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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on November 05, 2009, 11:54:43 PM
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UPMC unit to increase use of organs from living donors
By Andrew Conte and Luis Fabregas
TRIBUNE-REVIEW
Friday, November 6, 2009
The University of Pittsburgh Medical Center's transplant chief said Thursday he intends to dramatically increase the use of organs from living donors, a move that counters industry trend.
About two-thirds of UPMC's kidney transplants and more than a quarter of its liver surgeries could be done using organs from healthy donors, said Dr. Abhinav Humar, chief of transplant surgery.
Half of UPMC's kidney transplants this year had live donors, up from 34 percent last year, and Humar wants that to top 60 percent. Eleven percent of liver transplants at UPMC this year had living donors, up from 4 percent last year but still lower than the peak of 20 percent in 2006.
"You have to give your patient all of the opportunities that are available ... to maximize their chance of getting a life-saving procedure," Humar, 44, told the Tribune-Review in his first sit-down interview since coming to Pittsburgh in March.
UPMC was a leader in live-donor liver transplants under Humar's predecessor, Dr. Amadeo Marcos, who resigned in March 2008, citing personal reasons. A UPMC study initiated by its transplant pioneer, Dr. Thomas Starzl, showed a pattern of significant complications in the surgeries.
The hospital performed four live-donor liver transplants last year, down from a high of 36 in 2006, according to the United Network for Organ Sharing, which collects and analyzes transplant data. UPMC performed eight of the surgeries this year.
Surgeons cannot eliminate every complication, but can limit them by following regimented procedures, carefully screening patients and preparing for problems that occur, Humar said.
"The complication rates, even when you get as good as you can get, they're never going to be zero," he said, noting the technical aspect of the surgery and the liver's complex anatomy.
Starzl, now retired, said yesterday he never condemned using live donors for liver transplants, and pointed to an August editorial in the Journal of Hepatology that said the study suggested "appropriate monitoring" of outcomes and "a need for improvement ... to remain a viable option" for some patients with cancer and end-stage liver diseases.
"That's an unequivocal statement," Starzl said. "I hadn't condemned the procedure."
Humar said he agrees with Starzl on vigilant monitoring, but said some patients facing long waits for livers from deceased donors could benefit from surgery. More than 16,000 patients are waiting for livers in the United States.
"This is not something that can be utilized without due attention, but certainly there is a segment of diseased liver patients who would be very well-served by live-donor transplants," Humar said.
He said UPMC would not routinely perform transplants on liver patients at the low end of the Model for End-stage Liver Disease scale for distributing organs. A Tribune-Review investigation last year found UPMC had been one of four hospitals performing more than half of the surgeries on patients with low MELD scores, despite research showing many of them had better survival odds without transplants.
"Rules and guidelines are useful," Humar said. "Yes, we follow the guideline that (says) generally patients are ready for transplant when they get to MELD score 15. But have we, or will we, ever transplant patients that are below MELD score 15? Yes."
Some patients at the lower end of the MELD scale — which ranges from 6 to 40 — suffer from complications such as severe itching and fluid retention that are not reflected in their scores, he said.
The goal of using live donors for two-thirds of kidney transplants would put UPMC among the top centers, said Dr. Bryan Becker, a Wisconsin transplant nephrologist and president of the National Kidney Foundation. Becker said he worries the nation's live-donor kidney transplants have dropped each year since 2004, to 5,968 last year.
The live-donor kidney transplant poses few complications for the recipient or donor, whose organ is removed through a tiny incision with a minimal hospital stay, Humar said. To educate patients, UPMC has sent transplant coordinators to dialysis clinics and contacted patients on the deceased-donor waiting list, encouraging them to seek donors beyond their immediate families.
"It's achievable," Becker said. "I think it's very doable and very good."
http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_651813.html