In the U.S., there are more than 120000 people who are waiting for organs to become available. 100000 of those people are waiting for kidneys. In 2014, 17000 …
-Hello everyone, my name is Dr. Uttam Reddy and I'm the Medical Director here at the UC Irvine Kidney Transplant Program.
I'd like to give you, today, a brief introduction into the world of kidney transplantation.
First, I'd like to welcome you all to the University of California, Irvine health care system,
where our motto is to discover, teach, and
heal.
The kidney transplant team here at UCI consists of our Chief of Transplantation, Dr. Clarence Foster,
myself – the transplant nephrologist and medical director – and Dr. Hirohito Ichii, another transplant surgeon.
The history of kidney transplantation dates back to 1954, over 60 years ago,
when the first successful kidney transplantation was performed between identical twins in Boston.
Here at UC Irvine, we have been doing kidney transplantation since the late 1960s.
We have done live kidney donor transplants since the early1970s, pancreas transplant since 2000.
We are a Medicare approve transplant center, where our waiting list consists of over 600 patients.
Annually, we perform about 50 transplants per year and we're looking to grow that number.
So where does a kidney transplant occur on the body?
Well, the thing you need to know is we
don't touch your native, natural kidneys.
They stay in the body, in your back area,
and we perform a transplant surgery
either on the right or left lower
abdominal areas of the body.
So after transplantation, you will technically have three kidneys in place.
What are the major advantages to kidney
transplantation?
Well, the reason we're so excited about kidney transplantation is that
there's a notable improvement in life expectancy, patients notice increased energy levels,
improved mental and physical well-being, improved quality of life,
they're more free in their day-to-day life as they no longer require dialysis, and there's less dietary and fluid restriction.
Now there are some disadvantages to kidney transplantation, but the benefits typically outweigh the disadvantages.
Some of these include multiple medications which potentially have some side effects,
potential complications during any major
surgery and anesthesia,
with kidney transplantation, there's risk of
rejection in infection which we monitor closely,
and there's an increased risk of
cancer.
Now there is an issue with kidney transplantation of late,
where our wait list is growing at a significant number.
In the late 1990s, there were about 45,000 patients on the waitlist.
Currently, that number has crossed 100,000 and our transplantation rates have remained relatively stable
during the past 15 years.
So the waitlist continues to grow
Currently there are a 121,000 people waiting for a life-saving organ transplants in the United States.
Of these, over 100,000 are on the kidney transplant waiting list.
In 2014 in the United States, we have performed over 17,000 kidney transplants.
The greater Los Angeles area is represented by the One Legacy organ procurement organization.
So what type of kidney
transplants are there?
Well there's two main types – a deceased donor kidney and a living donor kidney.
As you can imagine, deceased donor kidney is someone who has been declared dead by either
irreversible loss of all brain function
or cessation of heartbeat and respiration.
A living donor is someone who is in excellent health and passes a
rigorous health evaluation by the
transplant team.
Deceased donor waiting times in the Orange County and Los Angeles areas
average about 6 to 10 years before getting a kidney transplant.
Now this is some of the highest waiting times in the entire country.
For blood type O, which is the universal recipient, wait times can approach 10 years.
For blood type A, the wait time is 7 to 8 years. For blood type B, the wait time is close to 8 to 10 years.
For the universal recipient blood type AB, the wait time is 5 to 6 years.
Regarding living donors patient outcomes
are typically better for those who
receive a living donor kidney transplant
as opposed to a deceased donor kidney
transplant.
Less than 1% of kidney donors have endured medical complications.
There is significantly less waiting time if a
recipient receives a living donor so
they don't they don't have to wait many
years for a deceased donor kidney
transplant.
Surgery is scheduled when
both the recipient and the living donor
have completed their evaluation and are
accepted as candidates. The surgery is
done laparoscopically for the living
donor with very small incisions. There
should be no donation-related costs for the living donor.
With regards to these living donors, they're typically people
between 21 years of age and 65 years of
age.
They must be in good physical and mental health. They can be a friend,
relative, or even a complete stranger.
It should be noted that they do not have to be compatible to you to be a living donor.
We have here at UC Irvine a paired exchange program
where if you have a living donor that's
not the same blood type we can enter
the patient and recipient in the exchange program and find a potential living donor for that recipient.
All donor information is confidential and it should be noted that it is illegal to buy or sell organs in the United States.
For anyone interested in being a potential living donor, please call 714-4566-256 for further information.
now I mentioned previously about the paired kidney transplant donation.
So imagine you have a brother or relative who would like to give you a kidney transplant
but they have a different blood type.
In another room, the same situation is
happening where a relative would like to
donate to a potential recipient but they
have a different type.
well we can do a paired swap where you
the donor would donate to that party's recipient
and that party's donor would
donate to your recipient.
And in that way, both parties would benefit from kidney transplantation.
So how does UCI compare to the national averages in terms of deceased donor or living donor
graft survival and patient survival
rates?
Well as you can see here from this chart,
our outcomes are on par with the rest of the nation.
So when can I be referred for
a kidney transplantation?
Well this is in two major scenarios – either you have End Stage kidney disease and you're on dialysis,
either hemodialysis or peritoneal dialysis, or your kidney function has a GFR of less than 20
so you have advanced kidney disease where your glomerular filtration rate is less than 20.
What would keep a patient from being a candidate for kidney transplantation?
Some contraindication for kidney transplantation include severe cardiac, liver and lung disease,
active systemic infections, a recent
diagnosis of cancer, severe obesity where your body mass index is greater than 40,
poor functional status, and patients of an advanced age of greater than 70 are evaluated on a case-by-case basis.
If you have a history of chronic non-compliant, you may not be considered for kidney transplantation.
Any active mental illness or psycho-social instability and evidence of drugs,
severe tobacco or alcohol abuse will also preclude candidacy for kidney transplantation.
So in summary, compared to remaining on dialysis, patients undergoing kidney
transplantation live longer, have a
better quality of life, and save on overall medical costs.
Kidney transplantation is the optimal therapy for ESRD patients who can
undergo transplantation.
Our goals here at UCI Kidney Transplant Program are to expand our program, to be a resource for
a kidney transplant expertise in the
Orange County area, and to continue to
provide exceptional care for a patient
in need of a kidney transplant and
patients who've had a kidney transplant.
Transplantation is a treatment option and a choice. It requires a lot of
commitment and hard work before and
after the transplant. So let's work
together to make it a success.
If you have any questions please feel free to
contact us at the UCI kidney transplant
program our phone number is 714 456 8441 or you can visit us on our website.
Thank you.

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