The UK Kidney Transplant program has been a leader in advanced kidney failure since 1964 when we completed our first live-donor kidney transplant. We've been saving lives ever since: more than 2,600 kidney transplants have taken place at UK Transplant Center since our program was founded.
Thomas Waid MD discusses the UK Transplant Center. He explains indications for referral, what the process looks like when a patient gets to the transplant center and why UK stands apart from others in the state as well as the nation.
Kidney Transplant - Provider Focused
Featured Speaker:
Learn more about Thomas Waid, MD
Thomas Waid, MD
Thomas Waid, MD is the Medical Director, Kidney & Kidney/Pancreas Transplant Program.Learn more about Thomas Waid, MD
Transcription:
Kidney Transplant - Provider Focused
Melanie Cole, MS (Host): The UK kidney transplant program has been a leader in advanced kidney failure since 1964 and has been saving lives ever since. Joining me is Dr. Thomas Waid. He's the medical director of the kidney and pancreas transplant program with the University of Kentucky Healthcare. Dr. Waid, I'm so glad to have you join us today. First, how common is kidney transplant? How many generally are performed on a yearly basis?
Thomas Waid, MD (Guest): Well, there are about 22,000 currently that are being performed per year. Now, that may actually go down this year a little bit because of the COVID experience. On a usual basis, around 22,000. Around 6,800 of those or thereabouts will be living donor kidneys. The rest will be deceased donor kidneys off of a donor list.
Host: Well then tell us a little bit about the University of Kentucky Healthcare’s history of kidney transplants.
Dr. Waid: Actually we were fairly early in the transplantation game. The first kidney transplant was done at the Peter Brigham Hospital in Boston. That was in 1954 through identical twins. So no immunosuppression to prevent rejection was necessary. We started in 1964, which was only 10 years later. As a matter of fact, the University of Minnesota, which is a very large well known transplant center, started in 1963. So we actually came along one year have Minnesota had started. The reason that we started transplanting was actually because the pediatric nephrologist at the time who really wanted transplantation as an option to take care of her kids with renal failure. So in August of 1964 after we had put everything together as a program, we did our first kidney transplantation which was a pediatric recipient and his donor was his mother. I took care of that patient when I got onto kidney transplantation here. I started actually in 1986. I took care of him for about another 15 or so years until he died of a heart complication that was kind of late in his game. He had been transplanted for about almost 30 years at that time.
Host: What an interesting story, Dr. Waid. Thank you for sharing that with us. So tell us a little bit about necessitating kidney transplantation and indications for referral to a transplant center.
Dr. Waid: Well, the indications are almost any type of kidney failure from just about any cause except for something that might recur in the transplant and would be prohibitive to do a transplant in that situation. Almost any cause of kidney failure can be evaluated and looked at with the potential treatment of transplantation being, I think, the primary option for treatment of end stage renal disease.
Host: Well then who qualifies if they get early referral. Speak about patient selection criteria and some general indications because not everyone is a patient that’s eligible, correct? Or is that not true?
Dr. Waid: Well, actually the eligibility criteria has been expanded over the years. When I first started doing this, we were very hesitant to take anybody who was over 60 years old, particularly if they had diabetes as their cause because of the complications that could be run into along the way. Now we’ve extended that age out to 70 years old and even beyond that. If a person is that old, they have to be in pretty good physical shape without too many other problems or comorbidities. I can tell you that the youngest person that we have ever done at the University of Kentucky was 13 months old. I think the oldest person that we have ever transplanted was 75 or 76. So that’s a pretty broad range.
Host: Well, it certainly is. So now tell us a little bit about living donor versus deceased donor transplant. What are you seeing in the trends as far as availability, accessibility? Speak about that a little bit.
Dr. Waid: Live donor transplants, generally speaking, are the best modality for transplantation. The kidneys generally have better function. They usually last for a longer period of time than a deceased donor. Deceased donor kidneys often go through a lot of trauma, ICU stays, changes in blood pressure and things like that before they're retrieved. Sometimes they are really good quality. Sometimes they are not of great quality. The live donors is generally predictable. Plus with the live donor transplantation you can actually time the donation to take place before the recipient needs to go on dialysis. This is called a preemptive transplantation. We used to do preemptive transplantation back in the earlier days when I first started off of the waiting list, but now the waiting list is so long. The wait time for transplantation has increased. So doing preemptive transplant off of the waiting list is very, very difficult. Having just said that, we’ve actually done two preemptive transplants off of the waiting list this year, but that’s unusual in this day and age.
