UH transplant program advancing the science, serving an unprecedented number of patients in its 50th year
UH Clinical Update -- May 2018
In transplant medicine, saving lives is part of the job. But for the team at UH’s Transplant Institute, it goes beyond that. It’s personal.
Several members of the UH transplant team have a personal connection to organ donation. One of the kidney transplant coordinators received a kidney transplant herself. Another mid-level transplant professional had a sister who died and became an organ donor.
“I’ve worked at several transplant programs during my training and career, and this situation here is very unique,” says Kenneth D. Chavin, MD, PhD, Director of the UH Transplant Institute. “It’s wonderful to come to work and be the director responsible for this group. We really walk the walk.”
UH is celebrating its 50th year doing organ transplants this year, and the program is approved by the Centers for Medicare and Medicaid Services (CMS) for all solid organ transplants. Recent growth has been rapid, Dr. Chavin says.
“We’ve transplanted over 3,700 patients in the history of our program,” he says. “From 2016 to 2017, we saw a 23 percent increase to 132 organs transplanted in 2017.”
This increase in case volume is all to the benefit of patients and the overall program, Dr. Chavin says.
“If you do more of anything, you have more expertise,” he says. “The larger we are within the guardrails of not losing our personal touch, the more streamlined and highly reliable medicine we’re providing. We’re also meeting the benchmark for a quality program.”
One factor that may be contributing to increased transplant volume is UH’s unusually high rate for adult organ conversion. This rate measures how many families agree to organ donation after being approached by the appropriate member of the care team. Nationally, this rate is 75 percent. But at UH, it’s 92 percent.
For Dr. Chavin, any action he and his team can take to increase the pool of available donors is a positive.
“The organ shortage continues,” he says. “Here at UH alone, we have more than 500 people on the kidney wait list; we have over 80 people waiting for a liver, 14 for a heart and seven for lungs.”
As it continues to serve an increasing number of patients, the UH Transplant Institute is also sharpening its focus on research and innovation. One promising area of investigation is the reconditioning of organs previously deemed unsuitable for transplant to make them usable.
“Not all organs are ideal to transplant, either because of the way the person lived or the comorbidities that led to their death,” Dr. Chavin says. “After a certain amount of fat in the liver, for example, transplant programs do not transplant those livers because there is a higher rate of those livers failing immediately. We’re working on what’s called ex vivo reconditioning of these organs where we take them out and put them on a machine for hours to treat them to get rid of the fat. Then they’ll be in a condition where we can safely transplant them instead of discarding them. The same is being explored with kidneys and lungs. The future is that we’ll be able to keep the organ viable in a machine outside the body, perfusing it with blood to keep it alive, but give it drugs and other interventions to make it better.”
Another avenue for transplant research at UH is a clinical trial evaluating stem cells as a substitute for immunosuppressive drugs taken post-transplant. This trial will be getting under way soon, starting with patients who’ve received a kidney from a living donor.
All this work is in service of the larger goal – to advance the science to transform heartbreak for one family into healing for another.
“When someone dies, it’s a terrible tragedy for a family,” Dr. Chavin says. “But the upside is that many lives can be saved at that moment. Out of tragedy, some wonderful things happen that are impactful for individuals, families and whatever those individuals go on to do.”