Refer a patient to Duke Transplant or learn more about kidney transplant at Duke (PDF).
When another center couldn’t handle the risk a 61-year-old man needing a kidney transplant presented, he came to Duke Health for help. Multiple comorbidities including gout, previous gastric sleeve, infectious disease issues, abnormal heart function, and calcification and narrowing of heart and iliac vessels made his case complex, says Matthew J. Ellis, MD, medical director of the kidney and pancreas transplant programs.
“The vascular problems were particularly challenging,” says Ellis. “His iliac arteries were significantly diseased.” In addition to impeding blood flow for the transplanted kidney, a calcified vessel can shatter when clamped for surgery. These issues contributed to the patient’s first denial as the other center didn’t feel they had a safe surgical site and were concerned that his other medical conditions would compromise his recovery.
“The patient brought a living donor, and we counseled the donor that it was possible that the recipient’s situation was challenging enough that we might have to abort, even after we’ve removed the donated kidney,” Ellis explains.
How did Ellis and the Duke team safely transplant a challenging patient?
Through collaboration with Duke Heart, Infectious Diseases, and Vascular Surgery, the transplant team determined the patient would likely do well during and after surgery. Within six months of the patient’s first appointment at Duke, the living donor transplant was scheduled.
“We were able to find one safe site along the iliac vessel to attach the kidney, and the patient is doing well now,” Ellis says. “In a patient with kidney disease like this, most comorbidities are best treated with improved kidney function.”
“The evaluation, all of the tests, everything was really seamless,” says the patient. “I can’t imagine how the surgery could have gone any better. The kidney started working before they sewed me up. I feel fantastic.”
As an advanced transplant center with extensive experience, Duke was able to manage the potential complications presented by complex comorbidities, even for a patient denied by another center. “A second opinion is always helpful,” says Ellis.
Ellis emphasizes that the program’s infrastructure allows a comprehensive and efficient evaluation. “Our paradigm is everyone we see is a kidney transplant candidate until proven otherwise. We know some won’t be able to tolerate such an intense surgery and subsequent anti-rejection medications, but we strive to give patients a 360-degree view involving cardiology, pulmonology, infectious disease, vascular, and more before we make any final decisions.”
Early referral helps to establish relationships and possibly avoid dialysis, which negatively impacts outcomes. “The best time for referral is when a patient’s GFR [glomerular filtration rate] is approaching 20,” Ellis says. “We encourage referring physicians to err on the side of early referral.”
Refer a patient to Duke Transplant or learn more about kidney transplant at Duke (PDF).