Our ProgramThe Kidney Transplant Program at the USC Transplant Institute is part of the multi-organ transplant program at Keck Medicine of USC in Los Angeles. The transplant program is considered a Center of Excellence for Aetna, Anthem Blue Cross, Cigna Life Source, Humana, Interlink, Optum and Medicare, which ranks it in the top 10 percent of all transplant centers nationwide in quality.
Keck Medical Center of USC in Los Angeles is one of the few medical centers in the country to offer “bloodless” transplant surgery, involving several procedures that forego the need for transfusions during surgery.
The program is part of a multi-center, multidisciplinary system at Keck Medical Center – including Keck Hospital of USC and USC Norris Comprehensive Cancer Center – and LAC+USC Medical Center. As part of an academic medical center, we are able to combine the latest research, advances in patient treatments and education to provide the best possible patient care.
Our renowned team of experts provides patients with a comprehensive approach to transplant patient care. Our physicians are involved in all aspects of treatment from the pre-transplant evaluation through the transplant procedure and into post-transplant immunosuppression management and long-term care. Our transplant programs are members of the United Network of Organ Sharing (UNOS), the central agency that coordinates the nation’s organ transplant system.
More than 700 kidney transplants have been performed at Keck Medical Center of USC in Los Angeles and LAC+USC Medical Center in the last seven years. In 2014, the Kidney Transplant Program at Keck Medicine of USC performed 123 kidney transplants. The previous year, 116 kidney transplants were performed.
Our one-year survival rates are among the highest in the Los Angeles area. The one-year survival rate of kidney transplant recipients is 98.55 percent. Graft survival after one year is 97.5 percent.
The three-year survival rate of kidney transplant recipients is 95.2 percent.
Three-year graft survival rate is 89.5 percent.
Survival rate of kidney transplant recipients:
Patients with end-stage renal disease (kidney failure) are candidates for a kidney transplant.
The treatments available for end-stage renal disease include two types of dialysis (one that filters your blood and another that filters wastes from blood through your abdomen) and kidney transplantation. Many patients who are accepted for transplantation have had previous dialysis treatments.
Before being accepted for transplantation, a multidisciplinary transplant team will provide patients a complete evaluation. Pre-transplantation tests help identify potential problems before they occur and help determine whether transplantation is truly the best option. This increases the likelihood of success.
If a patient is positively evaluated for transplantation, he/she is placed on the kidney transplant waiting list with the national United Network for Organ Sharing (UNOS), which matches living or cadaveric donors with potential transplant patients.
Receiving a TransplantThe USC Transplant Institute offers the following types of kidney transplants:
A bloodless transplant is a transplantation that is performed without a blood transfusion. This procedure involves surgical care without the transfusion of blood products. This technique has long been applied to patients who have specific spiritual beliefs, but it is now experiencing widespread popularity with other patients due to the lessened risk of infection and immunologic complications. Keck Medical Center of USC in Los Angeles uses a multidisciplinary approach to eliminate the need for the transfusion of blood and blood products. The strategy is to build up the body’s own reserve of blood components prior to an operation and perform all surgeries in a fashion that minimizes blood loss.
Keck Medical Center of USC in Los Angeles is one of the few medical centers in the country to offer “bloodless” transplant surgery, involving several procedures that forego the need for transfusions during surgery.
A cadaveric donor transplant is a transplant using an organ from a person who has been diagnosed as “brain dead” but whose other organs are functioning properly. These procedures make up the majority of kidney transplant surgeries. A potential transplant recipient, once evaluated, is placed on a transplant waiting list maintained by the United Network for Organ Sharing (UNOS). Once a donor is found that matches you, the transplant takes place often within hours of learning about the match.
A live donor transplant is a procedure in which a living person donates one of his or her kidneys to another.
In a minimally invasive (laparascopic) live donor transplant, it is possible for the surgeon, using narrow instruments inserted through punctures no more than a half-inch long, to free up the kidney and tie off blood vessels. A short incision about 2 ½ inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost. The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.
