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This section contains information for physicians and case managers of transplant patients. If you are searching for a physician, please click here.
For all referrals, please contact Transplant Intake Specialist Christianne Suszynski at (716) 898-4530.
Frequently Asked Questions
Who should consider renal transplantation?
All patients with chronic kidney disease or end-stage renal disease (ESRD) should be considered potential candidates for renal transplantation.
What are the indications for renal transplant?
Any patient with a glomerular filtration rate of less than 20 ml/min is a potential candidate for transplant. Early referral of patients for evaluation is encouraged. As an adult-transplant facility, we transplant patients 16 years of age and older. The life-extending benefit of transplantation is statistically significant through age 74. Potential recipients will need to successfully complete a rigorous age and sex-specific, nationally standardized transplant evaluation.
What are the contraindications for renal transplant?
Patients with prior malignancy, infectious processes, severe vascular disease or severe coronary artery disease present challenges to transplantation and may not be ideal candidates. Individuals who are non-compliant with their medical care may not be considered as candidates.
What are the risk factors for renal transplant?
Individuals with chronic conditions such as diabetes, heart disease, vascular disease or obesity have additional risk at transplant. Infection, primary graft dysfunction, reoccurrence of kidney disease in the transplanted organ, rejection and surgical complications are among the problems that may occur post-transplant.
What are the indications for pancreas transplant?
Individuals 50 years of age or younger with insulin-dependent diabetes and a C-peptide level of less than 1 ng/ml may be candidates for pancreas transplant. A creatinine clearance of less than 30 ml/min is required to be considered for a simultaneous kidney and pancreas transplant. The candidate must also successfully complete evaluation testing, including medical and surgical evaluations.
What are the risk factors for pancreas transplant?
Individuals with chronic conditions such as diabetes, heart disease, vascular disease or obesity have additional risk at transplant. Infection, primary graft dysfunction, reoccurrence of disease in the transplanted organ, rejection and surgical complications are among the problems that may occur post-transplant.
Is there a substance abuse protocol for transplantation?
Patients with a history of substance abuse will need to be seen by a counselor and a member of the psychiatry team to confirm that they are not at risk for relapse and will be able to remain compliant with their medications. Patients may be required to undergo drug screening as a condition of their evaluation and listing.
Will my patient still have to go to dialysis once he or she is transplanted?
Typically, no dialysis is required after renal transplantation. However, in some instances, one or two treatments may be required post-op. In 5–10 percent of cases, patients may experience delayed graft function and will need to go back to dialysis for up to two months post-transplant, after which the transplanted kidney functions normally.
What does insurance clearance mean?
Prior to being evaluated for transplantation, all potential recipients will meet with our financial coordinator to determine what their insurance coverage will be for the evaluation and transplant. Some insurance companies will not allow the patient to proceed with the evaluation until they have reviewed the case and committed to paying for it.
If my patient is listed both at ECMC and at another transplant center and an organ becomes available, where will the transplant take place?
If a patient is listed at more than one center, the transplant will occur at the center that has been offered the organ.
If my patient has a potential living donor that lives out of town, can the donor have his or her testing done close to the donor's home?
Ideally, any potential donors should be evaluated at ECMC. If this is not feasible, arrangements can be made for the evaluation testing directed by the transplant program staff at ECMC to take place close to the donor's home. Certain testing, such as a cross-match to exclude the possibility that the recipient has preformed antibodies to donor tissue, requires fresh samples and must be closely coordinated. Because many potential donors live at great distances from Buffalo, remote coordination of evaluation is commonplace. Specific arrangements must be made to ensure proper billing of donation-related procedures.
Why do patients have to be on a waiting list?
Currently, more than 90,000 people are waiting for organs (nearly 65,000 are waiting for kidneys). In order to fairly distribute the available organs, a national waiting list has been formed. The ECMC waiting time for potential recipients, however, is shorter on average than that of most programs in the United States. The United Network for Organ Sharing (UNOS) administers the Organ Procurement and Transplantation Network to ensure fair access to available organs.
What are some medications that may interact with the frequently used immunosuppressants, such as rapamycin, Prograf, cyclosporine (e.g., Neoral and Gengraf), CellCept and Myfortic?
Drugs that may possibly interact are antifungals, some antibiotics (macrolides) and some blood-pressure agents such as verapamil. Allopurinol can interact with Imuran. If you have any specific concerns regarding drug interactions, please contact the Transplant Office, and we will assist you in selecting appropriate medications for your post-transplant patient.
What help is available for patients who lose their medication coverage?
Our financial department, as well as some of the drug companies, have programs in which they sometimes can supply the drugs free of charge to those who qualify. In addition, we have a pharmacy that works with the hospital that can sometimes offer a cheaper price for the medications. We sometimes have samples of drugs or discount coupons. Our financial coordinator will work with the patient to review options for medication coverage in the event coverage is lost.
After transplantation, who manages the immunosuppressive therapy of patients? What about other medications (e.g., diabetes or blood-pressure medications)?
Generally, our physicians and physician extenders manage all medications immediately after surgery. If it is felt that additional expertise is required for some patients, they will be referred to an appropriate specialist who works with the transplant program.
When are prophylactic medications tapered off?
While each patient will follow the course best suited to his or her situation, in general patients are on antivirals for approximately three months post-transplant and antibiotics for approximately six months post-transplant.
After transplantation, when do recipients return to referring physician care?
Usually, patients are returned to referring physician care between three and six months post-transplant. This will depend on the course of the patient's recovery and the comfort level of the referring physician. Other factors, such as distance from the hospital, may influence this decision. The transplant center is required to report the patient's progress to UNOS yearly. Therefore, annual visits to the center are encouraged.