Cleveland Clinic doctor's research on transplant patients uncovers surprising

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Cleveland Clinic doctor's research on transplant patients uncovers surprising findings

Published: Tuesday, September 28, 2010, 9:00 AM
Angela Townsend, The Plain Dealer Angela Townsend, The Plain Dealer

People who have received a previous organ transplant are more likely to be placed on the list for a kidney transplant before starting dialysis than other kidney transplant candidates.

Those are the
findings of a study
published Sept. 2 in the Clinical Journal of the American Society of Nephrology.
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The fact that more patients are being placed on the kidney transplant list preemptively is a good sign, said Dr. Titte Srinivas, a physician at the Cleveland Clinic's Glickman Urologic and Kidney Institute said. "Doctors are doing a good job of offering [the option] of transplant much earlier," he said.

But it also raises big-picture questions about a patient's overall health at the time of the first transplant, what role anti-rejection medications play in the decline in kidney health, and how to prioritize people on the kidney transplant list, he said.

A patient of Srinivas served as inspiration for the research.

The patient was a woman who had received a lung transplant a decade earlier. Her kidneys were failing; Srinivas wanted to find a transplant for her quickly.

Struck by the woman's predicament, "I wanted to look at how many more people there were like her, and what their outcomes were," he said.

Srinivas and his colleagues conducted a retrospective review of data from 1995 to 2008 from the national Scientific Registry of Renal Transplant Recipients. During that time period, more than 4,900 people with a previous organ transplant (heart, liver or lung) were on the wait list for a kidney.

Before 1995, less than 1 percent of people who had received other organ transplants were placed on kidney transplant waiting lists.

In 2008, 3.3 percent of such patients were on the kidney transplant waiting list.

The most interesting finding?

There were several, Srinivas said.

•Among people with a previous organ transplant, 38 percent were put on the wait list before starting dialysis. That was higher than the 21 percent of people without a previous transplant who were put on the list before starting dialysis.

•People with a previous organ transplant died at a more accelerated rate than those without transplant surgery. And those with a prior heart, liver or lung transplant died sooner than those who had undergone a previous kidney transplant.

•Most people who had received a previous organ transplant were not listed to receive a kidney from an expanded criteria donor (a person with one or more risk factors, including history of high blood pressure and over age 50).

The advantage of being placed on the transplant list before starting dialysis is simple, Srinivas said. "Essentially, the longer you're on dialysis, the worse it is for your cardiovascular system and overall health," he said.

Finding a donor outside of the transplant waiting list isn’t always a viable option. A patient can’t always count on a friend or relative to step up as a donor.

"It's very easy to say, 'Go find a living donor,' " Srinivas said. "But the whole family is often strapped financially and emotionally."

Srinivas's patient eventually received a kidney from a deceased donor. "She's doing very well," he said.

http://www.cleveland.com/healthfit/index.ssf/2010/09/cleveland_clinic_doctors_resea_1.html