March 29, 2024
Watch the replay of our Live Expert Session “Lupus and Kidney Transplant” with Dr. Uttam Reddy of UCI below! In this session, Dr. Reddy, an expert nephrologist, answers our community’s top-asked questions.
You’ll also learn how lupus patients navigate kidney transplantation and what to expect.
Successful kidney transplants have become increasingly common for lupus patients with end-stage renal disease, offering hope and a new lease on life.
Moderator: Welcome everyone to tonight’s live expert session with Lupus LA and Dr. Reddy from UCI. We’re just getting started here. I’m going to wait for some people to trickle in, but Dr. Reddy is an expert nephrologist in the kidney and pancreas transplant program at UCI, and he’s here with us tonight to answer your top questions around kidney failure and kidney transplants in lupus!
This can be a bit of a daunting topic, so we’re very pleased to have you here tonight to discuss the ins and outs of how transplants are approached in this population. And if you’re just joining us please feel free to drop any questions that you have in the comments or send us a DM. And as usual, we’ll ask your questions anonymously on your behalf.
Dr. Reddy, would you like to kick us off by sharing a little bit about yourself before we dive in?
Dr. Uttam Reddy: Yeah, sure! Thank you, everyone, from Lupus LA for having me today to speak about lupus and kidney transplantation. The field of kidney transplantation is near and dear to my heart as the medical director here at the UC Irvine kidney and Pancreas transplant program. I’m a nephrologist that went on and did an extra year of specialization in kidney transplantation at UCLA.
I was a faculty member at UCLA for a few years before jumping down south to UC Irvine Which is about 30 minutes away. And I started in 2015 as the medical director of our kidney transplant program here. Our first year, we were building the program, we did 34 kidney transplants here my first year. We’re currently on pace for 175 to 180 kidney transplants this year. We’re very proud to be the fastest growing kidney transplant program in California. We also have very, very good outcomes. We hope to be a resource for anyone that would need our services, and I hope you guys enjoy the topic. Today I have a few slides, just basic slides, about the field of kidney transplantation. A lot of people don’t know about it and so I just want to introduce you into the world of kidney transplant and then follow up with any questions that you may have.
We have some questions that were submitted that we will review, and if there’s time, we could add questions, too. So thank you, everyone from Lupus LA. I can’t see you, but I can feel you. All right, so my first slide. So this is a slide of all the famous people that have gotten a kidney transplant sometimes when we have a health issue or a health journey we feel alone. I share this slide with some of my patients so they know that this can happen to anyone. It’s not anything that anyone did. M and, you know, Selena Gomez, who probably has more instagram followers than anyone in the world she had lupus and eventually got a kidney transplant when her good friend donated a kidney.
George Lopez got a kidney transplant , almost 20 years ago or so. Alonzo Mourning, NB Achampion from the Miami Heat, just celebrated 20 years with a functioning kidney transplant. Tracy Morgan, a famous comedian, has kidney failure due to diabetes. Got a kidney transplant. Tina Turner had one before.
Fife Dog on the bottom right, from Tribe Called Quest, also had diabetes and got a kidney transplant. So it’s only a slide meant for everyone to feel that they’re not alone, and it certainly can happen to anybody.
So this is a picture of a kidney that’s about to be transplanted, and that’s what we’re going to be talking about today. I’m going to have a few slides about the background and importance of transplantation. A lot of people think when you get a kidney transplant that we take your original kidneys out and put the new kidney in – but that’s not actually the case. In the graphic on the left, you can see the two kidneys that we’re born with. We don’t touch them, and we actually place this new transplanted kidney in the right or left abdominal space. The kidney comes with the artery, and it comes with a vein, and it comes with the ureter. We connect this artery, vein, and ureter to the recipient. The vein is connected, the artery is connected to the person’s vein, and the ureter is connected to the bladder. After a few seconds, this organ, which was on ice and in another person earlier, will start to turn pink. And once it gets its blood flow on the vein and the artery it’ll start to make urine, and that urine will flow down into the ureter, into the bladder, and voila.
