Kidney/Pancreas Transplant Program

Transcription

1 Recanati/Miller Transplantation Institute Kidney/Pancreas Transplant Program An RMTI transplant family: Gustav, heart transplant recipient 2005; daughter, Denise, kidney donor 2007; and wife, Gloria, kidney recipent For more information please call

2 From left: Arnold, heart transplant recipient 1995, kidney transplant recipient 2007, and his wife Barbara; Franklin, kidney and liver transplant recipient, 2005; Ellen Skolnick, kidney transplant recipient 1998, and her daughter, Rebecca. Mission Statement: The Mount Sinai Hospital reaffirmed its commitment to organ transplantation with the establishment of the Recanati/Miller Transplantation Institute (RMTI). RMTI is a comprehensive program for adults and children with end-stage organ disease, related cancers and other disorders. The RMTI focuses on three areas patient care, research and education. Dedicated to providing compassionate care of the highest quality, the RMTI team comprises world-renowned clinicians, surgeons and scientists in a wide variety of organ transplant and medical specialties. RMTI researchers are working, independently and in major collaborations, to improve organ preservation, reduce rejection, minimize post surgical complications and the side effects of immunosuppression, and prevent the recurrence of disease. We are proud of our results and will continue to strive to be a leader in the areas of transplant medicine, surgery and research. The RMTI has been a leader in the transplant community: 1967 Mount Sinai established one of first transplant programs in the Northeast 1988 Mount Sinai surgeons performed New York State s first liver transplant 1994 First pancreas transplant at Mount Sinai 1996 Mount Sinai performs first laparoscopic living donor kidney transplant 1998 First to perform isolated intestinal and multi-visceral transplantation in New York State 2001 First HIV positive patient to receive kidney transplant 2001 First patient to undergo transplantation after desensitization treatment 2008 First Mount Sinai living donor to participate in multi-center triple swap 1

3 Kidney Disease and Treatment Options All patients with end-stage renal failure who are on dialysis or who have an impending need for kidney replacement therapy are potential candidates for kidney transplantation a solution that yields longer survival and better quality of life than long term dialysis. Potential recipients undergo detailed medical and psychological evaluations to ensure that transplant is the right treatment choice for them. The Kidney Transplant Program: Mount Sinai offers the full range of transplant options, transplanting kidneys from deceased donors, living related donors and living unrelated donors. To date, Mount Sinai has performed over 1800 kidney transplants. The number of kidney transplant recipients served by the program averages over 200 per year. Mount Sinai has one of the largest living donor programs in the United States. Half of the yearly transplants performed are from living donors. Mount Sinai has developed an active and successful desensitization program. We can now treat many patients who, due to their high immunologic risk, were not previously eligible for transplantation. Additionally, Mount Sinai participates in local and national paired exchange programs and donor chain initatives. The pediatric kidney and liver transplant programs perform the most transplants in the northeast. Together, they have performed the most combined kidney/liver pediatric transplants than any other program in the world in the last 10 years. Mount Sinai s results have consistently outperformed the national average: Most recent data show: Patient survival rate of 98% at the end of the first year (vs. national average of 96%). Transplanted kidney survival rate (i.e., the body has accepted the new kidney and the replacement organ is functioning properly) of 93% (vs. national averages of 92%). First year acute rejection rate of 9%, far less than national averages of 15-20%. Evaluation for Transplantation: To begin the evaluation process you must make an initial call to Please have your insurance information on hand. After insurance 2

4 clearance is obtained, you will be scheduled for an initial evaluation appointment. Please bring your potential donor and other family members to this visit. At this appointment you will meet with several members of the transplant team: the surgeon, nephrologist, clinical coordinator, social worker, dietician and financial coordinator. A full evaluation for transplant will involve most of the following tests: Complete medical history (Completed at initial appointment) Full cardiac work up including a stress test and echocardiogram (Scheduled at our facility or through your own cardiologist) Complete blood typing and chemistry panel (Completed at initial appointment) Psychosocial evaluation (Completed at initial appointment) Gynecology exam including Pap smear, and Mammogram for women over 35 (You may forward records from your local gynecologist) PSA (Prostate test for men over 55) For patients with HIV: Forward CD4 counts and viral loads for past 6 months. A clearance from your HIV doctor is required. For patients with Hepatitis B or Hepatis C: Must have clearance from our hepatologists Liver biopsy required CT or ultrasound of liver After Kidney Transplanation: You will need to spend 3-5 days at Mount Sinai after a kidney transplant. During your recovery, we will monitor you closely and adjust your anti-rejection medications. After discharge, you will be followed weekly at the RMTI transplant office. The transplant team will closely monitor dosages of medications and check for early signs of rejection. Most rejection episodes are treatable when caught early. Therefore, these transplant office visits are essential to a successful transplant. After the third month post-transplant, most patients return to their community nephrologists or primary care doctors. The transplant team will consult and coordinate care as needed. You will then come to the transplant office for yearly follow up visits. 3

