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Fall 2009

Innovations in Living Donor Transplant

In California alone, there are more than 16,000 patients waiting for kidney transplants, and more than 3,000 patients awaiting liver transplants, according to the Organ Procurement and Transplantation Network. UCSF Medical Center has been at the forefront of helping more patients receive transplanted organs through innovations such as split liver transplantation, in which a single cadaveric liver is divided and transplanted into two patients.

Another major initiative is the medical center's living donor program, which offers hope to many patients who might die before an organ becomes available. UCSF offers state-of-the-art procedures, expert care and among the best outcomes nationally for living organ donors and transplant patients.

UCSF Medical Center is an international leader in the field of transplantation, and has one of the largest and most highly regarded transplant programs in the country. The medical center has performed more than 10,000 transplants, and this year is celebrating the 45th anniversary of its transplant service. In addition to a cadre of expert surgeons, UCSF Medical Center has an outstanding team of nurses, social workers and others who specialize in the care of transplant patients.

"It's a whole team effort to get patients through the operation and take care of them afterwards," said Professor of Surgery John Roberts, M.D., chief of the UCSF Transplant Service.

About 10 percent of the 140 liver transplants that UCSF Medical Center performs each year involve living donors, according to Roberts. UCSF performed its first adult-to-child living donor liver transplant in 1993, and has done 80 such procedures to date. The medical center performed its first adult-to-adult procedure in 2000, and has done more than 100 such procedures to date.

UCSF Medical Center radiologists use CT angiograms and CT cholangiograms to precisely map blood vessels and bile ducts prior to surgery, helping to accurately determine how to divide the donor's liver while minimizing adverse impact on the donor. Depending on the relative sizes of the donor and recipient, surgeons remove 25 percent to 60 percent of the living donor's liver. About 80 percent of the donor's liver regenerates within several weeks or months, while the last 20 percent can take up to a year to regenerate. Donors are usually off work for about six weeks.

The depth and breadth of the Transplant Service's experience translate into superior outcomes. For example, medical center adult liver transplant patients receiving organs from living donors have a one-year patient survival rate of 95.8 percent, compared with the national average of 89.3 percent, and a one-year graft survival rate of 95.8 percent, compared with the national average of 84.3 percent.

Living Donor Kidney Transplants

UCSF Medical Center has performed more kidney transplants than any other institution in the world — more than 8,000 since 1964 — and is the second-largest center for living donor kidney transplants in the country.

Most healthy adults can safely donate a kidney, and long-term outcomes for graft survival are significantly better for kidneys from living donors than from deceased donors. The average survival rate of a transplanted kidney from a living donor is 20 years, compared with 12 years for a kidney from a deceased donor.

"You're looking at perhaps only having to transplant a patient once, versus transplanting them with a deceased donor and having the graft fail after 10 years, and then they are back on the wait list again," said Professor of Surgery Chris Freise, M.D., a member of the UCSF Transplant Service.

Since 1999, UCSF Medical Center has performed nearly 1,000 laparoscopic donor nephrectomies to remove living donor kidneys. This minimally invasive procedure usually requires a hospital stay of only two to three days, and donors can usually return to work in three to four weeks.

UCSF Medical Center also has several new programs to increase the number of living donor kidney transplants, including:

  • Incompatible blood type and positive cross-match programs. Plasmapheresis can lower antibody levels of recipients who have incompatible blood types or positive cross-matches with their donors, thereby enabling them to receive a donated kidney from an otherwise incompatible living donor. Success rates are close to those for transplants from compatible living donors, and are better than the success rates for deceased donor transplants.

  • Paired exchange program. Matching two or more living donor-recipient pairs can allow compatible matches across pairs (e.g., from donor A to recipient B, and from donor B to recipient A).

  • Altruistic donor program. This program allows living donors without a specific recipient in mind to donate a kidney.

  • "Refurbished" kidney program. Some urology patients may choose to have a defective kidney removed, rather than risk complications associated with repair that may require another surgery. These patients may donate their kidney, which transplant surgeons repair and then transplant into a recipient.

Consultations and Referrals

For more information or to refer a patient, call (415) 353–1888 for liver transplants and (415) 353–1551 for kidney transplants.

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