A person with kidney failure now has a second chance at life. So, this is just a description or depiction of how it is anatomically. If a patient were to get a kidney transplant, they should know that the surgery probably lasts around four to 6 hours. Variable Depending on the complexity of the kidney and the recipient. Here at UCI, most of our patients are hospitalized for between four to seven days after surgery. So it’s not particularly long. We have some patients that are even strong enough to go home in three days because this is a foreign body, a foreign mass that is now entering your body, you can imagine that your body would want to fight it tooth and nail to get it out of there. The key thing in allowing a transplant to work for years and years and years is to put that person on immunosuppression. We basically take their immune system and shut it down so that it doesn’t fight the kidney. So the kidney can do its thing. So immunosuppression is necessary to keep the organ working. And It’s very important to realize that after transplant, hydration is very important. I tell patients that your kidney is like a plant. You need to water that plant every day. And Hydrating after kidney transplant will allow it to function better. , when you get a kidney transplant, you usually can’t work for two to three months.
There’s also a little bit of a variable based on, you know, each person, but we usually tell our patients to think about taking off for two to three months if they receive a kidney transplant. And then, like, the anatomical picture showed the surgery is in the right or left abdominal area, and you’ll have about a four to five inch scar. And you can imagine your kidney is like the size of your fist, and, you know, you can imagine if there was some object in the right or left abdominal area and that’s kind of how it feels like to have a kidney transplant. So, back to the immunosuppression. Lupus patients know all about immunosuppression, and you can think about kidney transplant has a lot of overlap with lupus, because in lupus, we’re trying to stop your body from attacking itself, and in transplant, we’re trying to stop your body from attacking the new kidney. So when you get a kidney transplant, we give a lot of strong medications up front, because that’s when your body’s gonna have a very strong response.
Cause it sees this foreign object. So, in the hospital, while you’re in the hospital for that first week we’re giving strong IV medications to stop your body from rejecting the kidney and essentially stopping your t cells from being activated and your b cells from being activated and your immune system from being activated. And after that period of a week of induction therapy, where you’re getting these strong iv medications, we will give you then oral medications that you take every dayto suppress your immune system from attacking the kidney. These essentially will be needed for life of the transplant. As long as that kidney is in you, you’ll be needing those medications.
And so just like with lupus or a lot of other diseases, compliance is very important. If we don’t have that 24 hours security in the body of protecting that kidney, then you can get rejection. And so compliance is very important. And like I mentioned earlier, the medications we use in our world and that lupus patients use are very similar. Cellcept and prednisone play major roles in our immunosuppression. Cellcept and prednisone are two out of our big three biggest medications that we use. , and so, essentially, you know, there’s a lot of overlap between the world of lupus and the world of transplantation from an, ah, immune system standpoint.
So when a patient is faced with kidney failure and dialysis and the prospect of transplant, it’s natural to just kind of feel down and feel sad and like, why is this happening to me? , but some things to understand about the speck of time that we, right now, our generation and the generation before, is 100 years ago, there was no dialysis. 100 years ago, there was no transplant. So when hans had kidney failure, that was it. And now we live in a time where dialysis can be a bridge to a kidney transplant. And so this slide depicts the idea that our first kidney transplant was not that long ago. Now, I think I have to update my slides.
Less than 70 years ago was the first kidney transplant at Brigham and women’s in Boston. , and at that time, we didn’t have immunosuppression, and the lead surgeon had this twin pair where one twin had kidney failure and the other twin didn’t. And he took a kidney from the healthy twin and transplanted it in the twin with a kidney failure and he went on to live eight more years. And at that time, that was a tremendous feat, to have eight more years of life. And so that lead surgeon that tried that experimental surgery ended up winning the Nobel Prize for his work in organ transplantation. So this slide is just meant to show that as awesome as kidney transplant is, it’s such a new thing. Doctors, before seven years ago, didn’t have anything like this. So, as we think about kidney transplant, I want you to understand there’s two main types – a living donor transplant, which is what we recommend for everybody. If you can’t have a living donor, then you’ll enter the waiting list and wait for a deceased donor kidney transplant. The majority of kidney transplants in America are deceased donors, but we recommend patients getting a living donor because you won’t have to wait as long, and it’s a better quality kidney, and they last as long. So two types of transplants, the living donor transplant and the deceased donor transplant. And we always want to promote living donation. So why is transplant so important? So the first reason it’s important because of survival it comes down to life and death sometimes. When we’re talking about dialysis versus kidney transplant, this is a slide looking at the survival of a patient who’s had five years of a kidney transplant, which is, like, still way over 80%, versus the survival of someone who’s been on dialysis for five years, which is, you know, 35% to 40%.