Host: Well, then let’s talk about the wait list for a minute. What can patients expect once they’ve been placed on the transplant list? Tell us a little bit about that experience, how waiting time is even calculated at this point, and what’s involved in management of patients that are on that wait list?
Dr. Waid: Well, first of all there are about 110,000 people in the United States waiting for kidney transplantation. As I said, there are about 22,000 transplants that are being done, including live donors. So that ratio is one in five. So there are five people waiting for every one kidney that becomes available. So the wait times have increased. As we list older patients for kidney transplantation, etcetera, the numbers are going up. The numbers of donors are not necessarily increasing in that proportion. So that makes it difficult for some patients who don’t have live donors. The patient’s waiting time is actually now calculated from the time that they start dialysis. It used to be that the waiting time was calculated from the time that the patient was seen in the transplant center, evaluated, deemed to be a candidate for transplant, and then added to the waiting list. That started their clock, so to speak. Now it’s retrospective back to the time that they start any type of modality of dialysis whether it’s hemodialysis or peritoneal dialysis. That adds a number of days or years to the listed waiting time. So it advantages the people who have been on dialysis for a longer period of time. I think a lot of that is rightfully so because when you're on dialysis, you start accumulating cardiovascular risk. With the cardiovascular risk comes life-shortening life-terminating problems that occur. For example, if you're on hemodialysis your chance of having a cardiovascular event is 9.9% per year. If you're transplanted, it’s 0.9% per year. So there's a tenfold advantage in terms of reducing cardiovascular risk if you're transplanted versus staying on dialysis.
Host: That’s fascinating, Dr. Wade. So tell other providers what the process looks like. If they are referring patients to your transplant center, what does that process look like? What makes this program so unique and outstanding?
Dr. Waid: Well, from the time that the patient is referred by their provider—And actually the patient can even self-refer if they want to. That’s usually not the case. From the time that they are referred, they come in to see us. We try and make the evaluation as inclusive as possible in one day of the patient’s time. So they come in and they will be seen by the transplant nurse coordinator, one of the nephrologists, one of the surgeons, the dietician, and they will even have a pharmacy consultation with regard to their medications. We explain to the patient what the risks and benefits are because this is all a process of informed consent. We tell them about the quality of kidneys, what is available, and what they would like to accept in terms of a kidney versus possibly kidneys that they might want to turn down because it is the patient’s right to do so. We find out if they have a live donor option. If they do, we basically evaluate them for living donation both related and unrelated. So from that standpoint, that’s the process in a nutshell. We see them in our committee. All of the patients, by regulation, have to be discussed by a multidisciplinary committee and either decide to list them or not list them. That decision has to be made and the patient has to be informed within a 10 day period of time. That’s a regulation which is put out by the United Network for Organ Sharing. That’s what basically we adhere to.
Host: As we look towards the future, Dr. Waid, tell us about the future of kidney transplantation. What you see on the horizon as we know this is determined by several issues the ongoing shortage, as you mentioned, or donor organs, and it’s fueled this search for alternative therapies for failing kidneys. Tell us some of the exciting research that you know about that you're doing. Tell us what you see happening.
Dr. Waid: I think a lot of the research that’s going on right now is to try and extend the life of transplants as much as possible because a lot of people have to go through several transplants in their lifetime. What we would like to see are kidney transplants that last instead of 10 or 15 years, they last 25/30/40 years or the life of the patient with a single organ transplant. There is more work looking into suppressing the immune system to allow that to happen. One of the things that are we are looking at here are what are called regulatory t-cells, which suppress rejection, and allow the kidney transplant or any transplant for that matter to persist for a longer period of time. It may also allow us to minimize or even in some cases stop immunosuppression medications which have their side effects of malignancy types of cancers and also infection. That’s is a goal of ours and an aspiration. Hopefully within the next five or six years we will have that moving down the line to try and change the course of the transplant.
There are other centers which are working on genetically engineering organs from animals. In this particular case what we call miniature swine. They're not so miniature. They're about 250 pounds a piece on average, but their organ size is very similar to human organ size. There are a lot of barriers to be overcome with that in terms of rejection and also infections that animals have that we don’t necessarily have. With gene editing, what we call the CRISPR-Cas system, we can edit out some of the impurities or viruses that are incorporated in their cells and make them suitable for possible donation in the future. Some people say that this is called xenotransplantation and that this is the future of transplantation and always will be. Every year we chip away a little more and get closer to that. So in our particular facility, though, the regulatory t-cells are a major project of ours. We have a study going on right now, one of the few in the country. I think that this is going to be our forte in the future.
