At one time, requirements for kidney transplantation were so stringent that only a select number of young and relatively healthy adults with end-stage renal disease were eligible. Fortunately, with advances in technology, the renal transplant population is now more inclusive. Today, transplant candidates may include those with a variety of medical conditions as well as older adults, many of whom may be at risk for multiple-system diseases, such as heart disease, liver dysfunction due to hepatitis B or C, as well as a range of vascular diseases. To ensure appropriate and viable transplantation, the Saint Barnabas Health Care System (SBHCS) Renal and Pancreas Transplant Centers employ a multidisciplinary approach when evaluating, listing and eventually transplanting patients with a variety of medical needs. A multidisciplinary approach involves the collaboration of several medical specialists, each providing specific services to the patient. Depending upon the pre-transplant evaluation findings, consultations may be obtained from specialists in cardiology, hepatology (the study of the liver), pulmonology, oncology, hematology and psychiatry. The key to coping with multiple-system diseases is accurate diagnosis and thorough treatment before a patient is placed on the transplant list as well as continued monitoring during any significant waiting period.
Many diabetic patients have benefited from this multidisciplinary approach. It is not unusual for diabetic and older patients to be assessed by a cardiologist who may request an echocardiogram, stress test and even a coronary angiogram to identify any potential problems prior to transplantation. Similarly, patients with hypercoagulation disorder, in which the blood clots much faster than normal, as in some patients with lupus, require specialized tests performed by a hematologist. These tests determine if blood-thinning agents like heparin and Coumadinâ should be used after transplantation. In the absence of such measures, there is great danger of the kidney allograft being lost to the formation of a blood clot.
Since the waiting time for cadaveric kidney transplantation can extend over years, once patients are listed, they need to be carefully followed over specific intervals to make sure they remain in good condition. This process is implemented and maintained by the Transplant Candidate Review Board (TCRB). The TCRB periodically reevaluates every high-risk patient’s medical history, blood tests, and x-rays. If necessary, repeat cardiac, liver and vascular work-ups are performed. If medical intervention is required to maintain eligibility on the list, it is done either at the SBHCS hospitals or by the referring physician. Transplanted patients are then followed with the same multidisciplinary intensity to keep them as healthy as possible. Kidney transplantation has evolved into a very successful treatment modality for patients with multiple-system diseases.
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