So just, you know, forget traveling and dietary, you know, discretions. If you have kidney failure, you got to get a transplant because it’s, you know, the best option to stay alive. Sounds good. So just get everyone, get a kidney transplant. , what’s the controversy here? Well, the problem is the organ shortage that’s happening in our country.
So this slide shows that in the nineties, the amount of people on the waitlist was just barely over the amount of transplants we were doing. But with time, with the with the aging population, people living longer the dietary issues in this country, and the amount of diabetes in this country, kidney failure has soared, but the amount of transplants that are happening per year, though their highest ever, every year that passes, they’re nowhere near the amount of patients that are entering kidney failure and needing a kidney transplant. So we have a tremendous supply and demand issue in this country. And the blue donors are the living donors and the red is the total number of transplants. So probably two thirds of the transplants we do are deceased donor, and maybe less than one third are living donor. And so if there’s things we can do as a society to increase living donationI think we can only then start to shorten this gap that we see with the wait list expanding and expanding.
This slide is just meant to show, like, there’s a lot of other organs that you can potentially transplant. , but kidney transplantation makes up the majority of the field of organ transplantation. So in this slide, you can see that in 2021, there were 90,000 people that were waiting for a kidney transplant, and we did 25,000 transplants that year, whereas with the livers, there were 11,000 people waiting, and they did 9000. And with the heart, you know, because without the liver and the heart, there is no dialysis. So if a patient passes away, then they’re no longer on the list and they no longer can get a transplant. , so because of dialysis, there’s such a big gap. But more than the gap, you can see the sheer volume of patients is highest with the kidney.So we make up the bulk of the field of organ transplantation. Just some stats. So, current stats we’re currently at 103,000 people in America waiting for a life saving organ transplant. And of that, 103,086% are waiting for a kidney. So again, we make the bulk of it in 2023, that was the highest year in terms of number of transplants in this country at 27,000, highest ever.
But it just pales in comparison to the need for those of us in this la lupus, la group that are here in Socal Southern California. , the transplantation organization of the greater Los Angeles area, which includes Orange County, is called One Legacy. It’s an organ procurement organization, and they’re the ones that will speak to the deceased donors about donating, and then they will coordinate the allocation of those organs to all the local transplant programs every day.
All of us local transplant programs are essentially competing for these kidneys that are procured by the organ procurement organization. It’s not a race to who can get to that hospital the fastest. We have an allocation system in the field of kidney transplantation that’s recognized by an entire country, and it’s divided regionally.So in Florida, for example, the wait time for a kidney transplant might be two to three years. In America, the average wait time for a kidney transplant is about four to five years. Here in southern California, with One Legacy the wait time is the longest in the country, eight to ten years.
When I go to national conferences and I talk about the eight to ten year wait in California or socal people that aren’t from here are, like, gasping in the crowd that I can’t believe people have to wait so long. So m. It’s unfortunate. And the powers that be with organ allocation are definitely working on different strategies of allocation that are not so regionally dismal for our area. So we’ll see, hopefully in the next couple years, if we change that. Butwhat happens is when a donor passes away, depending on the blood type of the donorthe organ is allocated. So if someone is an o blood type recipient, they can only accept an o kidney.
So that’s why the wait time is the longest. But if someone is an AB blood type, an AB person can, accept a kidney from an absolute a, b, a and o. So the pool is bigger, so the wait time is less. And your position on the waiting list is essentially when you start a dialysis. So if I started dialysis nine years ago, but my friend started dialysis nine months ago for the same blood type, my name is way higher on the list because the list is organized by your position when you started dialysis, or when you were listed for transplant before you started dialysis.