In a kidney-pancreas transplant, patients receive both a kidney and a pancreas. Some clinical studies show that diabetic patients undergoing kidney transplantation alone have higher organ rejection when compared with undergoing kidney and pancreas transplant procedures together. Most centers will transplant both kidney and pancreas together from the same donor. Monitoring is then done for the rejection episodes of both organs via the kidney graft. Most patients enjoy a normal life away from dialysis and reduced threat of hypoglycemic or hyperglycemic episodes. This operation takes approximately five to seven hours, and most patients are hospitalized for two to three weeks.
What to Expect
If you will be receiving a kidney from a living donor, your surgery can be scheduled for a specific date. However, for a cadaveric donor transplant, it may take days or even weeks for UNOS to locate the right kidney for a specific patient. In addition, you will have to report to the hospital very shortly after a cadaveric donor is found and validated. While waiting to hear of a match, you should prepare as much as possible and take steps to deal with the stresses of waiting, always staying focused on reaching the goal of transplant.
Your telephone is your lifeline
When a donor kidney becomes available, the coordinator will call you to get ready. Since this call could come at any time, the transplant team must be able to reach you whether you are at home, at school, at work or on vacation.
Be sure to provide your team with the phone numbers of family members and close friends as well, and do everything you can to make sure that you can be contacted immediately.
When the phone call comes
When your transplant team calls you, everything will move very quickly. Stop all eating and drinking. The transplant coordinator will advise you when to arrive at the USC Transplant Institute. You must get to the institute without delay. When a kidney becomes available, there is a time limit!
Make a list, pack ahead of time
Pack an overnight bag in advance as soon as your name is put on the UNOS waiting list. Make a list of items you will need in the hospital after surgery such as medications, as well as a list of people to be contacted when the kidney becomes available. Give this list ahead of time to a trusted family member or friend to pack any last-minute items and make the calls while you are on your way to the transplant center.
Getting to the transplant center
If the USC Transplant Institute is nearby, plan to have a designated driver – if possible – who will be standing by when the phone call comes. This person should be available at all times and reachable by phone. If the transplant center is farther away, the transplant coordinator can assist with transportation arrangements.
Preparing for Surgery
When that important phone call comes, bring the following to the hospital:
- a list of all the medications you are taking
- a list of your drug allergies, if any
- your health insurance information
IMPORTANT: As soon as a kidney is available, stop all eating and drinking immediately. Your stomach must be empty when you are taken into the operating room. Talk to your transplant coordinator about continuing or discontinuing any medications.
At the Hospital
After admission to Keck Hospital, you will have a thorough physical examination, including more blood work, a chest X-ray, an EKG and possibly other tests.
Unfortunately, surgery must be postponed in some cases. You will be sent home if you have an infection or developed any other medical problem that would interfere with surgery or recovery, or if the donor kidney shows signs of deterioration or poor function. If surgery is postponed, the transplant team can help you through the disappointment. This is only a temporary setback, and the search for a new kidney will resume once you have recovered from any medical problem or a new donor is found.
Preparing for Transplant
You may receive an enema to clean out your intestines and prevent constipation after surgery. Your chest and abdomen will be shaved clean to prevent infection, and an intravenous (IV) line will be inserted to give medication and keep you from getting dehydrated. You will also be given a sedative to help you relax and feel sleepy before going to the operating room.
You will be under general anesthesia throughout the surgery. Once asleep, the transplant surgeon will make an incision on the right or left side of the lower abdomen just above the groin. The surgical team will then place the donor kidney into the abdomen and connect the kidney’s blood vessels to the recipient’s iliac artery and vein. The surgeons will then connect the ureter to the bladder. A small drain may be placed into the abdominal cavity to drain any excess fluid. In the case of a live donor transplant, a team will operate on the donor to remove his or her kidney, and your team will replace your diseased kidney with the donated organ.
IMPORTANT: Because transplantation is a major surgical procedure, you may need a blood transfusion. Today, all blood is screened very carefully and the likelihood of contracting a disease is very small. Any concerns you have regarding the source of blood should be relayed to the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of “autotransfusion,” which is when a patient donates his or her own blood in advance well before surgery. The blood is stored and then used during transplantation.
