Managing the Health of Kidney Transplant Recipients

My name is Nada Alachkar. I'm a transplant nephrologist at, Johns Hopkins. I manage and care for patients with kidney transplants and I do an evaluation for patients to receive kidney transplantation. Patients with advanced chronic kidney disease, stage four, stage five, or kidney disease are candidates for transplantation. So the major contraindication to receiving kidney transplantations is usually acute or major cardiovascular diseases. 

A recent event like MI or stroke or peripheral vascular disease that's active or recent. Usually, those that we have to wait until they become stable so we don't transplant them at that point. The other major contraindications are cancers. Any acute or recent cancers are contraindication. There are only a few cancers that we can transplant them. Breathe like shortly after they're treated for cancer, otherwise, we have to have free cancer waiting time. Acute or active infection is also a major contraindication unless they are treated and cleared the infection. There are a couple of others but they're usually, once they're cleared, we can put them on the waiting list and clear them for transplant. To manage the recipients before kidney transplantation, I do their evaluation initially. 

I see the patients in the clinic. I explained to them what they are going through and then what test need and then I review the medical record, we order few of the tests that to clear them for kidney transplantation. Then I review the results of those tests we ordered and 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 records on regular basis with the help of the waiting list team. [MUSIC] To manage the recipients after the surgery, I see the patients after they receive the kidney transplantation in the hospital. We see them with the surgeons. 

We have a comprehensive team. We worked together. We see the patients on daily basis. We manage their medical problems along with the surgeons, and after they get discharged when they are cleared from the surgical standpoint, the majority of the times they're 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. We manage their immunosuppression. We manage if they have any infections, blood pressure, diabetes, their lab works. So mainly we are the main provider for those patients and then we work for other providers to care for those patients. 

The quality of life of those patients who receive kidney transplants 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 a 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 or they did not receive kidney transplantation. [MUSIC] So the prognosis of transplant patients is excellent. We look at the survival of patients and kidney transplants about more than 90% on the majority of the centers it's really much better than patients who are staying on the waiting list. And five years and ten years we look about 80% allograft survival and more than 50% allograft survival if they've received a kidney transplant from a deceased donor. I would look about 15 years of allograft survival from living donors. 

And the survival of the patients is much more than patients staying on dialysis or on the waiting list.  Hopkins has a very well-organized comprehensive kidney transplant center that has significant expertise in different fields of transplantation. We are one of the only few centers in the nation that have an incomparable program that Transplant patients who are incompatible with their donors and we do the peer exchange, and our program is one of the leads in this field. Adding to the expertise in the incompatible field, we have a very large research program and we have a basic research lab and our transplant program that works on patients and also on mice in the transplant field. Adding to the organization of the transplant patients follow up and caring for patients transplant makes Hopkins one of the lead transplant centers in the whole nation. 
Managing the Health of Kidney Transplant Recipients Managing the Health of Kidney Transplant Recipients Reviewed by Reaz blog on July 10, 2020 Rating: 5

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