Scott Webb (Host): Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting edge research and the latest innovations to help you achieve optimal health and wellness.

I'm Scott Webb, and today we're talking about kidney transplants and the advantages of receiving a kidney from a living donor with Dr. Dhiren Kumar. He's the Medical Director of Living Kidney Donation, VCU Health Hume-Lee Transplant Center.

Dr. Kumar, thanks so much for joining me today. We're going to talk about kidney transplants and living donations and what that all means for folks. Just as we get rolling here, tell us about your background, why you're passionate about living donation and your work at Hume-Lee.

Dhiren Kumar, MD: My name is Dhiren Kumar. I've been at VCU Hume-Lee Transplant Center for the last 13 years. I've been with VCU for almost 20 years. I'm a Transplant Nephrologist trained in kidney transplantation, providing care to patients with kidney transplant.

With respect to Hume-Lee, I think the tradition of Hume-Lee being one of the first transplant centers in the United States and our kind of dedication to innovation providing second, third, and fourth chances to patients getting a kidney transplant here, is what drives and kind of fuels my passion with working with Hume-Lee.

And when it comes to living donation, in our field, that is the pinnacle of care that we can provide our patients the best quality organ, the best chances for success. So that by itself, makes pursuing living donation and encouraging living donation and increasing the chances of a patient getting living donation adds motivation to my work here. 

Host: Motivation for sure. So then let's talk about kidney transplants. Like, who's the typical patient for a kidney transplant?

Dhiren Kumar, MD: So the typical patient for a kidney transplant is somebody who has kidney failure to the point that it cannot be reversed by non-transplant means, and patients who have been on dialysis for years. Now, the ideal kidney transplant recipient, you know, if people are fortunate enough, they would want to be referred for a kidney transplant even before they start dialysis. So we can start getting them a kidney transplant even before they have to do dialysis. So usually overall, it's kind of patients with irreversible kidney failure that come to us for a kidney transplant.

Host: Alright, so then let's talk about kidney disease, right? Who's at risk for kidney disease? And what happens if you just stay on dialysis forever, basically?

Dhiren Kumar, MD: People who are at risk for kidney disease, our patient population is those who have diabetes associated kidney disease. In addition, hypertension associated kidney disease. African American patients are at higher risk for kidney disease. Unfortunately, kidney disease, remains silent up until the last stages, and by the time some people find out, it's too late.

So high risk patients, such as patients with high blood pressure, patients with diabetes, should follow their kidney function with their primary care physicians regularly and be referred to a nephrologist if they do develop kidney failure. Now, when it comes to options of treatments for advanced kidney failure, it’s dialysis versus kidney transplant.

And, anecdotally there are people on the bell curve who do well on dialysis, but if you statistically speak, majority of people do better with the kidney transplant, live longer, healthier, and a better quality of life with the kidney transplant as compared to those doing dialysis long term.

Host: I see what you mean. So, let's shift gears here and talk about living donation. You mentioned earlier that it really is the best option. Let's roll up our sleeves a little bit and let's talk about that. Why is living donation the best quality organ transplant?

Dhiren Kumar, MD: Let me give you a brief background as to the shortage of organs with respect to kidney transplant. Brief numbers, almost 130,000 people waiting for a kidney transplant. In the U.S., we do about 16 to 20,000 kidney transplants a year. And we add 30,000 people to the waiting list every year.

So that gulf between people waiting for a kidney transplant versus the number of kidney transplants we're doing keeps getting bigger, right? Now to bridge that gulf between the people needing a kidney transplant and the number of kidney transplants we're doing, a living donor kidney transplant provides a means to bridge that gulf, right? So that's the need for a living donor kidney transplant. And then, statistically speaking in studies, a living donor kidney transplant is far superior to a deceased donor kidney transplant when it comes to longevity of the kidney transplant. We're looking at on average 15 to 20 years of lifetime of a living donor kidney transplant versus 10 to 15 years on average with a deceased donor kidney transplant. So that's why it's under the umbrella of kidney transplantation, living donor kidney transplantation is by far the most superior option for a kidney transplantation.

Host: Yeah. So it's one of those things where I think, again, anecdotally, we all sort of understand that the demand far outweighs the supply, but you give us a sense there. And especially why a living donation would be preferred, I think, at least by the surgeons, of course. So let's talk about the surgery, the recovery, what does that entail for a living donor?

Dhiren Kumar, MD: Everybody who comes forward to be evaluated as a living donor goes through an extensive workup. They meet medical professionals, a nephrologist such as me, they meet the surgeons, and they go through an extensive workup to make sure that they're okay to donate one kidney.

Then, they are matched with their recipient or any other person that they want to donate to. The living donor surgery lasts about four to six hours as such. And then recovery is pretty rapid. The donor is up and about the day of surgery and is discharged from the hospital in about two to three days.

The risk of living donor surgery, since the surgery is done on healthy people; the risk of the living donor surgery is very low, caveat being having gone through this extensive workup and making sure that they are healthy in the best health possible and the surgery by itself is done by very experienced surgeons because every program has their most experienced surgeon working on a living donor donation. So that by itself reduces the risk of surgery quite significantly. And, the risk of any complication associated with living donor surgery is less than three percent. And the risk of a living donor having gone through this workup of requiring dialysis in their entire lifetime is less than 1%.

So that's a testament to the workup as well as the safety of the surgery, that it is a safe surgery for people who have gone through the workup successfully.

Host: Yeah, I see what you mean. Very safe for those who have gone through successfully, relatively quick recovery time, all things considered. So, great information today. Just want to have you tell us more about the Hume-Lee Transplant Center. Tell us more about the center itself.

Dhiren Kumar, MD: The Hume-Lee Transplant Center was the one that did the second kidney transplant here in the United States. So we have a great tradition here. And over the years, our goal is to innovate safely so that we can provide kidney transplantation to as many patients as possible.

In this field, we offer our donors robotic surgery, which allows for faster recovery, better visualization for the surgeon and lesser complications of infections. That's one of our major modes that we offer our living donors. Now in addition, for our recipients, we want to innovate and try to find avenues for getting our patients a kidney transplant sooner.

So compared to other programs in this area, we have a lot shorter wait time for a kidney transplant as compared to other centers; almost 30, 40 percent lesser wait time as compared to other centers in our area. And that gives our patients and our recipients the opportunity to get off of dialysis as soon as possible.

Our outcomes even with innovation the fact that we're doing it safely are better if not comparable to all the centers and all the centers nationally and locally. I feel that I'm on the cutting edge of providing patients with the cutting-edge technology safely, and that kind of sets us apart from other people in the area.

Host: Yeah. Cutting edge for sure for Hume-Lee. I love hearing about it and loved getting to meet you today and hear more about your work and really emphasizing the importance of donations, but the living donations and why, especially after the workup, they're so successful. So, thanks so much for your time today. You stay well.

Dhiren Kumar, MD: Thank you.

Host: And thank you for listening to Healthy with VCU Health. For more information about Hume-Lee's Living Donor Program, visit vcuhealthlivingdonor.org or call 804-828-2762.