Totally Transplant

Send us Fan Mail

Drs' Nadig and Samra talk about the wave of invention and innovation coming up in the world of Transplantation. 

Dr. Nadig shares his path to transplantation which he describes as a calling. 

Has had world-class training. He has worked on Regulatory T cells as part of his his PhD and are currently in clinical trials at Northwesterm.  project. 

Northwestern is also part of the first FDA trial on Xenotransplant Trial. 

"Do you what you love and call it work."

They 1950s- 1970s was the start/birth of Transplantaion and the Era of Immunosuppression with Cyclosporine 

1980s The Era of preservation. Transplanting organs across state lines. 

Then the Era of Technique -minimal invasive surgery, laparoscopic donor nephrectomy and split liver transplantation. 

We became better at immunosuppression and Extending criteria for donation. 

Right now we are at the era of Technology : with robotics, nanotherapeutics, xenotransplantation and CRISPR gene editing 

Tolerance is on the horizon(tolerance induction protocols- getting patients off immunosuppression). 

As is safely performing transplants as an outpatient procedure with spinal anesthesia and a less than 24 hour hospital stay. In selective patients, not on anticoagulation. May help in pateint who are older, who have had mandibular cancer, who have had lung tranplants, or those with allergies to anesthesia. 

Xenotransplant trials as well.  

Tolerance protocols: Right now it is limited to living donor kidney patients. 

Stem cells from the donor go into the recipient. Recipient gets cytoablative therapy and becomes a donor chimeric and are able to maintain their graft. 

Regulatory T- cell therapy trials are starting soon, to include deceased donor transplants. Donor Antigen specific regulatory T cells will be isolated,expanded and infused into patients pre- implant and perioperatively and patients are followed up with protocol biopsies. 

Targeted drug delivery to the organ(rather than the recipient), using 1/10th of the dose and delivering it directly to the endothelium of organs- pretreat/precondition the organs. 

End stage organ failure has hope and that hope is Transplant and that is only getting better. 

Life changing 

Life extending 

Life saving

are all applicable to Transplantaion. 

https://www.nm.org/doctors/1356580187/satish-n-nadig-md-phd

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

They discuss Monica's Transplant journey.

There are 37 million people in the US with chronic kidney disease and 80% do not not know it. 

Monica discusses her journey as a two-time kidney transplant recipient.

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

They talk about outcomes for patients with End Stage kidney disease and how much better they do after a kidney transplant as opposed to being on dialysis. Their physiologic milieu improves. 

They then discuss how exhaustive the cardiac work up is while upholding a stewardship for this limited organ and long waiting list of about 100,000.

The goal is to mitigate the cardiac risk so that the patient and the organ do well post-transplant. Especially reducing the risk for fatal MI. 

There are now novel immunomodulators, better medical management and new medications like GLP-1 agonists. 

Cardiac phenotypes were discussed including

-pump issues 

-valve abnormalites

-Heart failure

-Arrythmias

The most common cause of poor outcomes post transplant is previous hx of MI, heart failure and arrythmias. 

Coronary artery testing is covered with stress testing, and cardiac catheterization, angiogram as well as echocardiogram. 

We should consider heart failure. Heart failure with preserved ejection fracture is one type as well as pulmonary hypertension. 

Atrial fibrillation is the most common arrythmia that exists pre and post transplant. It is important to evaluate the atria on echocardiograms looking for dilation. 

Heart failure assesement pre transplant: There are more studies coming by her workgroup. ESKD patients tend to have diastolic heart failure and preserved ejection fraction. 

NYHA - New York Heart Association is a functional assessment commonly used to assess patients iwth heart failure. 

NYHA at least < 3/4

Optimized clinical symtpoms. No SOB, no leg swelling.  

Balancing patient outcomes, frailty and functionality are also very important so as not to limit access to transplantation . 

Factors found to place patients at higher risk include:

-Longer Dialysis Vintage 

-Long time with  DM

-Older age 

-Pulmonary HTN 

-Multivessel disease 

-LAD lesion

-Low ef

-smoking 

Pulmonary HTN :Have a multidisciplinary approach include pulmonary and cardiology. ensure their volume is optimized. Early right heart catheterization, An echocardiogram. 

ACS(acute coronary syndrome such as unstable angina and a myocardial infarct) vs Stable ischemic heart disease. 

The goal being to prevent ACS by doing the pre transplant cardiac testing. 

Goal Directed Medical therapy is the gold standard of management. 

They conclude by discussing the future of cardiac testing and upcoming trials to discuss the frequency of testing. 

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.045009

https://www.kumc.edu/mgupta5.html

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Join us as we talk about how advocacy can look like within Transplantation. 

Dr. Doshi shares a step by step how to. 

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Join us as we discuss all things related to Transplant access. The importance of prevention of disease, advocacy and what that looks like in real life. How important knowing our local region and state is. 

https://www.organdonationalliance.org/events/2026-national-critical-issues/

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Enjoy this real life journey into being a Kidney donor with Colleen Echteroff. 

