University of Maryland Medical Center Study Shows New Approach Expands Donor Pool
Four years after starting to use a new, less invasive approach to remove a kidney from living kidney donors, surgeons at the University of Maryland Medical Center in Baltimore say the procedure has opened the door to many more donors for patients in need of a transplant. They credit the new technique, as well as an educational program for patients and family members, for making more living donor transplants possible.
Results of a study on the impact of laparoscopic kidney removal will be presented at an American Surgical Association meeting in Philadelphia on April 7 by Stephen Bartlett, M.D., professor of surgery and medicine at the University of Maryland School of Medicine and director of Transplant Surgery at the University of Maryland Medical Center in Baltimore.
"The educational program and the less-invasive method of donating a kidney have more than doubled the chance that a patient with kidney failure today will receive a transplant from a friend or loved one, compared to just a few years ago," says Dr. Bartlett.
Before the University of Maryland Medical Center began offering the educational program and the laparoscopic technique, 35 percent of its newly evaluated patients were able to find someone to be tested as a donor, and only 12 percent went on to have a live donor transplant.
With the educational program and the less-invasive removal technique in place, half of the patients found at least one possible donor to be tested, and 25 percent ultimately received a transplant from a living donor.
The University of Maryland Medical Center, which has the nation's largest kidney transplant program, has performed the most laparoscopic kidney removals from living kidney donors in the world, more than 460.
The educational program for patients and their family members, which includes a video and discussion with transplant nurse coordinators, began in October 1994. The medical center became the second institution in the world to perform the laparoscopic technique in March 1996.
Using the laparoscope, surgeons only need to make a small incision near the navel, about two-and-a-half inches wide, as well as four small holes in which they insert instruments. The laparoscope contains a miniature camera and surgeons watch what they are doing on a video monitor. When the kidney is disconnected, they use their instruments to wrap it in a plastic bag and slide it out of the small incision.
The traditional, "open" surgery requires an incision of about ten inches long, which cuts through abdominal muscles and takes a long time to heal. Donors stay in the hospital about six days and need about six weeks to recover. In contrast, the new technique allows a kidney donor to leave the hospital within two days and return to work or normal activities with two weeks.
"We believe that this less-invasive approach will have a tremendous impact for thousands of people who need a kidney transplant. More than 44,000 people are on a waiting list nationwide," says Dr. Bartlett. "The waiting list grows by around 17 percent each year, and that is why living donors are so necessary."
Four years ago, about 25 percent of the University of Maryland Medical Center's kidney transplant patients received their organ from a living donor. Today, more than 40-percent of the kidney transplants come from living donors. Dr. Bartlett and his colleagues credit the faster recovery of the donor and excellent results for the recipients for the surge in the number of people who now volunteer to donate a kidney to a loved one.
The study showed that kidneys removed from donors with the laparoscopic technique were still functioning in 94 percent of the recipients after one year. After three years, 90 percent of the kidneys were still working.
From May 1991 to February 2000, the University of Maryland Medical Center evaluated 3,298 patients with end stage renal disease for possible kidney transplant. Of that group, 620 patients went on to identify a living donor who was able to provide them with a transplant. The transplant surgeons say not only does the laparoscopic technique make it easier for someone to donate a kidney now, a person who needs a kidney finds it easier to ask a loved one to donate.
Among the living donors who had the laparoscopic technique of kidney removal, 32 percent were distant relatives or were unrelated to the recipients, and 39 percent traveled from outside of Maryland to donate their kidney.
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