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Managing the Health of Kidney Transplant Recipients [Transcript]
Featuring Nada Alachkar, Assistant Professor of Medicine
Describe what you do.
My name is Nada Alachkar, I’m a transplant nephrologist at Johns Hopkins. I manage and care for patients with kidney transplant and I do evaluation for patients to receive kidney transplantation.
What makes someone a candidate for a kidney transplant?
Who is not a candidate for a kidney transplant?
The major contraindications to receive kidney transplantations are usually acute or major cardiovascular diseases, recent event like MI [myocardial infarction] or stroke or peripheral vascular disease that’s active or recent. Usually those…they will have to wait until they become stable, so we don’t transplant them.
The other major contraindication are cancers. Any acute or recent cancers is a contraindication. They are only a few cancers that we can transplant them, shortly after they are treated for the cancer, otherwise we have to have a free cancer waiting time.
Acute or active infection is also a major contraindication unless they are treated near the infection. There are a couple others, but usually once they are cleared, we can put them on the waiting list for a kidney transplant.
What do you do to manage the health of the recipient before surgery?
To manage the recipients before kidney transplantation, I do their evaluation. Initially, I see the patients at the clinic. I explain to them what they are going through and then what tests we need. And then I review their medical record. We order a few of the test to clear them for kidney transplantation. Then I review the results of those tests we ordered. If there is any abnormality or any abnormal test, I follow up and we ask for more investigation. I sometimes contact their provider – local providers – and ask for further tests or further treatment or management. Once the patients are on the waiting list, I monitor those patients and we review their record on a regular basis with the help of the waiting list team.
What do you do to manage the health of the recipient after surgery?
To manage the recipients after the surgery, I see the patients after they receive their kidney transplantation in the hospital. We see them with the surgeons, we have a comprehensive team. We work together. We see the patients on a daily basis, we manage their medical problems along with the surgeons. After they get discharged when they are cleared from the surgical standpoint, the majority of the time, their transitioned to different nephrologists. I receive some of those patients and I continue to monitor those patients on a regular basis. I see them in the clinic; I manage their allograft function; I manage their immunosuppression. They will manage if they have any infections, blood pressure, diabetes, their lab work. So mainly we’re the main provider for those patients, and then we’ll work with other providers to care for those patients.
How is their quality of life?
The quality of life of those patients who receive kidney transplant is excellent. They do very well, they live a normal life. The majority of them, they do very well, they go back to work. They live normal life, as I said. Some people with major comorbidities, they do a little bit worse, but they still do much better than patients who stayed on dialysis and did not receive kidney transplantation.
What is their prognosis?
So the prognosis of transplant patients is excellent. We look at survival of patients and kidney transplant more than 90% of the majority of the center, so it’s really much better than patients who stay on the waiting list. And five years and ten years, we look at 80% allograft survival more than 50% allograft survival if they received a kidney transplant from a deceased donor. We look at that fifteen years allograft survival from living donor and the survival of the patients is much higher than patients who stayed on dialysis or the waiting list.
Why choose Johns Hopkins?
Hopkins has a very, well organized, comprehensive kidney transplant center that has a significant expertise in different fields of transplantations. We are one of the only few centers in the nation that has an incompatible program. We transplant patients that are incompatible with our donors and we do the paired exchange, and our program is one of the leads in this field. Adding to the expertise and the incompatible field, we have a very large research program and we have a basic research lab in our transplant program that work on patients and also mice in the transplant field, adding to the organization of the transplant patients follow up and caring for patient transplant. Hopkins is one of the lead transplant centers in the nation.
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