Kidney Transplant Program Helps More Patients with an Impressive Expansion of Services

It has been an unprecedented year of growth for the Kidney Transplant Program at the Medical University of South Carolina (MUSC). “It’s an exciting time,” says Michael J. Casey, MD, Professor of Medicine in the Division of Nephrology and Interim Medical Director of Kidney Transplantation. “In 2021, we were one of the top five kidney transplant programs in the country for volume. We’re also on track to break last year’s record with over 400 transplants in the last calendar year.” This impressive total is approximately three times higher than the average number of kidney transplants performed at other US health centers where the procedure is available.

The program’s remarkable success is the result of long-term planning, adapting to new circumstances, and committing to expand the number of eligible patients and available donor organs.

In terms of planning, bringing new hospitals in the midlands and upstate under the MUSC Health umbrella has helped improve patients’ chances of getting on the kidney transplant waiting list and receiving an organ. In addition, a new MUSC Kidney Transplant Center will soon open in Lancaster, SC. “This is an underserved area with a really great need. National data show that the lowest percentage of patients referred for transplant are from southern states like North and South Carolina,” says Prince Anand, MD, Associate Professor of Medicine and Medical Director of Nephrology Transplant Services at the new Lancaster center. “Part of the reason is an overall lack of transplant services where they live. Many people don’t have the resources to make a three-hour trip to Charleston or have trouble completing the pre-transplant workup tests. Having this program right in their backyard makes all of that easier. We can coordinate with other local providers to get their pre-transplant and follow-up testing done in a more timely, convenient way.”

The new center also offsets geographic disadvantages due to changes in the national organ allocation system. “UNOS (United Network for Organ Sharing) decided to give greater priority to transplant centers within 250 miles of a deceased donor to avoid sending organs long distances because the shorter the distance, the better the organ does in transplant,” says Dr. Cayce. “But, because Charleston is so far down on the coast, kidneys from a deceased donor in the upstate are prioritized to other transplant centers in Georgia or North Carolina.”

The Lancaster center effectively levels the playing field. “This program gives us priority for receiving organs from a larger catchment area,” says Dr. Anand. “That’s a huge plus for our patients because they’ll have a more competitive chance to get a kidney.” In addition, the clinic will offer a customized program to patients with issues related to overweight and obesity. “For some patients, this prevents them from getting a kidney transplant. So, we’ll be starting a transplant weight management clinic in Lancaster to help our overweight patients reach their goal weight and get transplanted,” says Anand.

Transplant patients in the midlands and upstate have also benefitted from expanded telemedicine services that allow them to consult with physicians in Charleston without leaving their home town. Dr. Casey, who is also Medical Director of Transplant Telemedicine, explains, “When the pandemic started, we quickly transitioned to telemedicine for routine visits. It works really well because our patients are immunosuppressed. Telemedicine helps us stay connected with them while reducing their potential exposure to COVID.”

The team also expanded MUSC’s living and deceased donor programs in the past year. “We did about 50 living donor transplants in the past year and our goal is to ramp up to around 70 next year and 90 in the year after that,” says Dr. Casey. To increase living kidney donations, the MUSC Nephrology Transplant Program developed the ability to run its own paired kidney exchange program by matching incompatible living donors to patients on the transplant list within the MUSC Health system–something that is not typically available at smaller centers due to the need for computer support, personnel, and a large pool of potential donors. “Doing our own internal match runs really cuts down on red tape and medical uncertainty because we know all recipients and donors involved in the paired exchange.”

That’s been a big improvement in our living donor program,” says Dr. Casey, who estimates that it typically takes about three months to find a matched pair through the internal system. “It’s like a donor swap where people who already have an eligible but incompatible donor are matched with another incompatible pair. That’s improved our number of living donor transplants was well.” If internal matching fails, the team reaches out to one of the national kidney paired exchange programs.

Last year, the program also increased the number of deceased donor transplants by leveraging recent advances in the treatment of infectious diseases. “Over the past couple of years, we’ve seen the emergence of very good therapies for Hepatitis-C (Hep-C) that are 98-99% effective in treating it,” says Dr. Casey. “So, now we can transplant a kidney from a deceased donor with Hep-C and treat the recipient for about three months afterward with an oral pill regimen.”

The Nephrology Transplant Program will add two to three new transplant nephrologists in the coming year to help keep up with the growing volume. Genta Uehara, MD, currently finishing the Nephrology Transplant Fellowship program, will join the faculty as an Assistant Professor in mid-2022. “When I rotated onto the transplant service, I noticed how happy the patients were. I enjoy working in a field where I can make patients so happy,” says Dr. Uehara. “During training I had a patient who’d been on dialysis for over 10 years before she got a new kidney. When she started to make urine, she cried tears of joy in front of me. That was when I knew that this was what I really wanted to do.”

Dr. Uehara is also excited to help educate and exchange ideas with the next generation of nephrologists. “The way we practice here is completely different from in Japan,” he explains. “There, decisions are mostly based on the opinion of senior physicians whereas, here, it’s based more on published evidence. Even young students and residents can have a free discussion with the attendings. They can say, ‘Hey, I just read a new article and it said something different than what you’re saying.’ And the attending is interested in hearing what they have to say.”

That enthusiasm for exploring new ideas and finding innovative ways to help patients with kidney failure receive a transplant are truly the heart of the MUSC Nephrology Transplant Program. “It’s gratifying to get up every morning and know I’m going to help someone today,” says Dr. Anand.

Article by Kat Hendrix, Ph.D.