Summer 2006

Kidney Transplantation

UCSF's largest transplant service is its kidney program. More kidney transplants have been performed at UCSF than any other institution in the world — about 7,500 since the program began in 1964. Each year, the transplant team evaluates about 1,200 patients and performs more than 250 kidney transplants. Its one-year success rate is the highest of all Northern California programs, according to program director John Roberts, M.D.

UCSF has been a leader in living donor kidney transplants. These now represent 50 percent of donor organs in the program. The living donor option has several advantages over the traditional wait for a deceased donor. Wait time to transplantation is typically shorter when a friend or relative is able to serve as a living donor. Kidneys from living donors last longer than those obtained from deceased donors. Half of the living donor kidneys still function 10 years after transplantation, compared to a third of cadaver kidneys.

In 1999, UCSF transplant surgeon Chris Freise, M.D., and colleagues began harvesting donor kidneys with a laparoscopic procedure rather than traditional open nephrectomy. As a result of improvements in the operative technique, almost all living donor kidneys are now obtained in this less invasive manner, shortening the recovery time for the donor.

Expanding the Donor Pool

In cooperation with the United Network for Organ Sharing (UNOS), UCSF offers several options to expand the availability of living donor kidney transplants.

Patients who have relatives or friends who wish to donate a kidney but who are not compatible with the prospective recipient, can donate to someone near the top of the deceased donor wait list. The prospective recipient then takes that person's place on the deceased donor wait list.

Paired exchange allows two living donors and two recipients to undergo surgery at the same time, exchanging kidneys to make a compatible match. Working with the UCSF Immunogenetics and Transplant Laboratory headed by Lee Ann Baxter-Lowe, Ph.D., the kidney transplant program offers several options for overcoming immunological incompatibility between donor and recipient.

When the donor and recipient antibody profiles do not match (positive crossmatch), the kidney transplant recipient may undergo several plasmapheresis treatments before and after transplant surgery to remove antibodies that could lead to rejection. This approach is also being used to permit kidney transplantation despite blood group differences between the donor and recipient.

UCSF accepts kidneys from an expanded deceased donor list, including individuals over 60 or with some underlying disease. These are carefully matched with selected recipients. Kidneys from donors with hepatitis C, for example, can be transplanted into recipients with the virus. UCSF has also been a leader in the field of kidney transplantation in HIV-positive patients.

Interdisciplinary effort

Kidney transplant program medical director Stephen Tomlanovich, M.D., credits a close-knit group of physicians and nurse coordinators with the program's high success rates. Since the early 1970s, UCSF has worked to seamlessly combine all aspects of care.

"Many of the issues patients deal with in kidney transplantation are not so much surgical as medical," Tomlanovich said. These include managing organ rejection and the side effects that can accompany antirejection medications as well as comorbidities. Increasing numbers of older patients with complex medical histories are being transplanted, requiring careful and follow-up. The team also works with patients who have undergone bariatric surgery to reduce their weight and become eligible for a kidney transplant.

Under the leadership of Flavio Vincenti, M.D., UCSF has for many years been a leading participant in trials of new immunosuppressive agents. Several novel biologic agents are being tested in an effort to facilitate drug withdrawal and induce a state of tolerance without the need for maintenance immunosuppression.

Consultations and Referrals

For more information, please call the Kidney Transplant Service at (415) 353- 1551.

Patient assessment is offered in San Francisco and at clinics in Mountain View, Fresno, Stockton and San Luis Obispo, Calif. and in Hilo and Honolulu, Hawaii.

Related Information

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The UCSF Heart and Vascular Center has been designated a center of excellence in heart transplants by Blue Cross and Blue Shield in California.

UCSF Medical School Among Nation's Best
The UCSF School of Medicine is among the nation's top 10 medical schools in seven of eight specialty programs in an annual ranking of U.S. News & World Report.

UCSF Receives Stem Cell Training Funds
UCSF and 15 other California institutions received the first year of funding for a three-year program to train stem cell scientists.