Host: Such an interesting topic and a really exciting time to be in your field Dr. Waid. Thank you so much for joining us today and sharing your incredible expertise and telling us about the University of Kentucky Healthcare kidney and pancreas transplant program. For more information on the University of Kentucky Healthcare kidney and pancreas transplant program, please visit our website at ukhealthcare.uky.edu for more information and to get connected with one of our providers. That concludes another episode of UK Healthcast. I'm Melanie Cole.
Kidney Transplant - Provider Focused
Melanie Cole, MS (Host): The UK kidney transplant program has been a leader in advanced kidney failure since 1964 and has been saving lives ever since. Joining me is Dr. Thomas Waid. He's the medical director of the kidney and pancreas transplant program with the University of Kentucky Healthcare. Dr. Waid, I'm so glad to have you join us today. First, how common is kidney transplant? How many generally are performed on a yearly basis?
Thomas Waid, MD (Guest): Well, there are about 22,000 currently that are being performed per year. Now, that may actually go down this year a little bit because of the COVID experience. On a usual basis, around 22,000. Around 6,800 of those or thereabouts will be living donor kidneys. The rest will be deceased donor kidneys off of a donor list.
Host: Well then tell us a little bit about the University of Kentucky Healthcare’s history of kidney transplants.
Dr. Waid: Actually we were fairly early in the transplantation game. The first kidney transplant was done at the Peter Brigham Hospital in Boston. That was in 1954 through identical twins. So no immunosuppression to prevent rejection was necessary. We started in 1964, which was only 10 years later. As a matter of fact, the University of Minnesota, which is a very large well known transplant center, started in 1963. So we actually came along one year have Minnesota had started. The reason that we started transplanting was actually because the pediatric nephrologist at the time who really wanted transplantation as an option to take care of her kids with renal failure. So in August of 1964 after we had put everything together as a program, we did our first kidney transplantation which was a pediatric recipient and his donor was his mother. I took care of that patient when I got onto kidney transplantation here. I started actually in 1986. I took care of him for about another 15 or so years until he died of a heart complication that was kind of late in his game. He had been transplanted for about almost 30 years at that time.
Host: What an interesting story, Dr. Waid. Thank you for sharing that with us. So tell us a little bit about necessitating kidney transplantation and indications for referral to a transplant center.
Dr. Waid: Well, the indications are almost any type of kidney failure from just about any cause except for something that might recur in the transplant and would be prohibitive to do a transplant in that situation. Almost any cause of kidney failure can be evaluated and looked at with the potential treatment of transplantation being, I think, the primary option for treatment of end stage renal disease.
Host: Well then who qualifies if they get early referral. Speak about patient selection criteria and some general indications because not everyone is a patient that’s eligible, correct? Or is that not true?
Dr. Waid: Well, actually the eligibility criteria has been expanded over the years. When I first started doing this, we were very hesitant to take anybody who was over 60 years old, particularly if they had diabetes as their cause because of the complications that could be run into along the way. Now we’ve extended that age out to 70 years old and even beyond that. If a person is that old, they have to be in pretty good physical shape without too many other problems or comorbidities. I can tell you that the youngest person that we have ever done at the University of Kentucky was 13 months old. I think the oldest person that we have ever transplanted was 75 or 76. So that’s a pretty broad range.
Host: Well, it certainly is. So now tell us a little bit about living donor versus deceased donor transplant. What are you seeing in the trends as far as availability, accessibility? Speak about that a little bit.
Dr. Waid: Live donor transplants, generally speaking, are the best modality for transplantation. The kidneys generally have better function. They usually last for a longer period of time than a deceased donor. Deceased donor kidneys often go through a lot of trauma, ICU stays, changes in blood pressure and things like that before they're retrieved. Sometimes they are really good quality. Sometimes they are not of great quality. The live donors is generally predictable. Plus with the live donor transplantation you can actually time the donation to take place before the recipient needs to go on dialysis. This is called a preemptive transplantation. We used to do preemptive transplantation back in the earlier days when I first started off of the waiting list, but now the waiting list is so long. The wait time for transplantation has increased. So doing preemptive transplant off of the waiting list is very, very difficult. Having just said that, we’ve actually done two preemptive transplants off of the waiting list this year, but that’s unusual in this day and age.
Host: Well, then let’s talk about the wait list for a minute. What can patients expect once they’ve been placed on the transplant list? Tell us a little bit about that experience, how waiting time is even calculated at this point, and what’s involved in management of patients that are on that wait list?
