Cleveland Clinic doctor's research on transplant patients uncovers surprising findings
Published: Tuesday, September 28, 2010, 9:00 AM
People who have received a previous organ transplant are more likely to be placed on the list for a kidney transplant before starting dialysis than other kidney transplant candidates.
Those are the findings of a study published Sept. 2 in the Clinical Journal of the American Society of Nephrology
The fact that more patients are being placed on the kidney transplant list preemptively is a good sign, said Dr. Titte Srinivas, a physician at the Cleveland Clinic's Glickman Urologic and Kidney Institute said. "Doctors are doing a good job of offering [the option] of transplant much earlier," he said.
But it also raises big-picture questions about a patient's overall health at the time of the first transplant, what role anti-rejection medications play in the decline in kidney health, and how to prioritize people on the kidney transplant list, he said.
A patient of Srinivas served as inspiration for the research.
The patient was a woman who had received a lung transplant a decade earlier. Her kidneys were failing; Srinivas wanted to find a transplant for her quickly.
Struck by the woman's predicament, "I wanted to look at how many more people there were like her, and what their outcomes were," he said.
Srinivas and his colleagues conducted a retrospective review of data from 1995 to 2008 from the national Scientific Registry of Renal Transplant Recipients. During that time period, more than 4,900 people with a previous organ transplant (heart, liver or lung) were on the wait list for a kidney.
Before 1995, less than 1 percent of people who had received other organ transplants were placed on kidney transplant waiting lists.
In 2008, 3.3 percent of such patients were on the kidney transplant waiting list.
The most interesting finding?
There were several, Srinivas said.
•Among people with a previous organ transplant, 38 percent were put on the wait list before starting dialysis. That was higher than the 21 percent of people without a previous transplant who were put on the list before starting dialysis.
•People with a previous organ transplant died at a more accelerated rate than those without transplant surgery. And those with a prior heart, liver or lung transplant died sooner than those who had undergone a previous kidney transplant.
•Most people who had received a previous organ transplant were not listed to receive a kidney from an expanded criteria donor (a person with one or more risk factors, including history of high blood pressure and over age 50).
The advantage of being placed on the transplant list before starting dialysis is simple, Srinivas said. "Essentially, the longer you're on dialysis, the worse it is for your cardiovascular system and overall health," he said.
Finding a donor outside of the transplant waiting list isn’t always a viable option. A patient can’t always count on a friend or relative to step up as a donor.
"It's very easy to say, 'Go find a living donor,' " Srinivas said. "But the whole family is often strapped financially and emotionally."
Srinivas's patient eventually received a kidney from a deceased donor. "She's doing very well," he said.
Related topics:
Published: Tuesday, September 28, 2010, 9:00 AM
People who have received a previous organ transplant are more likely to be placed on the list for a kidney transplant before starting dialysis than other kidney transplant candidates.
Those are the findings of a study published Sept. 2 in the Clinical Journal of the American Society of Nephrology
The fact that more patients are being placed on the kidney transplant list preemptively is a good sign, said Dr. Titte Srinivas, a physician at the Cleveland Clinic's Glickman Urologic and Kidney Institute said. "Doctors are doing a good job of offering [the option] of transplant much earlier," he said.
But it also raises big-picture questions about a patient's overall health at the time of the first transplant, what role anti-rejection medications play in the decline in kidney health, and how to prioritize people on the kidney transplant list, he said.
A patient of Srinivas served as inspiration for the research.
The patient was a woman who had received a lung transplant a decade earlier. Her kidneys were failing; Srinivas wanted to find a transplant for her quickly.
Struck by the woman's predicament, "I wanted to look at how many more people there were like her, and what their outcomes were," he said.
Srinivas and his colleagues conducted a retrospective review of data from 1995 to 2008 from the national Scientific Registry of Renal Transplant Recipients. During that time period, more than 4,900 people with a previous organ transplant (heart, liver or lung) were on the wait list for a kidney.
Before 1995, less than 1 percent of people who had received other organ transplants were placed on kidney transplant waiting lists.
In 2008, 3.3 percent of such patients were on the kidney transplant waiting list.
The most interesting finding?
There were several, Srinivas said.
•Among people with a previous organ transplant, 38 percent were put on the wait list before starting dialysis. That was higher than the 21 percent of people without a previous transplant who were put on the list before starting dialysis.
•People with a previous organ transplant died at a more accelerated rate than those without transplant surgery. And those with a prior heart, liver or lung transplant died sooner than those who had undergone a previous kidney transplant.