After the surgery is completed, you will wake up in the intensive care unit (ICU) after the anesthesia wears off.
- You will probably feel some pain and discomfort, which medication will help to relieve.
- A tube will have been inserted through your nose, running down the throat and into your stomach. This tube will keep your stomach empty and help prevent nausea and vomiting.
- A tube may have been inserted into your throat to help you get enough oxygen. It will be connected to a breathing machine called a ventilator. Relax and let the machine breathe for you. You will not be able to talk with this tube in place, but you will only need it for a few days. Nurses will do everything they can to help you communicate. Your throat may feel sore or scratchy for a few days after its removal.
- You will be asked to cough periodically to keep your lungs clear. If it hurts to cough, ask someone to support your abdomen.
- You will still have an IV line in your arm or neck under the collarbone for the first few days after surgery in order to receive fluids and medication.
- For several days after surgery, you will have a catheter in your bladder to drain urine. You may feel uncomfortable and feel a need to urinate constantly, but the feeling is only temporary.
The length of a hospital stay will depend on your progress. Most patients can expect to be in the hospital between 12 and 30 days.
Acute Care Unit
After your medical condition has stabilized, you will be transferred from the ICU to the acute care unit. During your say here, laboratory studies, medications, nutritional status and exercise tolerance will be monitored. As soon as you are able, discharge instructions will begin to prepare you for going home.
Clinic and follow-up visits
Upon leaving the hospital, you will receive a schedule of follow-up clinic visits for lab tests and checkups. These are set up to track your progress and detect potential complications as early as possible.
At home, you will continue taking most of the medicines you began taking in the hospital after the transplant surgery, especially anti-rejection medications. Your immune system recognizes the new kidney as foreign and will try to reject it. Therefore, your immune system must be controlled with immunosuppressive medications. You probably will have to take one or more of these drugs for the rest of your life, in addition to other medications.
Talk to your physician, pharmacist, transplant nurse and/or coordinator to understand fully:
- the name and purpose of each medication
- when to take each medication
- how to take each medication
- how long to continue taking each medication
- principal side effects of each medication
- what to do if you forget to take a dose
- when to order more medication
- how to order or obtain medications
- what to avoid while taking medications
About Your KidneysThe kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. About the size of a fist, they are protected by other organs and two lower ribs. Normal functioning kidneys serve the body by:
- Cleaning your blood and removing waste products
- Controlling the amount of potassium, calcium, magnesium and phosphorus in the blood
- Balancing water and salt to control fluid in the body
- Helping make red blood cells and strong bones
- Controlling blood pressure
Inside each kidney, blood vessels contact millions of tiny structures called nephrons. These filter waste, water and other chemicals from the blood. These become urine, which is collected by tubes called ureters. The ureters then transport the urine into the bladder, where it is eventually excreted.
Most of the time, kidney disease is caused by damage to the nephrons. This damage can be caused by injuries, disease or certain medicines. People with diabetes, high blood pressure or a family history of kidney disease are at greater risk of having kidney disease. Chronic kidney disease takes place usually over a long period of time, but can eventually damage the kidney enough to require dialysis and transplant.
Symptoms of kidney disease may include:
- Fluid retention
- Shortness of breath
- Change in mental status
- Abnormal urine or blood test results
- High blood pressure
It is important to discuss any symptoms with your physician and ensure that a proper diagnosis is made before determining the proper treatment of kidney disease (including transplantation).
The following procedures are used to evaluate a patient’s health status:
Chest X-ray – determines the health of the patient’s lungs and lower respiratory tract.
Electrocardiogram (EKG or ECG) – determines how well the patient’s heart is working and may reveal heart damage.
Ultrasound – ensures all of the main blood vessels leading to the kidney are functioning normally. This test is also used to check for collections of fluid, such as blood.
Computerized tomography (CT) scan – allows the physician to view the patient’s kidney from many different angles to detect infections, fluid collections, or other problems.
MRI (magnetic resonance imaging) – may be used in place of CT scan or ultrasound to see inside the patient’s body.