Dr. Waid: Well, first of all there are about 110,000 people in the United States waiting for kidney transplantation. As I said, there are about 22,000 transplants that are being done, including live donors. So that ratio is one in five. So there are five people waiting for every one kidney that becomes available. So the wait times have increased. As we list older patients for kidney transplantation, etcetera, the numbers are going up. The numbers of donors are not necessarily increasing in that proportion. So that makes it difficult for some patients who don’t have live donors. The patient’s waiting time is actually now calculated from the time that they start dialysis. It used to be that the waiting time was calculated from the time that the patient was seen in the transplant center, evaluated, deemed to be a candidate for transplant, and then added to the waiting list. That started their clock, so to speak. Now it’s retrospective back to the time that they start any type of modality of dialysis whether it’s hemodialysis or peritoneal dialysis. That adds a number of days or years to the listed waiting time. So it advantages the people who have been on dialysis for a longer period of time. I think a lot of that is rightfully so because when you're on dialysis, you start accumulating cardiovascular risk. With the cardiovascular risk comes life-shortening life-terminating problems that occur. For example, if you're on hemodialysis your chance of having a cardiovascular event is 9.9% per year. If you're transplanted, it’s 0.9% per year. So there's a tenfold advantage in terms of reducing cardiovascular risk if you're transplanted versus staying on dialysis.
Host: That’s fascinating, Dr. Wade. So tell other providers what the process looks like. If they are referring patients to your transplant center, what does that process look like? What makes this program so unique and outstanding?
Dr. Waid: Well, from the time that the patient is referred by their provider—And actually the patient can even self-refer if they want to. That’s usually not the case. From the time that they are referred, they come in to see us. We try and make the evaluation as inclusive as possible in one day of the patient’s time. So they come in and they will be seen by the transplant nurse coordinator, one of the nephrologists, one of the surgeons, the dietician, and they will even have a pharmacy consultation with regard to their medications. We explain to the patient what the risks and benefits are because this is all a process of informed consent. We tell them about the quality of kidneys, what is available, and what they would like to accept in terms of a kidney versus possibly kidneys that they might want to turn down because it is the patient’s right to do so. We find out if they have a live donor option. If they do, we basically evaluate them for living donation both related and unrelated. So from that standpoint, that’s the process in a nutshell. We see them in our committee. All of the patients, by regulation, have to be discussed by a multidisciplinary committee and either decide to list them or not list them. That decision has to be made and the patient has to be informed within a 10 day period of time. That’s a regulation which is put out by the United Network for Organ Sharing. That’s what basically we adhere to.
Host: As we look towards the future, Dr. Waid, tell us about the future of kidney transplantation. What you see on the horizon as we know this is determined by several issues the ongoing shortage, as you mentioned, or donor organs, and it’s fueled this search for alternative therapies for failing kidneys. Tell us some of the exciting research that you know about that you're doing. Tell us what you see happening.
Dr. Waid: I think a lot of the research that’s going on right now is to try and extend the life of transplants as much as possible because a lot of people have to go through several transplants in their lifetime. What we would like to see are kidney transplants that last instead of 10 or 15 years, they last 25/30/40 years or the life of the patient with a single organ transplant. There is more work looking into suppressing the immune system to allow that to happen. One of the things that are we are looking at here are what are called regulatory t-cells, which suppress rejection, and allow the kidney transplant or any transplant for that matter to persist for a longer period of time. It may also allow us to minimize or even in some cases stop immunosuppression medications which have their side effects of malignancy types of cancers and also infection. That’s is a goal of ours and an aspiration. Hopefully within the next five or six years we will have that moving down the line to try and change the course of the transplant.
There are other centers which are working on genetically engineering organs from animals. In this particular case what we call miniature swine. They're not so miniature. They're about 250 pounds a piece on average, but their organ size is very similar to human organ size. There are a lot of barriers to be overcome with that in terms of rejection and also infections that animals have that we don’t necessarily have. With gene editing, what we call the CRISPR-Cas system, we can edit out some of the impurities or viruses that are incorporated in their cells and make them suitable for possible donation in the future. Some people say that this is called xenotransplantation and that this is the future of transplantation and always will be. Every year we chip away a little more and get closer to that. So in our particular facility, though, the regulatory t-cells are a major project of ours. We have a study going on right now, one of the few in the country. I think that this is going to be our forte in the future.
Host: Such an interesting topic and a really exciting time to be in your field Dr. Waid. Thank you so much for joining us today and sharing your incredible expertise and telling us about the University of Kentucky Healthcare kidney and pancreas transplant program. For more information on the University of Kentucky Healthcare kidney and pancreas transplant program, please visit our website at ukhealthcare.uky.edu for more information and to get connected with one of our providers. That concludes another episode of UK Healthcast. I'm Melanie Cole.