Geisinger Wyoming Valley has now given the gift of life to more 100 kidney transplant patients, including one that accepted a donated kidney from Greece, as the facility’s transplant program continues to thrive.
Chintalapati Varma, M.D., Geisinger’s director of transplantation surgery, explains that the program began in the Wyoming Valley in July of 2006. At that time, the health system’s transplant team had to travel from Danville. However, by 2007, the system hired staff specifically for Wyoming Valley.
Today, Geisinger Wyoming Valley boasts impressive transplant success rates. On a national scale, 92 percent to 94 percent of transplanted kidneys are still functioning one year after surgery. At Geisinger Wyoming Valley, success rates stand at a solid 94 percent.
Although kidney transplants as a life-saving procedure are not new, the procedure is new to NEPA. Dr. Varma explains that the first kidney transplant was attempted in the 1950s on a set of identical twins from New England. The fact that donor and recipient were genetically identical helped deter rejection. Since then, the transplant process has come a long way.
Modern transplants such as are being done at Geisinger Wyoming Valley match blood and tissue types and antigens between donor and recipient. Certain combinations are preferable, and better matches lower cases of rejection.
“We also look for antibodies in the organ recipient from past activations of the immune system during infection, blood transfusion, or pregnancy,” says Dr. Varma. “These may attack the transplanted organ, and rejection can take different forms, and can be immediate.”
Dr. Varma explains that, as a rule, the life of a transplanted organ, also referred to as a graft, can now be forecast. Kidneys recovered from a cadaver function for eight to 10 years, but functional life rises significantly if a kidney is donated by a living relative.
Approximately 75 percent of donor organs are harvested from a recipient’s live family members, friends, church peers, or an altruistic public. The donation is completed laparoscopically, requiring only a two-day hospital stay but also a six- to eight-week recovery period for the donor.
Pharmaceutical breakthroughs to inhibit rejection also play a role in transplants. Physicians now use a “shock and awe” approach, where powerful drugs — and possibly antibodies — are administered immediately to the organ recipient.
Transplant patients must accept that they will need maintenance on immune-suppressing and infection-fighting drugs for as long as the transplant functions. Costs for these medications total $18,000 to $20,000 for the first year, but only make up a small part of the total $250,000 in costs required to transplant a kidney.
Geisinger employs specially trained transplant coordinators, social workers, and financial counselors as part of its transplant team.
Candidates for transplant receive head-to-toe tests for conditions that might affect their survival, including screening for diabetes, drug and alcohol abuse, cardiac problems, and digestive irregularities.
“Obesity also is a major problem for transplant candidates,” says Dr. Varma. “All of the screening we do is directed at creating a good outcome for the transplant patient.”
Geisinger in Danville also implants livers and pancreases. The system as a whole participates in The Gift of Life program, which obtains and delivers organs to transplant centers in Pennsylvania. Additionally, the Geisinger system takes part in the expansive Kidney Paired Donation (KPD) Program, which is an option for recipients who have a living donor who is an incompatible match due to blood or tissue type.
On a disappointing note, Dr. Varma points out that the waiting list in Pennsylvania for a cadaver kidney can be very long, with a median time of five to six years. This contrasts with kidney transplant time in Florida, which averages waits of less than three years.
“We are dealing with organ allocation disparity problems,” say Dr. Varma. “At Wyoming Valley, we have about 150 people waiting for a kidney, and the number at Danville is the same. In the city of Philadelphia, there could be 800 people waiting for a kidney at any given time.”
Obviously, Pennsylvania’s Northeast region has strong competition for organs. However, things may deteriorate a bit when the regional organ allocation system is changes next year. Dr. Varma states that the revised system will not favor potential kidney recipients in Geisinger’s region.
“As a rule NEPA has older patients. Because the ages of donor and recipient are matched, it creates a problem here with organ availability,” say Dr. Varma.
Another challenge facing the Geisinger transplant team involves the awareness of local patients and physicians that an excellent transplant program is now in their own backyard. Travel for an organ recipient with any medical complications can be very tough — both for patient and family. “The NEPA region has a large geography, and this creates challenges for us to spread the word that we have a first-rate transplant facility right here,” says Dr. Varma.
The experience of Anthony Lupinski of Luzerne, a Geisinger Wyoming Valley kidney transplant patient, illustrates the fact that kidney transplants are almost becoming routine.
Lupinski, who works as a grocery seafood manager, has actually received two kidney transplants over a 26-year period.
Lupinski’s first transplant, which was performed at Geisinger in Danville, was needed after the youth was experiencing kidney failure due to the effects of repeated strep infections. Five years ago he again began to feel ill, and diagnosis confirmed that the transplanted kidney was failing, requiring medications and life-saving dialysis.
In June of 2013 Lupinski was once again on the transplant table, this time at Geisinger Wyoming Valley, and received a cadaver kidney from a 31-year-old donor in Philadelphia. He felt an immediate improvement to his health after the operation and was pleased that the surgical incision was about half the size of his first scar.
Lupinski returned home three days after the transplant and also noticed the effects age played in his (longer) recovery period. However, today he is back at work and thankful to once again have received the gift of life.
“The Geisinger Wyoming Valley transplant team has been just great helping me with this experience,” adds Lupinski. “This includes counseling about all of the financial implications, which are always a factor with a transplant.”