So, just a thing to know about organ allocation. If there are local people in the crowd, these are the centers that do transplants in our area. UCIwe do about 170. St. Joe’s across the street does about 80 to 90. UCLA is one of the biggest transplant programs in the country. They do 350 to about 375, sometimes 400 transplants. USC pushes between around 200 cedars, also major transplant program, does 250 to 300 transplants. Loma Linda does 200 plus. And harbor UCLA, a smaller transplant program, does about 25 to 30. Andso anytime a kidney comes in this area all of our programs are offered the kidneys. And depending on where our patients are on the list, based on when they started dialysis and their blood type, then we get the organs. And every donor typically has two kidneys. Soone kidney might go to UCI and another kidney might go to Loma Linda. , and there’s two organs for donors for the most part.
Living Donation
So I want to talk about living donation. Cause I think deceased donation is fine to know about. But who wants to wait eight to ten years for a kidney? I mean, it’s not something we recommend. So the real key, if you have kidney failure, whether it’s from lupus or diabetes or from whatever is, we have to start thinking and talking to our world about finding a living donor.
And when I say world, I mean, like, each person has their own world. If it was me, I would talk to my basketball teammates, I would talk to my friends, I would put a social media blast. I would try to engage anyone around me to help me find a living donor.
And so this is a slide that looks at the change in America in living donation. So, in the past, it used to be that, like, you, you see in the purple, the amount of related donors was a lot higher. So usually you would only ask, like, your loved ones, your mom, your dad, your kid, maybe, your cousin, things like that.
And You know, society has changed now. Now with social media and other creative things that are happening in the transplant community. Unrelated donors are rising and related donors are kind of falling down. , and the overall living donor rate is actually relatively stable. And I think we have to do something about that kind of thing together.
If you can imagine, America has 330 million people and we did 6000 living donors as a country. Let’s say out of the 330 million people, I don’t know, 10 million or 20 million are eligible healthy living donor candidates. We’re only getting 6000 from there and we have this huge pool of people waiting.
I think the real revolution I think we need to see in the next decade is expansion of living donation and , as a whole. Probably another talk. One of the things we did to be creative with living donors is in the past. Let’s say you, you know let’s say, the donor one is my wife and I’m the recipient one.
So my wife wants to donate a kidney to me, but we’re a different blood type so she can’t. So in the past that would be it. They would just say, okay, go home and you don’t have a living donor. But let’s say in the room next to me there is a brother and sister that are also not compatible because they have different blood types.
Then programs started getting clever. They were like, wait a minute, this wife can donate to this brother or, and this sister can donate to this husband. And that was the the beginning of the paired exchange. And that allowed programs to kind of try to increase the amount of living donation by taking incompatible pairs and making them compatible.
Now we took that even further. There are some people that want to donate just out of goodness over their heart. They did nothing, they always had good health. They didn’t know anyone with kidney failure. But they just said, you know, I want to donate a kidney. So if our program had three pairs of incompatible people, we take this altruistic or non directed donor.
Once he donates to the first recipient, then it unlocks all these pairs to donate to another incompatible pair. And eventually multiple people get transplanted. And that was the birth of the, the kidney transplant chain. And , we’re part of, you know, multiple chains. And , now we’re creative where we work with 80 different transplant programs and we have chains where we have kidneys flying from New York, New York kidney flying to St. Louis and the St. Louis kidney flying to us. And , it’s pretty exciting to be a part of. So I’m selling you so far on, you know, the benefits of kidney transplant. Now, what are some situations where someone might not be a candidate for kidney transplant? So, sometimes people have, like, real severe infections where if I shut down their immune system, that infection is going to go crazy. And maybe this ain’t not the right time for a kidney transplant. So a recent infection or even a cancer with no immune system, the cancer could, you know, take, take a hold of the person. So those are sometimes contraindications. If someone had an uncontrolled psych disease, then, and then we, we weren’t sure they would be compliant with their medications or whatever that’s contraindication. Kidney transplantation requires a lot of support. You’re not going to be able to work or drive for a first month. You might need help taking care of you after the transplant for a few weeks. So having some support is important to us. If someone is smoking cigarettes we’re not going to transplant them and try to enhance their health when they’re doing an activity that actively, you know, worsens their health.