Blood tests – used to check the patient’s blood count, blood and tissue type, blood chemistries and immune system function. In addition, blood tests for certain infectious diseases will be performed. These tests include measurements of:
- WBC – reveals whether your white blood cells have increased (usually a sign of infection) or decreased (indicating a lower defense against infection).
- HCT – hematocrit, which is the percentage of red blood cells in the blood. Red blood cells carry oxygen to all parts of the body. When your HCT is low, you may feel tired or have little energy.
- PLT – the level of platelets. Platelet cells form blood clots when the body is injured. Low platelet levels may cause someone to bruise easily and bleed for a longer time when injured.
- Creatinine and BUN – reveals how well the kidneys work by measuring levels of creatinine and blood urea nitrogen, which are waste products normally removed from the blood by the kidneys.
- Ca – calcium, necessary for strong bones and teeth, blood clotting, and heart and nerve function.
- PO4 – phosphate, which works closely with calcium to strengthen bones.
- Mg – magnesium, which is necessary for normal functioning of muscles and for blood clotting.
- K – potassium, which is needed for normal heart and muscle function.
- Na – sodium, which helps maintain the balance of salt and water in the body.
- CO2 – bicarbonate, which helps maintain acid balance in the body.
- Glu – measures glucose, levels of sugar in the blood; some medications may produce a diabetes-like condition in which blood-sugar levels are too high.
Drug level tests – measure Tacrolimus (Prograf®) or Cyclosporine (Sandimmune®) in the blood. Tacrolimus or Cyclosporine blood levels must be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection. NOTE: The desired level (normal range) of these drugs will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant.
Pulmonary function test – reveals how well lungs are working and determine the blood’s capacity to carry oxygen.
Upper gastrointestinal (GI) series – will show whether the patient’s esophagus and stomach are disease-free.
Lower GI series – ensures that the patient is free of intestinal abnormalities.
Renal function studies – urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.
Tissue typing – done on white blood cells. White blood cells have special “markers” that distinguish “tissue type,” which are used to find a matching kidney.
Panel Reactive Antibody (PRA) – A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient’s immune system is calm or measures 0%. An immune system may be active from blood transfusion, pregnancy, a previous transplant or a current infection.
Viral testing – determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome.
Mammogram – X-ray of a woman’s breast that can detect signs of breast cancer.
Pap smear – Cells are collected from a woman’s cervix and microscopically analyzed for signs of cancer.
Echocardiogram – Reveals any abnormalities in the heart.
Dental Evaluations – patients need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.
Crossmatch Testing – done when a donor kidney is available. Your blood is mixed with the donor’s blood. If there is no reaction (negative crossmatch) it means you are “compatible” with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is “incompatible.”
Clinical TrialsFor more information about kidney disease and kidney transplant clinical trials, contact the transplant coordinator office at (323) 442-6074, or Linda Sher, MD, director of research at the Kidney Transplant Program at (323) 442-5908.
The kidney transplant program at Keck Medical Center of USC is a Center of Excellence for Aetna, Anthem Blue Cross, Cigna Life Source, Humana, Interlink, Optum and Medicare.
People of any age with end-stage renal disease requiring dialysis or a transplant receive coverage from the federal Medicare health insurance program. If you have not had Medicare previously, you can sign up for Medicare coverage of end-stage renal disease. Contact us so we can help you determine whether pre-authorization or special testing is required in advance of your visit. You should check to make sure whether or not you are responsible for any co-payments. Please bring your insurance card with you to all your appointments.
Your Transplant Team
Each skilled health care professional who makes up the transplant team takes a personal interest in answering your questions and taking care of your medical needs. They will also help keep your spirits up through recovery. Your physical, emotional and practical needs will help them shape a personalized pre-transplant and post-transplant treatment program.
The transplant surgeon performs the actual transplantation procedure and monitors medication before, during and after surgery. He or she will assess the quality of the donor’s kidney before surgery and monitor your health and kidney status following transplantation. He or she will also check your medication needs and periodically check the incision to make sure it is healing properly.
