
Dr. Prabhakar Baliga: They do not have to. In our program, we serve a large number of African-American patients, many of them in smaller counties or smaller cities and their education level tends to be lower and they may not be as educated about transplant. This has been a continuing problem for the program over the last several years that have been trying to address. Compared to some other programs, our pre-emptive transplants, meaning transplanting patients before they begin dialysis, is only in the range of 10 to 12 percent. Ideally, we would like to see that number be a little higher. And the second part of that answer is the difficulty of getting a transplant in time. Unless you have a living donor, you may not be able to go directly to a transplant. You may have to undergo a couple of years of dialysis before you can get a transplant.
Dr. Linda Austin: I have heard that it is really a liberating surgery, that dialysis itself is not a particularly fun process, and people can really reclaim their lives when they finally do a get a kidney transplant.
Dr. Prabhakar Baliga: I think, Linda, you have no idea what a statement you have made. You know, for years, people only considered kidney transplant as improving quality of life and now there are more and more studies that show us the number of life years gained by performing a kidney transplant. It protects your heart. It protects you from all the changes of dialysis over time. So, without any question now, a kidney transplant has far more advantages than being on dialysis.
Dr. Linda Austin: How many of these procedures do you do a year?
Dr. Prabhakar Baliga: The last couple of years have seen a significant increase in the number of kidney transplants that we have done. In the last two years we have done close to 200 kidney transplants. A large part of that is due to an increase in the number of cadaveric donors we have been able to procure in the state as well as an increase in living donor transplants, people feeling more comfortable with the idea of living donation.
Dr. Linda Austin: That is right because, I guess, we have to underline that humans have two kidneys and so you can spare one kidney and still be okay.
Dr. Prabhakar Baliga: Very true. There have been tremendous advantages to living donation and we have learned over time about living donation. If you look back at the history of kidney transplants, living donations were performed in 1954. They were the earliest successful kidney transplants from living donors. So we have a track record of more than 50 years of living donation and kidney transplantation.
The second part which has changed is that with improved anti-rejection medicines, or immunosuppressants, we no longer rely very much on immunological matching. We need only match for blood type and unrelated donors, those who are not necessarily family members, it could be someone from your church, your community, someone you went to school with, spousal donation, have broadened the donor pool as to who could be a living donor. And the success rate with these unrelated living donors is as good as getting a kidney from your own mother, or sister. Living donation has a one-year success rate of close to 95 to 97 percent and the best long term success. We calculate kidney success rates base on what is called a half-life and the living donor success rate is close to 18 years, what we call a kidney transplant half-life for a living donor.
Dr. Linda Austin: That is remarkable. I did not realize that the criteria for who can be a donor is much broader now. What percentage, then, of the donors are living donors as opposed to cadaveric donors?
Dr. Prabhakar Baliga: One more time, Linda, you hit the nail on the head. You know, it is a big problem in our program. We serve, like I mentioned earlier, a very large African-American community, close to 80 percent on our waiting list are African-Americans. And we have a huge problem in terms of education, fear and misconceptions pertaining to organ donation and transplant. So, unfortunately, we have one of the lowest rates of living donation in the country with only 15 percent of the program being living donors.
There are several centers in the Midwest and the Northeast having between 50 to 75 percent of their donations from living donors. I think it is not entirely based on a given community. There are also a tremendous number of conditions that run in families, such as of diabetes and high blood pressure. This is called the Stroke Belt of the country. We have a high incidence of diabetes, high blood pressure and obesity in this population, so it is hard sometimes to find a living donor in this community compared to places like the Midwest, the Northeast, or California.
So, overall, it is an area that we are trying to improve, at least we want to improve the education so at least people can overcome their fears as well as help people understand that it does not have to be just family members that can donate. It can go beyond family members.
Dr. Linda Austin: This is really important work. Thank you so much for talking with us today.
Dr. Prabhakar Baliga: Thank you very much.
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