Sometimes when you have a kidney transplant candidate and they’re really severe heart disease or liver disease, then maybe they’re not a candidate for a kidney alone and they need a dual organ transplant. Age used to be a contraindication to a lot of programs in the country. For us, we don’t have an age cutoff. You know, age is still a real thing. It’s a biological risk factor. In the past, the cutoff was 70, but, you know, we’ve transplanted people up to 79 that were healthy enough. More important to us is how strong they are, how well you move, how functional you are than the actual age. The other thing I want you to realize is dialysis treatments in the United States are very expensive. Hemodialysis is very, very expensive. Peritoneal dialysis is a little less expensive, but still expensive. And transplantation actually is the most cost efficient. So not only is it saving lives, but it’s also cost efficient. So for the government, which is paying for dialysis, there’s a big push to kind of increase transplantation in this country. And so we’re seeing a lot of initiatives to try to push and promote transplantation.
I’m almost done with my slides, but just want to share some key stats. So southern California, again, has some of the longest wait time for a transplant in the country. Eight to ten years for most blood types. Now, if you have a living donor transplant, you don’t have to wait eight to ten years if you’re compatible with your living donor and both are cleared. You know, at UCI, you can get a transplant between three to six months. If they’re not compatible blood type, then we put them in our national kidney registry chain and we can find a kidney again in just a few months. So, living donations, these numbers don’t apply. Now, let’s say you get a kidney transplant, the first thing patients like to ask me is like, how long is it going to last? They don’t come with expiration dates, but in general deceased donors tend to last about ten to twelve years. It’s just the average. And living donors last upwards of 15, sometimes 20 years. Again, I had transplant patients that have had their organs for 40 plus years. So these are just averages in our area, the average age of a waitlisted patient is between 62 and 64 years. And all transplant programs also are mandated, ah, by the government to have good outcomes. Government doesn’t want you to take a scarce resource and just, like, give it to people that they’re not going to live long or not going to take care of it. So there’s a strict kind of criteria on patient and graft survival that they expect for us. They want us to be successful for patient graft survival, upwards of 95% for the first year. So besides, you know, the mortality benefit and the cost benefit, there’s a huge quality of life benefit.
So when you’re on dialysis, it’s often a very restricted diet. But with the kidney transplant diet is much more liberalized. Patients can kind of eat what they want. They tend to gain weight after transplant, so we often have to kind of hone that in a little bit. traveling on dialysis is very difficult if you’re on hemo, but once you get a transplant you’re free to travel again. One of the most gratifying things for me as a doctor has been being able to take a young woman who thought that she’d never have kids because she had kidney failure.
They get a transplant and she’s able to become pregnant. We’ve had 20-25+ births here in the nine years I’ve been here. And it’s amazing to see young women, you know, start their own families, and all that comes with the kidney transplant. Also, you know just lifestyle constraints – with dialysis, people can work more, bring more money back to their homes and their families.
You know, if they’re in construction, gardening, painting, whatever it is you’re going to have more physical strength and be able to bring more back to your family. So quality of life benefits are very, very important when you think about kidney transplantation. So just to summarize, just the world of kidney transplant compared to dialysis, patients live longer, have a better quality of life, save on overall medical costs, and in our belief, it’s the optimal therapy when you have kidney failure.
I have two slides about how I connect lupus more into kidney failure and transplantation. So when you have lupus end stage kidney disease represents one of the most severe manifestations of lupus. It doesn’t happen to everybody, but when it happens, it is a pretty significant deal. Up to 40% of lupus patients will develop CKD, which is called chronic kidney disease. Doesn’t mean it’s kidney failure, but some level of kidney disease, whether it’s proteinuria or elevation in the lab over the course of their disease, and of these 40% that do develop this chronic kidney disease, 10% of those will then progress to ESRD. Some studies estimate that if a patient has lupus nephritis that 10% to 30% of those will progress to kidney failure. There are different factors and degrees of the lupus nephritis that lead to the variance of those numbers. The one thing I do want to mention is that if you’re a lupus patient, in my world, there are other forms of kidney disease. There’s things like membranous nephropathy, iga nephropathy, focal segmental glomerulosclerosis, and lupus diabetes. These are some of the major ones. And these other diseases can come back and affect the new transplant, and we have to deal with that. Some can come back at the rate of 30 or 40%, but lupus is one disease which has the lowest or most rare kind of rate of recurrence, occurring after transplant. So once a patient has lupus nephritis and kidney failure, their rate of that lupus affecting the transplant is probably the lowest of any other major diseases of kidney failure.
