Comprehensive Strategies Cut Waiting Times in Half
Transplant surgeons at the University of Maryland Medical Center say they have successfully reduced barriers to kidney transplantation for African-Americans to cut the median waiting time for transplant in half. Their achievement stems from a comprehensive program that includes patient education and efforts to increase living donation and improve overall kidney graft survival. Results of their decade-long strategy are being presented today (April 25) at the American Surgical Association national meeting in Hot Springs, Virginia.
Lead author of the report, Clarence E. Foster, III, M.D., a transplant surgeon at the University of Maryland Medical Center, says African-American patients now have a median waiting time of 681 days to receive a transplant at the medical center. Nationally, according to the United Network for Organ Sharing (UNOS) database, African-Americans wait about 1,335 days.
African-Americans encounter several barriers to kidney transplantation. "Doctors traditionally have been less likely to suggest transplantation to their African-American patients because of lower rates of kidney survival and a higher rate of acute organ rejection," says Dr. Foster, who is also an assistant professor of surgery at the University of Maryland School of Medicine.
"As a result, African-Americans are less likely to be referred for transplant, they are placed on transplant lists less often after evaluation and end up waiting much longer because fewer organs are available that are a good match," adds Dr. Foster.
The University of Maryland Medical Center has the largest kidney transplant program in the United States. During the past ten years, over 2,100 kidney transplants have been performed. Forty-three percent of the Maryland transplants were in African-Americans, significantly more than the UNOS-computed national average of 32 percent.
Stephen T. Bartlett, M.D., director of Transplant Surgery at the University of Maryland Medical Center and an author of the study says, "The success of our African-American outreach comes from our efforts to eliminate barriers to transplantation and our focus on educating patients about living kidney donation." This focus is important because transplant waiting lists continue to grow, while cadaver organs remain in short supply.
"Our outreach includes an education program that is sensitive to minority patients and a video that highlights the benefits of living organ donation. Also, the development of laparoscopic surgery to retrieve a kidney from a living donor, with its small incision and faster recovery, has made more recipients consider discussing donation with their loved ones, whereas they were reluctant to do so before," says Dr. Bartlett, who is also a professor of surgery and medicine at the University of Maryland School of Medicine.
Surgeons at the University of Maryland Medical Center use hepatitis C positive donors for recipients who are also positive for hepatitis C. The virus affects about 6 percent of dialysis patients. They also encourage vaccination for hepatitis B, to allow safe transplantation of kidneys from people with past, inactive hepatitis B virus.
Dr. Foster says this practice helps African-Americans, because of a higher prevalence of hepatitis in that population. Hepatitis B and C are blood-borne infections that affect the liver. Vaccinations can prevent the spread of hepatitis B, but there is no vaccine for hepatitis C. The Centers for Disease Control and Prevention report African-Americans are twice as likely as whites to be infected with the hepatitis C virus. As for hepatitis B, the CDC says African Americans are three-to-four times as likely to be infected as whites.
Dr. Foster says use of these organs is safe, but "it would be impossible to implant them in individuals who are not already infected with hepatitis C, or vaccinated against hepatitis B."
Dr. Foster says these combined strategies result in earlier transplants, often before the patient is sicker, which leads to better outcomes. The comprehensive outreach at the medical center has also benefited non-African-Americans, whose average waiting time for a transplant is 391 days, well below the national waiting time of 734 days, as calculated by UNOS.
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