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Leadership Series

Meeting Opportunities and Solving Kidney Transplantation Challenges

By N. Thao Galván, MD, MPH, FACS, transplant surgeon at Baylor St. Luke’s Medical Center and Associate Professor of Surgery in the Division of Abdominal Transplantation at Baylor College of Medicine

March 05, 2024 Posted in: Leadership

In the U.S., kidney disease poses a significant public health challenge. This disease takes an outsized toll on minority populations, where rates of diabetes and high blood pressure—which increase the risk of chronic kidney disease—are highest, and racial disparities in care remain stubbornly persistent.

Kidney transplantation is the gold-standard treatment for end-stage renal disease, and transplant centers have a major role to play in ensuring all patients can access this lifesaving treatment, including living donor transplants. At the Kidney Transplant Program at Baylor St. Luke’s Medical Center, we’re embracing innovation to increase accessibility and reduce the burden of kidney transplantation for everyone we serve. 

Unique Moment

Known for exceptional outcomes, a deep commitment to patient care and an experienced, multidisciplinary team, the Kidney Transplant Program—a partnership between St. Luke’s Health and Baylor College of Medicine—has a long history of caring for patients. The program has performed more than 2,100 kidney transplants over the past 38 years and offers both deceased and living donor transplants.

This is a critical time, both for our program and kidney transplantation as a whole. We face significant challenges in our field, including an organ shortage—nearly 89,000 people sit on the waiting list for a new kidney—transplant rejection and long-term complications following transplantation. Still, exciting opportunities await us, including advancements in immunosuppressive therapies, novel diagnostic modalities and the potential for bioengineered kidneys.

The Kidney Transplant Program contributes to solving the challenges of kidney transplantation through research, clinical trials and a comprehensive, up-to-date approach to patient care. As one example, I work in the field of bio-additive engineering to develop functional kidney tissue. We’re not quite ready for clinical trials yet, but I’m sure that time is fast approaching. 

Comprehensive Care From a Multidisciplinary Team

Ultimately, we want to perform a kidney transplant for any patient with end-stage renal disease or chronic kidney disease who is healthy enough to withstand the stress of surgery and do well thereafter. At our Transplant Center, a team that includes nephrologists, social workers, dietitians, physical therapists, pharmacists and nurse coordinators provides education, counseling and comprehensive medical management to patients awaiting transplantation.

Every member of our team cares deeply for patients, and I see and am inspired by this every day. Many of our team members have been part of the Kidney Transplant Program for more than 20 years, which speaks volumes about their commitment to those in their care. This evident passion for patients, along with the multidisciplinary collaboration, surgical excellence and fidelity to outstanding outcomes, motivated my decision to join the program in 2017 after training at BSLMC since 2008.

Our care and support continue long after transplant surgery, as the same team of transplant experts helps patients transition safely into life with a new kidney. The team provides immunosuppression therapy to enable each patient’s body to receive the transplanted organ. Before discharge, we educate patients and families on the essential details of life as a transplant patient, from diet and medication dosage to the types of places patients can go and the people who can safely visit them. Close monitoring continues in the outpatient setting.

Increasing Access to Living Donor Transplants

In addition to deceased donor transplants, the Kidney Transplant Program offers transplants from living donors, which come with several advantages for patients. Kidneys from living donors tend to start functioning sooner and last longer than those from deceased donors. With living donor transplants, surgery can take place when convenient for both the donor’s and recipient’s schedules.

Unfortunately, despite its advantages, living donor transplantation remains out of reach for many patients of color, especially African Americans, due to a variety of factors. For one thing, African Americans are underrepresented in the living organ donor pool. In 2021, for example, the percentage of white living donors was nearly twice that of African American living donors, according to the U.S. Department of Health and Human Services Office of Minority Health.

Lack of availability of kidneys from diverse living donors combines with other factors to hinder minority populations’ access to living donor transplantation, including:

  • Lower rates of referral for transplant evaluation

  • Mistrust of the health care system

  • Social determinants of health, such as limited access to medical care and education

At BSLMC, we’re making living donor kidney transplants more accessible through innovations such as a swap program between our Transplant Center and those at Texas Children’s and VA Houston. Through the swap program, community members can support each other and provide kidney matches for loved ones. Our Kidney Transplant Program also uses advanced laparoscopic techniques and personalized care plans, both of which help increase access to living donor transplantation.

Future Focused

In our field, it’s important to celebrate victories while remaining squarely focused on doing more to extend organ transplantation to everyone who needs it.

In 2023, kidney transplants in the U.S. reached an all-time high of 27,329, according to the Organ Procurement & Transplantation Network. Kidney transplants among African Americans and Hispanics increased, and both groups set new records for overall organ transplants. Living donor organ transplants in 2023 reached 6,953, the most since 2019. More than 90 percent of those were kidney transplants.

The Kidney Transplant Program at BSLMC continues to embrace leading-edge technologies to enhance our care. We’re developing a robotic kidney transplant service that will allow us to offer transplantation to patients who weren’t candidates previously. This robotic program will help more of our patients recover faster and easier so they can return to life as they envisioned it.

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