The Duke Transplant Center completed its 10,000th solid-organ transplant in June, crossing a threshold reached by fewer than 20 centers in the United States, according to United Network for Organ Sharing (UNOS) data. Duke leads all Carolinas hospitals in transplant volume and ranks among the leaders in the Southeastern US.
This achievement represents a significant milestone for a center that has leveraged decades of clinical innovation and research to become a leading referral center for patients facing challenging diagnoses.
“Duke is one of the best places in the nation to receive a transplant, one of the best places to be trained in this discipline, and one of the best to continue to practice as a specialist in transplant,” says Stuart J. Knechtle, MD, executive director of the Duke Transplant Center.
According to the Organ Procurement and Transplantation Network (OPTN), the lung transplant and heart transplant programs are currently ranked first and sixth, respectively, in total transplant volume. Despite experiencing dramatic growth in volume in recent years, Duke continues to offer among the shortest median wait times in the nation for lung, heart, and liver transplants.
Beginning with immunology, experimental surgery
Knechtle credits Duke’s surpassing 10,000 transplants after nearly 60 years of operation to the center’s founders, who recruited national experts in immunology and experimental surgery to launch the program in 1963. Two years later, a kidney was the first organ transplanted at Duke.
Key early accomplishments include:
- 1964: The first international histocompatibility workshop was convened at Duke, a conference in which human leukocyte antigens were formally named. During the sessions, specialists compared skin grafting and serology and provided the first description of leukocyte antibody crossmatch.
- 1968: Duke transplant specialists created the Southeastern Organ Procurement Foundation, a precursor to UNOS, the non-profit, charitable organization that administers OPTN.
High-performing transplant hospital
Approximately 15% to 20% of clinical services at Duke are devoted to transplant patients, and these teams operate in a “highly matrixed endeavor,” Knechtle says, requiring broad expertise and skillful integration.
“Highly trained, specialized, and cohesive teams are involved in evaluation and post-operative care,” Knechtle explains. “If transplant is running well, it’s a good indication that the hospital is performing at a high level because so many critical partners contribute, including immunology, diagnostics, radiology, pathology, advanced nursing, transplant coordinators, critical care, and many clinical services.”
Commitment to research, innovation
Research and innovation have been at the center of the Duke Transplant Center’s mission, and participation in national trials have accelerated the program’s growth. Among the most important:
- Pioneering integration of novel devices such as Ventricular Assist Devices.
- Early adoption of organ recovery and transport systems.
- Clinical trial leadership, notably in such efforts as the Donation Before Circulatory Death initiative, which expanded the number of donor hearts.
- Participation in NIH research programs designed to monitor organ health following transplant and reduce rejection.
“Duke has a very proud history of clinical expertise in immunology, and the scientific dimension of transplant continues to be very strong,” Knechtle says. “We are one of the highest funded research institutes in the nation.”
The miracle of transplantation
Successful outcomes have transformed a once-rare option into a relatively common procedure. But Duke physicians emphasize the human dimension of each surgery.
“Transplantation is one of those rare achievements in medical science that retains a miraculous quality,” says Allan D. Kirk, MD, PhD, and chair of the Department of Surgery. “The transformation of lives achieved through organ sharing remains remarkable, even though milestones like this suggest that it is routine.”
Transplants require close ties with patients’ families during both pre- and post-transplant care, physicians say. The role of transplant coordinators, advanced practice providers, and surgical specialists have elevated the effectiveness of the Duke program.
To enable growth, Duke has maintained a long-term partnership with HonorBridge, the federally monitored organ procurement organization serving 7.5 million people in 77 NC counties.
“As a provider of needed organs for those on the national wait list, HonorBridge is proud of the partnership and Duke’s unwavering dedication to their patients who wait in hope for lifesaving transplants,” says Danielle Niedfeldt, HonorBridge President & CEO.
Chantal Howard, MSN, RN, chief nursing and patient care services officer, emphasizes the “patient-centered” focus of the program. “Our program is highly effective; we often embrace the sickest of patients and transform their lives.”
National leader in NIH research
During the 2021-22 round of NIH funding, four significant grants were awarded supporting adult and pediatric kidney as well as lung and liver rejection. Key active trials include:
Abdominal Transplant Team Leads Trial Studying Organ Rejection: Duke transplant surgeons and researchers will lead a $16.5 million, seven-year NIH-funded trial to assess new therapies targeting antibody-mediated rejection in patients who have undergone kidney transplant.
$21M NIH Grant Extends National Lung Transplant Research: A $21 million, seven-year grant from the National Institute of Allergy and Infectious Diseases will support the search for more durable treatments for lung transplant patients, says Scott M. Palmer, MD, MHS, the Duke transplant pulmonologist and researcher who directed the application.
Duke Liver Specialists Join NIH Biomarker Transplant Trial: Duke liver transplant specialists will analyze the value of biomarkers to monitor organ health following transplant as part of an NIH-sponsored trial designed to lower the use of antirejection drugs and preserve kidney health.
NIH Grant Supports Novel Pediatric Kidney Transplant Trial: Promising research from the Duke Pediatric Kidney Transplant Program created the framework for an NIH trial on a novel therapeutic immunosuppressive drug combination to improve allograft function and clinical outcomes in children and young adults.