8 Transplants in 10 days for Solid Organ Transplant

UR Medicine's Solid Organ Transplant team recently performed eight transplants in just 10 days, an uncommon number of procedures given the lack of donated organs available in the Upstate New York region and nationwide.

“I attribute the stellar dedication of the entire multidisciplinary team and the great ability we have, due to our extensive, collective experience with identifying and transplanting appropriate organs,” said Roberto Hernandez-Alejandro, M.D., chief of the Division of Solid Organ Transplant at the University of Rochester Medical Center. “Our mission each day is to save and extend the lives of our patients who come to us from across Upstate New York and northern Pennsylvania, providing them with a second chance with their loved ones. These recent cases are an illustration of that commitment.”

The cases consisted of five kidney transplants, one pancreas transplant, and two liver transplants. Patients hail from Monroe County, Buffalo, Utica and Elmira.

Saving more lives

Hernandez-Alejandro admits it is unique to have this number of procedures in such a short period of time, in part because of the lack of donated organs available for transplant, an issue faced by all transplant programs across the United States.

What has had a positive effect on steadily growing the number of transplants performed at URMC over the past year, resulting in more lives saved, are initiatives Hernandez-Alejandro began to implement upon his arrival to Rochester a year ago when he was recruited from Western University, Ontario, Canada.

Increasing resources

Hernandez-Alejandro has begun recruiting new, additional faculty to the team to support increasing transplant numbers, including:

• hiring the experienced transplant hepatologist Mark A. Levstik, M.D., to serve as medical director of Transplant Hepatology;
• recruiting Koji Tomiyama, M.D., Ph.D., an expert in complex liver transplants, particularly living donor cases, as the team’s fourth transplant surgeon;
• welcoming David Dewolfe, M.D., as a third transplant nephrologist;
• enhancing hepatology support by recruiting Bandar Al Judaibi, M.D., and Marie Laryea, M.D., to the bring the team to four dedicated hepatologists.

Transplant expertise

In his role as director of Liver Transplantation at Western University, Hernandez-Alejandro was a leader in accepting organs from patients who had suffered a cardiac issue that led to their death (known as Donation after Cardiac Death, or DCD). Many transplant centers shy away from this type of donor due to the expertise needed to match donors to recipients and the time constraints that hasten decisions and the transplant itself. If a transplant team is successful in expertly managing DCD donors, Hernandez-Alejandro said, it increases the number of recipients who can be transplanted. More than 15 percent of liver transplants at URMC are now a result of DCD donors, which has helped increase the total volume of liver transplants by 70 percent in just one year.

Half of the eight transplants that recently took place were a result of the gift of life provided by DCD donors, a testament to the proficiency the transplant team has in this area.

Living donor efforts

Because of the low rate of traditional donors, Hernandez-Alejandro also worked to enhance the transplant program’s focus on living donor kidney and liver transplants. Two of the eight transplants were living donor cases.

One was a living donor pair – a husband who donated a kidney to his wife.

The other was part of the paired kidney exchange program, which connects URMC to a consortium of approved academic medical centers across the country. It allows living donor kidney donors, who are not a match for a known recipient such as a family member but are still willing to donate, to give their kidney to a stranger in need of transplant, and in turn their loved one receives an organ from a similar donor. The paired kidney program is headed by transplant surgeon Randeep S. Kashyap, M.D., and transplant nephrologist Jeremy G. Taylor, M.D.

URMC has participated in 12 paired exchanges over the past three years. 

Multidisciplinary approach

“I am fortunate to work with one of the best and most enthusiastic transplant teams ever assembled,” Hernandez-Alejandro said. “Nothing great has ever been achieved without enthusiasm.”

The surgeries were performed by transplant surgeons Mark Orloff, M.D., Randeep S. Kashyap, M.D. and Koji Tomiyama, M.D., Ph.D., as well as by Hernandez-Alejandro.

The team included transplant hepatologists Mark A. Levstik, M.D., medical director of Transplant Hepatology, Bandar Al Judaibi, M.D., Gopal Ramaraju, M.D. ?and Marie Laryea, M.D.; transplant nephrologists Jeremy Taylor, M.D., associate director of the Transplant Service Line, David Dewolfe, M.D., and Mohammad Karim, M.D.; dedicated transplant anesthesiologists Joe Dooley, M.D., Keith Franklin, M.D., Jeff Kolano, M.D., Stewart Lustik, M.D., Laura A. McElroy, M.D., and Christopher F. Galton, M.D.; transplant psychiatrist Mark Nickels, M.D.; infectious disease specialist Paritosh Prasad, M.D.; and David C. Kaufman, M.D., director of the Surgical Intensive Care Unit.

They also were supported by the OR team, transplant coordinators, pathologists, pharmacists, nurse practitioners/physician assistants, social workers, dieticians and nurses, all who are essential to the ongoing success of the program.

Additionally, the transplant program relies on the Finger Lakes Donor Recovery Network (FLDRN), the organ procurement organization affiliated with the University of Rochester Medical Center that coordinates organ donation with hospitals throughout the Finger Lakes Region, Central and Northern New York.