So that’s a little bit of a relief. And some literature quotes 0%, some literature quotes between 2% and 11%. In my nine years, I can count less than one hand how many times we had lupus recurrence. Some of the risk factors for recurrence are young age, black, non hispanic ancestry, and female. There is some data that suggests that plaquenil or hydroxychloroquine decrease the rate of recurrence in some observational studies, but not all patients with lupus are on that after transplant. So that was just a bunch of slides I put together to introduce you to the world of kidney transplant connected a little bit to lupus. And I think maybe now we’ll pause for some questions that had been submitted by you this week, about this topic.
Moderator: Yes, thank you so much, Dr. Reddy! That was a great overview. We do have community questions, so we’ll just dive into those right away. You talked a little bit about some of the causes and different conditions that can cause issues within the kidneys, but, to your knowledge, what causes someone with lupus nephritis specifically to need a kidney transplant? What’s going on in the kidney that requires a transplant?
Dr. Reddy: So, essentially, the question is, like, if you have lupus nephritis, like, you know, what is causing it to make your kidneys fail? And I think that’s a pretty complex question, and I think there’s a lot of variability. So a lot of that comes down to what is the biopsy of the lupus shown on the kidney biopsy, some of these very proliferative. Proliferative lupus nephritis will progress to kidney failure at a faster rate. It’s often decided by what we see on the pathology of the kidney when we biopsy it as to what causes it to progress faster than the others. Some lupus nephritis cases are less aggressive, and they won’t progress as frequently to end stage kidney disease. So, oftentimes it comes down to what’s on the biopsy of the kidney.
Moderator: Okay, got it.
Dr. Reddy: And then you have to think, like, let’s take that question again – when do you need a kidney transplant? A patient is a candidate for a kidney transplant if you’re on dialysis or if your GFR or your glomerular filtration rate or the percentage of kidney function is less than 20%. So you cannot be considered for a transplant if you’re at 30% or 40% only – it has to be less than 20% or you’re on dialysis, and then you can be considered for a transplant.
Moderator: Our next question here is, once you get a transplant, what medications do you have to take forever?
Dr. Reddy: Yes. So there’s a big three that I tell my patients that we use. For the majority of our patients, there are other regimens, but the majority of our patients are on something called tacrolimus. It’s a calcineurin inhibitor, and it’s usually taken once or twice a day, and we check blood levels of it with every clinic visit. And based on the blood levels, we either go up or down. That is like the main drug we use. The other two drugs are very known to probably all of you guys. One is mycophenolate Cellcept or Myfortic. That’s our second biggest drug when you give that twice a day. And our third drug is prednisone – the lupus best friend drug – but we only use five milligrams of prednisone. So in lupus, if you think about some of the side effects you had with prednisone, we, don’t see that to that degree. Cause we use five milligrams of prednisone that the patient usually takes for the life of the kidney. And those three medications represent the bulk of our immunosuppression for a life of the transplant in the majority of our patients.
Moderator: Got it. And in looking at contraindications that you were speaking about earlier, if someone is already on like, a steroid or an immunosuppressant medication that’s affecting, say, like, their white count, would that prevent them as a candidate, or would you wait for labs to normalize before operating or their lab?
Dr. Reddy: Yeah, not always. If the white count is a little abnormal, that shouldn’t affect us too much, again, because of the overlap in transplant and lupus. So what if you’re on myfortic and prednisone, because we’re going to put you on that anyway. So, for me it’s like a plus, actually, because sometimes these drugs are hard to tolerate. Myfortic diarrhea, nausea, vomiting, if I know a patient’s already on it and taking it – I mean -I think it makes our life easier. And I think because of the overlap is why you see the recurrence rates of lupus being so low. Because we probably use more immunosuppression than a lupus patient is getting. And so all of that immunosuppression together will suppress their lupus, too.