5 Living Donor Kidney Transplantation: Donating a kidney is one of the greatest gifts a person can give. Blood relatives, spouses, close friends and altruistic people can be considered potential donors. Living donor transplantation is possible because we are born with two kidneys. After removal of one kidney, the remaining kidney takes over. Recent studies examining the longterm effects of kidney donation have not demonstrated any increased risk of kidney disease or decreased lifespan, compared to the rest of the population. The benefits of living donation: The main advantage is that the recipient does not have to wait for years on dialysis to receive a transplant and the procedure can be scheduled for a time that is medically best for the patient. Many studies have shown that kidney transplants from living donors are more likely to function longer and better. The living donor will have to undergo an evaluation to make sure it is safe to donate. The evaluation and surgery is covered by the recipient s insurance. Conditions that can exclude a donor: Age (donor must be 18 years or older) Medical Risk Factors High blood pressure Kidney stones Diabetes Chronic infection Obesity (BMI > 35) Any other possible signs of kidney dysfunction Genetic Risk Factors Social/Psychological Issues Financial Incentives Since 1996, Mount Sinai s living donor surgeries have been done laparoscopically this technique significantly shortens the recovery time. The incidence of complications for over 600 laparoscopic surgeries performed is under 1%. There have been no deaths. On average, the length of surgery is 2-3 hours and length of hospital stay is 1-2 days. We are able to initiate evaluation for donors who are out of state or in a different country. 4

6 Pancreas Transplantation: Patients who have both kidney disease and insulin dependent diabetes may be eligible for a pancreas transplant either with the kidney transplant (SPKT) or following the kidney transplant (PAK) Pancreas transplantation is the only readily available treatment to achieve freedom from the use of insulin in patients with diabetes mellitus. This improves their quality of life and prevents the progression of secondary diabetic complications. Pancreas transplantation is not offered to all diabetic patients. Insulin-dependent diabetic patients with normal kidney function are considered for pancreas transplantation only in rare circumstances. Mount Sinai is one of the few centers in the New York region that offers pancreas transplantation as a surgical option. As with the kidney program, our program is one of the largest and our outcomes exceed national standards. We have performed over 150 kidney/ pancreas and pancreas transplants to date. Most recent data show: Patient survival rate of 100% for SPKT (vs. national average of 95%). Pancreas survival rate of 91% for SPKT (vs. national average of 85%). Patient survival of 100% for PAK (vs. national average of 96%). A pancreas survival rate of 85% (vs. a national average of 79%). Other Procedures Offered: Combined kidney/liver Combined kidney/heart Combined kidney/intestine Dialysis access surgery for hemodialysis and peritoneal dialysis Clinical Trials: Part of the Mount Sinai mission is clinical research, which benefits all patients. The transplant community at Mount Sinai is constantly in search of new and improved methods to achieve long-term survival in transplant recipients, while decreasing the side effects of medications. There are several advantages for patients involved in our studies and research projects. Most significant among these is access to the newest treatment regimens and along with some free medications, medical exams and testing. 5

7 Transplant Liaisons Mount Sinai has outreach liaisons who work exclusively in the community, visiting dialysis units and providing on-site or individualized education on various aspects of transplantation and organ donation. Covering most of the tri-state area, the liaisons help ensure continuity of care for dialysis patients who are undergoing evaluation or awaiting transplantation at Mount Sinai. The liaisons are available to assist any patient or provider in the community, regardless of institutional affiliation. Please call the main office at to request assistance from the liaison team. Websites of interest: The Mount Sinai Medical Center National Kidney Foundation United Network for Organ Sharing New York Organ Donor Network Medicare American Association of Kidney Patients The Kidney and Urology Foundation Our location: The RMTI Outpatient Offices are located at: 5 East 98th Street, 12th Floor New York, NY The RMTI Administrative Offices are located at: 1425 Madison Avenue, 4th Floor Rev

8 Directors of Kidney Transplant Program Jonathan Bromberg, MD, PhD Bernd Schröppel, MD Teresa Rodriguez, RPA-C Surgeons: Scott Ames, MD Jonathan Bromberg, MD, PhD Ed Chin, MD Michael Edye, MD Daniel Herron, MD Susan Lerner, MD Michael Palese, MD Hiroshi Sogawa, MD Mark Sturdevant, MD Nephrologists: Corinne Benchimol, MD Graciela de Boccardo, MD Rajani Dinavahi, MD Peter Heeger, MD Barbara Murphy, MB, FRCPI Vinar Nair, MD Tina Neade, MD Jeff Saland, MD Lisa Satlin, MD Bernd Schröppel, MD Vinita Sehgal, MD Patricia Weng, MD The Recanati/Miller Transplantation Institute Mount Sinai School of Medicine One Gustave L. Levy Place Box 1104 New York, NY (212)