A transplant physician (nephrologist) monitors all non-surgical aspects of patient care for kidney transplants. You will see this doctor often. The transplant physician performs examinations, checks test results and adjusts medication as needed. Don’t be shy in asking questions and alerting this physician regarding changes in the way you feel, no matter how insignificant it may seem.
The transplant coordinator, usually a registered nurse, will have two key responsibilities:
- He/she will coordinate all events leading up to and following surgery. These may include scheduling pre-transplant testing, locating a donor kidney, testing for donor compatibility, contacting you once a kidney has been found and making sure that you have proper follow-up care.
- Teaching you how to take care of yourself before and after transplantation, including how to take medication and when to return to the transplant center for follow-up visits. He or she can put you in touch with community services that will make life easier for you and your family.
Nurse practitioners are responsible for monitoring your daily status and care, and will meet with you regularly during your clinic visits. They will provide patient and family education, including teaching you how to check your vital signs and identify any signs of infection. They will help you learn how and when to take your new transplant medications. They play an important role in alerting the team to any potential problems.
The floor or staff nurse will help coordinate activities of your other caregivers, as well as tending to your needs during your hospital stay and preparing you for discharge.
A physical therapist will set your exercise limits after surgery and will advise when it is safe to increase activity. Exercise will improve your circulation, make you feel stronger, help avoid excessive weight gain and increase your sense of well-being. Ask your therapist to help devise an exercise plan that will be beneficial.
A dietitian, following doctor’s orders, will create a special diet plan that will help you stay healthy and avoid excessive weight gain after surgery. Follow the diet plan prepared specifically for you. Proper nutrition can speed recovery and help a patient stay healthy.
A psychologist/psychiatrist can offer insight and support along every step of the procedure. You and your family members may find it helpful to talk about your feelings with a professional before and after surgery. Frank discussion may help you cope with the transplant experience and with the changes it will make in your life.
The social worker will link you to services and people in the community who can help with recovery after leaving the hospital. If you need transportation, help at home or a hand when going back to school or work, the social worker will help arrange it. The social worker can also advise about Medicare, Medicaid and other insurance coverage, as well as help with psychosocial and family matters.
The pharmacist will be available to educate you and your family about the medication that will become a regular part of your life before and after surgery. He or she can give advice about drugs, including the immunosuppressive medications that will help prevent the body from rejecting new kidneys.
The United Network for Organ Sharing is the national organization for registering, waiting list management and matching of donors and organ recipients. UNOS is responsible for matching all organ donations in the United States, including liver transplants. Physicians register qualified patients on the list. Visit http://unos.org for more information.
USC Kidney Transplant support group
The group is a place for patients to mutually support each other while awaiting a kidney transplant.
USC Hepatobiliary Program
The USC Division of Hepatobiliary, Pancreas and Abdominal Organ Transplant at the Keck School of Medicine consists of health care professionals who specialize in the following hepatobiliary and pancreatic procedures in addition to kidney transplants: liver surgery, pancreatic surgery, gallbladder and bile duct surgery, and portal hypertension surgery.
American Association of Kidney Patients
3505 East Frontage Rd., Ste. 315
Tampa, FL 33607
American Kidney Fund
6110 Executive Blvd., Ste. 1010
Rockville, MD 20852
Dialysis Patient Citizens
900 7th St., NW, Ste. 670
Washington, DC 20001
National Kidney Foundation, Inc.
30 East 33rd St.
New York, NY 10016
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892
Donate Life California
Donate Life California is the state-authorized nonprofit organization responsible for managing the organ, eye and tissue registry. It saves lives by inspiring people to sign up with the state organ, eye and tissue donor registry. Visit donatelifecalifornia.org for more information.
The Kidney Transplant Program at Keck Medical Center of USC in Los Angeles boasts experts from several specialties. Specialists include seven transplant surgeons, three transplant nephrologists, social worker liaisons to dialysis centers, transplant-trained registered nurses, transplant coordinators and an expert clinical trials team.
Medical Team (Nephrologist)
Miroslaw Smogorzewski, MD