Moderator: Got it. So if someone was having an issue with a recent infection, the labs and the infection would be up to the discretion of the nephrologist or the rheumatologist?
Dr. Reddy: Yes. The infection could be a potential problem. So let’s say you got lupus therapy and you’re immunosuppressed and you had some severe pneumonia, and you got called for a kidney transplant. We probably would skip it at that time and let you get through the pneumonia and wait for the next kidney to come.
Moderator: Okay, got it. How long can you stay on dialysis until you need a kidney?
Dr. Reddy: So if you’re on dialysis for a day, you need a kidney. Everybody on dialysis is in need of a kidney. So essentially that question means, like, how long can I live on dialysis? Right? And so that’s going to be different for everybody. You know, the mortality at, five years, I showed you is pretty high. And so the sooner you can get a kidney, the better. And that’s why living donation, getting everyone you know to know about your disease to see if they could be a donor to get tested, that’s going to be key. So the question isn’t, like, how long can I live? Because, you know, we did a transplant last week and The guy was on dialysis for ten years!
Moderator: Wow!
Dr. Reddy: Because our average wait is eight to ten years. So that’s sad, you know, but that’s the norm for us. But that man that’s been on dialysis for ten years, like, all the people he started dialysis with in 2013, like, very few have made it to this point, and now he has to get a surgery. And, like, you know, he went through ten years of, like, you know, struggle. Like, even his ability to improve after transplant is gonna be dissipated. But let’s say he was on dialysis for ten months because he got a living donor, the equation changes dramatically. Soyou can. You can live, you know, beyond ten years sometimes on dialysis. But the goal shouldn’t be that. The goal should be looking as. At dialysis as a bridge to your life of transplant. And what can we do to shorten that bridge?
Moderator: Yeah, absolutely. Hearing You talk about the One Legacy wait list times being higher in socal is absolutely wild. When you highlight that local centers compete for organs within the One Legacy program in SoCal, is that straight time on the list? And the blood type, in terms of who gets a kidney, those are the factors?
Dr. Reddy: Those are the factors. So there’s no, like, you know, wheeling and dealing that can happen. It’s just like, where. When did you start dialysis? When did you start dialysis? And then based on the blood type there are some nuances to the allocation. So some pediatric patients won’t have to wait as long, and they tend to get the better kidneys, and some people that need two organs will jump the list. So if you need a liver and a kidney, then you don’t have a ten year wait. You go right towards the top. There are some nuances, but in general, for someone that’s just waiting on the kidney list it’s your blood type and then how long you’ve been on. On dialysis. that essentially determines your position.
Moderator: Okay, makes sense. Our next question is, will your second kidney be affected if you have a transplant? If you have lupus?
Dr. Reddy: So that’s like asking about the recurrence. So, again, recurrence is. Is rare. I wouldn’t say a zero. But for all the other diseases that affect the kidney, lupus is the best one to have in terms of, like, you know rates of recurrence.
Moderator: We have a question just submitted: What is the pain situation after surgery, and how long do most people need to take pain medication after being discharged?
Dr. Reddy: I like that. So, I would say, you know, for some surgeries, you go, like, two steps back before you go forward. Some, you go one step back. I think kidney transplant is a surgery where you go one step back. So it’s core muscles that are affected, right? So it’s intra abdominal. So even, like, turning from side to side or getting up from a bed position to standing up, you’ll feel it because it’s your core muscles. So there is a little bit of pain, but I would say it’s probably not that bad. Most of our patients are not on pain meds by the time they’re discharged, and some are on pain meds, but there are very few patients on pain meds beyond two weeks. Pain meds – they have their own risks. So if some patients are just so used to taking pain meds a lot of them can get constipated with the abdominal surgery and pain medication, and then it kind of perpetuates even more pain, but I would say that, for the most part, pain is not a huge thing for us. We are a center that does a lot of nerve blocks, too, and so the nerve block at the time of the transplant surgery has helped our patients. Like, in terms of post op day pain, not a particular pain is usually not a huge part for us. I mean, it’s a surgery, so there’s going to be some soreness, right? But it’s not particularly painful. I will tell you that whatever pain is happening – the bliss of seeing a full bag full of urine for a patient that hasn’t peed in, like, five years it’s a pain worth tolerating.
