UAB opens Kidney and Pancreas Transplant Clinic (video, gallery)

[Clark]

http://blog.al.com/spotnews/2012/03/uab_opens_kidney_and_pancreas.html

UAB opens Kidney and Pancreas Transplant Clinic (video, gallery)
By Jeff Hansen -- The Birmingham News

The doors to UAB's new Kidney and Pancreas Transplant Clinic opened Thursday at 6:30 a.m. for patients to get their blood drawn. This new home for the medical center's busiest transplant service is a street-level clinic on Sixth Avenue South, in the space that once housed the hospital emergency room.
Since the first kidney transplant at UAB in 1968, the academic medical center has transplanted nearly 9,000 kidneys, and for past 25 years, UAB has been the busiest kidney transplant center in the United States.
But the long-term success for transplant patients depends on a large health care team from many disciplines. The new clinic -- five times larger than the one it replaces -- lets those different disciplines easily mix.
The goals are a better experience for patients coming to UAB, and increased efficiency and productivity for the kidney and pancreas transplant team.
On Thursday, the team was expecting four potential living donors of kidneys, six or seven potential recipients for kidney transplants, and more than a dozen kidney recipients coming in for tests of how their replacement organs are working.
"The biggest reward is seeing patients 10 and 20 years out whose lives were changed," said Dr. Mark Deierhoi, a surgeon who directs the UAB renal transplant program.
Nationwide, about 300,000 Americans have suffered kidney failure. They stay alive through blood dialysis -- a painstaking filtering of the blood to remove wastes.
Dialysis is a cost that "consumes a substantial portion of the U.S. health care budget," Deierhoi said. "A kidney transplant can save $10,000 to $25,000 a year over the cost of dialysis."
Donors needed
But the need for donor kidneys greatly exceeds the supply.
UAB has 3,380 patients waiting for a kidney transplant.
Depending on their blood type and other variables, they may have to wait 5-7 years for a deceased donor organ. About 60 percent of the people on the waiting list are African-American, a group that has higher rates for some chronic diseases that lead to kidney failure.
A vital source of donated kidneys is living donors -- altruists who are willing to give up one of their two kidneys to help another person. About half of the UAB kidneys come from living donors.
Sherry Knox, 55, is a kidney recipient from a living donor.
Doctors told Knox she had protein in her urine test in 2003. Her kidneys quickly failed and she began 14 months of dialysis.
Then Estella Purifoy, one of her co-workers at BellSouth, offered one of her kidneys to Knox. The pair were a match.
But some friends or family members who volunteer to donate may find that their kidneys are not compatible for the intended recipient. That can lead to a "paired donation," where the family member donates to some unrelated person who needs the kidney, and that family donates back.
This pairing can create of a chain of giving -- family A gives to family B, family B to C, C to D and so forth. A recent example described on the front page of The New York Times involved 60 people and 30 kidneys. This chain registry started with a Good Samaritan willing to give a kidney and expect nothing in return, much like Purifoy did for her friend Knox.
The operation to donate a living kidney is done through several small incisions on the abdomen, Deierhoi said, usually as the donor lies on his or her right side to give access to the left kidney.
One incision is for a light source, another to insert surgical instruments and the longest -- about 3 inches -- lets Deierhoi put his hand inside to hold the kidney and take it out when ready. After a quick flush with fluid, the kidney is immediately placed in the lower abdomen of the recipient, and the surgeon connects the vein, artery and ureter.
The patient is up and walking the next day.
While the three- to four-hour surgery is dramatic, long-term success of the transplanted kidney depends on the patient who has to diligently and continuously take anti-rejection drugs to stop the body from attacking the new "foreign" kidney.
"At first I took about 30 pills in the morning and about 15 at night," Knox said of her new kidney. "Now I'm down to about eight in the morning and eight at night."
The new UAB clinic is about 11,000 square feet, including four exam suites and 14 exam rooms. It has curbside drop-off for patients, and the second lane of the old ER driveway will soon be dug up to make a green space.
Appointments for potential donors and recipients can last all day. The patients get diagnostic tests and have blood drawn; talk with social services workers, a surgeon, a nephrologist and a transplant coordinator; and have a class about transplants.
They also talk to a financial coordinator, to get a good idea of what they will face in out-of-pocket expenses for medications.
"Transplants don't work without immunosuppressive drugs," said Dr. Robert Gaston, co-director of the UAB Comprehensive Transplant Institute. "UAB has spent a great deal of time, money and energy to make sure that patients have access to drugs."