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Transplant Program Celebrates Milestone

Jan 4, 2008 7:00 AM

On the morning of Nov. 16, Edward W. Nelson, M.D., professor of surgery and surgical director of the Kidney Transplantation Program, removed one of Robyn Fillmore’s kidneys and handed it off to his colleague, Jason Schwartz, M.D., assistant professor of surgery, who transplanted it into Fillmore’s younger brother, Curtis Barney. While the family celebrated the beginning of a new quality of life for the 31-year-old Barney, the U also marked an important milestone: the program’s 2,000th kidney transplant.

Nelson has been around for 1,500 of those adult and pediatric transplants and has performed hundreds of kidney transplants during his 25-year tenure. Nevertheless, Nelson says he still never sleeps well the night before a transplant. “There’s nothing more stressful than a living donor transplant,” he says. “It’s the only operation where you have two people at risk.” The expectation is that everything will go picture perfect, Nelson says, and with the U’s impressive 99 percent patient survival and 94 percent kidney graft survival, it nearly always does.

When asked to reflect back to his first kidney transplants, Nelson says it was a totally different experience. “There were two surgeons, a nurse, and a secretary. We’d find out there was a kidney donor, get on a plane and fly to places like Elko and Pocatello,” he says. “We did the surgery and brought the kidney back with us. We gave the immunosuppression drugs and did our own tissue typing. It used to be that the surgeons did everything. Now there are a cast of thousands.”

The program, which began in 1965, has expanded to include all abdominal organs, including the pancreas and liver. That “cast of thousands” includes four transplant surgeons (Nelson and Schwartz along with John Sorensen, M.D., professor of surgery, and Tim Gayowski, M.D., adjunct professor of surgery), pediatric and adult nephrologists, pre-and post-transplant nurse coordinators, social workers, child-life specialists, pharmacists, dietitians as well as financial advisers, researchers, pathologists, clinic staff members, the tissue typing lab, the OR and ICU staff, floor nurses, surgical residents, and Intermountain Organ Services, among others.

All those people work together to care for the whole patient—physically, emotionally, and financially. “It’s absolutely a team approach and all of those people on the team should be recognized,” says Nelson. “It’s a much more successful operation today with a much higher volume.”

Sophisticated antirejection drugs have greatly increased both patient safety and the success rate of the kidney graft. And an expanded donor pool, especially of living donors, has allowed for many more successful matches. “We don’t do this unless we have donors,” emphasizes Nelson. “They’re the ones who really deserve to be recognized.”

Fuad Shihab, M.D., professor of internal medicine and medical director of the Kidney Transplantation Program, also credits the program’s success to the U’s team approach. “We put patient care above any other consideration, and then learn how to work together to achieve that goal,” says Shihab. “Everyone is involved in major decisions that affect patient outcome; we listen to what any person on the team has to say.” Shihab says the U continues to follow transplant patients closely so they can avert any long-term or permanent complications. “The goal is to ensure the best outcome for the patient.”

While life is not completely normal for transplant patients—they go home with a number of new medications that have side effects—Shihab says it’s a small price to pay for the markedly improved quality of life. “Just witnessing a patient go from having a very poor quality of life to leading a normal, healthy, and productive life … it’s like seeing a transformation in front of your eyes,” says Shihab. “That’s what keeps us going.”

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