Moderator: Sure. Absolutely. , and then our last question here. What does the donor have to worry about in terms of health issues after donation, if my family member is donating?
Dr. Reddy: For me, I love that question because when I talk about living donation, I speak about it. Like, I take it for granted. Like, oh, there’s so many donors out there. , but the truth is, for a transplant program it is the donor’s health that is first and foremost for us. So all our donors that have donated, I warned them ahead of time that it’s going to feel like we don’t want your kidney. We’re going to do so many tests on you that you’re going to wonder, like, are they just trying to rule me out? But we’re not. We are just trying to cross, like, every t and dot every I to make sure that that person is healthy. This only works when you have, you know, a sick person and a healthy person, and the healthy person donates a kidney and the sick person is better, and the healthy person remains healthy for the rest of their life. So things that we tell our patients that donate are one. , just. I’ll go over the donation process. So once they’re cleared, and I would say if I get ten donors, maybe one or two are cleared. So, like, eight or nine, we either find something or they’re not good enough, or they’re overweight or, you know, they have risk factors themselves. Sowe’re pretty stringent. So you. If you’re a living donor, you’re, like, in, usually in tip top. so if we do it, we do most of our living donors on Monday. Living donors usually go home on Tuesday or Wednesday. So the only one or two days post op. And then after donation, there’s no medication they have to take. there’s nothing they essentially have to do other than just maintain good habits about hydrating well. So I tell my patients, like, when you have one kidney, you want to really make sure you’re one of these people that carry a water bottle, make sure you’re not, like, peeing, like, super yellow urine and hydrate your body. Well, we like to avoid ibuprofen or nsaids, if they have pain. So they were asked to take tylenol if they ever get pain. as far as diet, they can. They can pretty much do what they want. when you have one kidney, when you donate a kidney, probably the thing we will say is like, avoid these, like, high protein only. Only keto, all keto everything. Diets are probably not best when you have one kidney, but as long as they have a reasonable, balanced diet and they take care of themselves, there’s nothing really they need. They don’t, they don’t need to take any medic medications. We will follow them up at one month, six months, one year, and two years. And we recommend they just, you know, get their blood checks regularly. But when you donate a kidney, after you donate one, the remaining one will grow in your body. So it’ll. You won’t be kind of like, you won’t lose 50% of your kidney function, you’ll gain some of it back because the remaining kidney that, you know, we retain will grow a little bit, kind of like a woman in pregnancy.
Your kidneys grow a little bit to meet the fetuses needs. Your. Your kidney will grow a little bit. It won’t be as if you’re having two, but you can live a healthy, normal life with. With one kidney. If you’ve been pre screened and, . And let’s say. And it rarely, rarely happens, but in the worst case scenario, if a person that donated a kidney went on to need dialysis, the way the allocation system is, there’s no wait time. They would go to the top of the list and they would get a transplant even before they started dialysis. And that rarely happens, but that’s just kind of a safe gap that we have.
Moderator: Well, thank you so much for your time, doctor Reddy. This was really helpful. If any viewers are interested in learning more about your practice or UCI’s kidney transplant program, should they just head to the UCI health center?
Dr. Reddy: Yeah. Ah, at the UCI health site, there’s a link, ah, for the UCI kidney transplant program, and you can find more information on there. And we have some videos, too, and. Yeah.
Moderator: Okay, great. We’ll link that in the comments then. Thank you so much for joining us. The recording of this session will be available for a replay here on Facebook, as well as Lupus, LA’s YouTube channel to follow in case there are any sections of the talk that you’d like to hear again. That was a lot of information. , and make sure to follow Lupus LA on social media so that you don’t miss out on upcoming events that we have. Like this one. Thank you so much, doctor Reddy!
Dr. Reddy: Yeah, thank you, everyone!
Want to learn more about Dr. Reddy and the UCI Kidney and Pancreas Transplant Program? Visit https://www.ucihealth.org/medical-services/transplant
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