•Most people who had received a previous organ transplant were not listed to receive a kidney from an expanded criteria donor (a person with one or more risk factors, including history of high blood pressure and over age 50).
The advantage of being placed on the transplant list before starting dialysis is simple, Srinivas said. "Essentially, the longer you're on dialysis, the worse it is for your cardiovascular system and overall health," he said.
Finding a donor outside of the transplant waiting list isn’t always a viable option. A patient can’t always count on a friend or relative to step up as a donor.
"It's very easy to say, 'Go find a living donor,' " Srinivas said. "But the whole family is often strapped financially and emotionally."
Srinivas's patient eventually received a kidney from a deceased donor. "She's doing very well," he said.
Related topics:
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Have Faith Live Longer
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This is a story in which science proves that having faith in something or someone actually helps, as a new study found that religiosity actually prolongs life span, after a liver transplant.
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Italian researchers concluded that liver transplant candidates who have a strong faith, regardless of the religion, also have better post-transplant survival.
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Italian researchers concluded that liver transplant candidates who have a strong faith, regardless of the religion, also have better post-transplant survival.
The research also discovered that regardless of the cause of death, religiosity extends the life span of patients having underwent liver transplantation.Most doctors focus on rehabilitating a patient's health, and do not give much importance to the spiritual side of the patient's condition.Even though most medical professionals have no interest in religion, the authors of the study stressed that 90% of the world's population is involved in some kind of religion or spiritual quest.
Previous studies have already concluded that religious people cope better with diseases and religiosity might actually have an influence on the evolution of a disease.At the study took part 179 patients having received a liver transplant between January 2004 and December 2007, and completed a religiosity questionnaire.The 129 males and 50 females had an average age of 52 years old and were followed for 21 months after transplant.
The causes of these liver transplants included viral hepatitis (68%), alcoholic liver disease (17%), and autoimmune hepatitis (7%)...
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October is National Liver Awareness Month and the American Red Cross reminds blood donors that organ transplant patients often rely on their donated blood.
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Two patients at a hospital served by the American Red Cross recently underwent liver transplants and received more than 130 units of red blood cells.
“Liver transplant patients often require large amounts of blood transfusions during surgery,” said Geoff Kaufmann, CEO of the local Red Cross Blood Services Region. “Thanks to our dedicated blood donors, the Red Cross was able to meet the needs of these two patients and countless others.”
Two patients at a hospital served by the American Red Cross recently underwent liver transplants and received more than 130 units of red blood cells.
“Liver transplant patients often require large amounts of blood transfusions during surgery,” said Geoff Kaufmann, CEO of the local Red Cross Blood Services Region. “Thanks to our dedicated blood donors, the Red Cross was able to meet the needs of these two patients and countless others.”
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For more information, visit liverfoundation.org.
Upcoming blood donation opportunities in this area include:
•October 11, 1:30 to 7:30 p.m. – St. Mary’s Catholic Church, 411 Hawthorne Street, Alexandria.
•October 12, 10:30 a.m. to 4:30 p.m. – St. Mary’s Catholic Church, 411 Hawthorne Street, Alexandria.
•October 12, noon to 6 p.m. – Community Center, 18 East Nokomis Street, Osakis.
•October 12, 12:30 p.m. to 6:30 p.m. – Sacred Heart Catholic Church, 105 North Franklin, Glenwood.
•October 13, 10 a.m. to 4 p.m. – Minnewaska High School, 25122 State Highway 28, Glenwood.
To donate blood, call 1-800-GIVE-LIFE (1-800-448-3543) or visit redcrossblood.org to make an appointment or for more information.
For more information, visit liverfoundation.org.
Upcoming blood donation opportunities in this area include:
•October 11, 1:30 to 7:30 p.m. – St. Mary’s Catholic Church, 411 Hawthorne Street, Alexandria.
•October 12, 10:30 a.m. to 4:30 p.m. – St. Mary’s Catholic Church, 411 Hawthorne Street, Alexandria.
•October 12, noon to 6 p.m. – Community Center, 18 East Nokomis Street, Osakis.
•October 12, 12:30 p.m. to 6:30 p.m. – Sacred Heart Catholic Church, 105 North Franklin, Glenwood.
•October 13, 10 a.m. to 4 p.m. – Minnewaska High School, 25122 State Highway 28, Glenwood.
To donate blood, call 1-800-GIVE-LIFE (1-800-448-3543) or visit redcrossblood.org to make an appointment or for more information.
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