MDNews - Greater Boston

COV ER FE AT UR E "We are aware that patients on dialysis don't have much extra time," says Shiang- Cheng Kung, MD, Medical Director of the Kidney Transplantation Program. "They have multiple appointments a week, and sometimes they don't feel well. We try to help them by consolidating visits as much as possible." This hands-on approach can improve a patient's quality of life. Excellent Time-to- Transplant Rates The Department of Transplantation's efficiency also applies to their efforts to decrease the amount of time a patient stays on the transplant list. Due to the program's size and the expertise of its physicians, opportunities to match a patient with the appropriate liver or kidney are vastly increased, whether the organ comes from a living or deceased donor, or from another region. "Our goal is to get the patients in and taken care of as quickly as possible," Dr. Pomposelli says. "Our patients often do not have to wait until they get extremely sick to receive a transplant." The Department of Transplantation also calibrates its search for donor organs to include organs considered to be in expanded criteria zones. Those categories can con- sist of donors who have been exposed to hepatitis B or C, for example. In both cases, Dr. Pomfret explains, the department is able to safely transplant the organ to the appropriate patient, and prevent the transfer of disease with the necessary vaccines. If such an organ becomes available, the medical team provides the patient with a detailed explanation of the donor's history and the reason the organ is categorized within the expanded criteria. Since the department is well-versed in complex liver surgery, partial or split liver organ donations are also within reach for its patients. For example, in a case in which an organ is allocated to an infant who only needs a small piece of liver for transplant, the remainder of the organ can be transplanted into an adult. Patients with renal failure who are found to be highly "sensitized" to a new kidney because of high levels of preexisting antibodies in their system, or those with living donors of incompatible blood-type, typically wait longer to receive an organ. These patients benefit from LHMC's par- ticipation in the National Kidney Registry paired-exchange program to find a compat- ible organ. Strong Outcomes The Department of Transplantation utilizes less invasive laparoscopic assis- tance for both living donor nephrectomy for kidney transplantation and living donor hepatectomy for liver transplantation pro- cedures. These approaches offer donors the benefit of a smaller surgical wound with minimal muscle division, a quicker discharge from the hospital and a shorter recovery. According to Dr. Kung, donors undergoing living donor nephrectomy can expect to be home within two to three days and return to normal activity typically within four weeks. In addition to decreasing stress for patients who are waiting for an organ match, the department's approach has proven to yield superior outcomes. Data from the Scientific Registry of Transplant Recipients shows that the program is performing at a statistically appropriate level for observed- to-expected patient and graft survival outcomes. In many categories, the program is performing better than expected, with a higher than expected rate of transplant for both liver and kidney and a lower rate of mortality for patients on the waiting list. "What this demonstrates is that we are very aggressive in taking organ offers that might be turned down by other centers, and yet, in doing so, we're not compromising patient outcomes," Dr. Pomfret says. Supporting Continued Health To ensure a patient's long-term health, the department developed the Transplant Wellness Program, which offers com- prehensive medical support pre- and post-transplant. Patients are followed closely in the immediate weeks and months after transplantation and visits continue annually after that. Living donors are followed closely for two years and then each year after that. Each appointment includes a complete evaluation of the patient's health by a variety of medical specialists. Physicians may also recommend consultations with other specialists, such as a cardiologist, endocrinologist or dermatologist, to moni- tor for evidence of heart disease, diabetes or skin cancer, which can develop as a result of side effects from some of the anti- rejection medications. Patients return to their primary care physicians with a wellness report card detailing information about blood pressure, lipids, follow-ups with other specialists and general transplant concerns. Importantly, referring physicians continue as an integral part of the circle of care for patients of LHMC's Department of Transplantation. For more infor mation, please visit Lahey.org/Transplantation. ■ Dr. Pomposelli and Dr. Pomfret are two members of the transplant team at Lahey Hospital & Medical Center, which is home to the country's largest live liver transplant program. 8 | Greater Boston MD NEWS ■ M D N E W S . CO M

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