We go over the work-up she had done in order to be considered a candidate to donate a kidney.

The music she went to sleep to (anesthesia).

How she felt when she woke up from surgery.

That first sleep after donating. 

How taste can be transferred when one donates. 

She shares how this was a gift for her as much as a gift for the recipient.

She had follow up with labs for two years after donation. 

She now continues to live a normal life.

If you're thinking about becoming a donor- 

https://www.organdonor.gov/sign-up

Here is the facebook group that Colleen talks about. https://www.facebook.com/groups/2246296390/

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Dr. Samra interviews Dr. Lichvar, a Transplant Pharmacist at the University of Irvine, California. She shares excellent analogies as they review Immunosuppression. She describes the body as a garden we need to get ready before we implant the organ. There is induction immunosuppression which is given at the time of transplant this is usually thymoglobulin or Basiliximab.

Then there is Maintenance immunosuppresion.  Which is usually a a two drug or three drug regimen which consists of a calcineurin inhibitor usually Tacrolimus or Cyclosporine, a growth inhibitor such a mycophenolate and with or without prednisone are the most common. 

Personalization of IMS involves looking at Recipient risk, Immunologic risk, Donor Risk and what is the integration of of other tools in follow up.

Pharmacogenomics - pharmacogenetics testing to review CYP polymorphisms. Tells us about CYP3A5 metabolism especially for Tacrolimus. 

HOPE trial - No longer an active trial. Access to transplant patients for HIV positive patients. 

 BENEFIT trial -Showed better graft survival. Belatacept is a replacement for calcineurin inhibitors mostly Tacrolimus because of its side effects like, high serum creatinine, electrolyte abnormalities, increased risk of Diabetes and hypertension. 

BEST trial- Better kidney function and also found higher risk of rejection. 

How Belatcept can be used de novo at the time of transplant or later on, Belatacept conversion which is given an infusion every 4-6 weeks. They stay on prednisone because of the elevated rejection risk. Some will convert to Belatacept.

DCD- Donation oafter circulatory death - not brain dead 

DBD- Brain dead donor 

KDPI is the kidney donor profile index- gives us an idea of the longevity of a kidney. Age,height, weight, diabetes, HTN, DCD, serum creatinine. Its a score from 0-100.

> 85% KDPI donors require a special consent. 

In the future, we look forward to advancements in imuunosuppresion, we might have new tools. We really need to focus on policy  that affects medication access. As well as AI assisted customization and Xenograft. 

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

In this episode Dr. Samra interviews Dr. Krishnamoorthy, a Transplant Nephrologist, the Medical Director of the Living Kidney donor at the Uiversity of Chicago. She shares what got her interested in Transplantation during Residency and Fellowship.

They talk about DDKT (deceased donor kidney transplantation) or a cadaveric kidney and LRKT/LUKT (Living donor (related and unrelated)  kidney transplantation) from living donors. 

They talk about how donating a kidney can change a persons life, both the donor and the recipient. There are 400 people who altruistically donate their kidney to recipients without knowing them at all. They talk about using social media to find donors. 

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Dr. Samra sits down with Linda Ohler. Having had an illustrious career which started in the 1960s, and she doesnt show any sign of slowing down. Linda is currently working on another book. She is a nurse, a leader, an author, a mentor and a life long learner and educator. 

She discusses how she has dedicated her life to Transplantation, and it will always be a part of her identity. Starting as a nurse coordinator in heart transplantation, to becoming an author and educator starting with writing a book called Transplantation nursing secrets followed by the core curriculum for bedside nurses. She has lectured nationally and internationally in 10 countries. She shares what ISHLT(International society of heart and lung transplant), NATCO (North american transplant coorindators organization) and AST(american society of transplantation) are. Groups like this have really helped transplant professionals learn form one another 

In 1971 there was a life magazine article that showed 7 heart transplanta patients die and it was in the 1980s that we began to get better immunsouporewison , liek cyclosporine. 

The evolution of the multisdisciplinary team. 

She is now writing a book about >200 transplant professionals and looking at the evolution of each organ system in transplant. 

They talk about who a donor is, brain death and circulatory death and the laws around this. 

They talk about donor care units where brain death patients may need further work up before donation is consented to and alloccated it. They are staffed by ICU clinicians that could be from the hospital or the OPO (organ procurement organizations). The US non- profit organizations responsible for recovering organs for transplantation were established as a national network following the National Organ Transplant Act of 1984. When the National Organ Transplant Act (NOTA) was signed into law in 1984 it created the National Organ Procurement and Transplant. 

They talk about the applications of AI in transplant and concerns such as accuracy and how important it is to keep the human in the loop. They talk about xenotransplantation being part of the future of Transplantation and past successes. 

At the conclusion, Linda states that patients should become familiar with the SRTR so that they know how the transplant programs they are being evaluated at, listed and transplanted at are performing. 

https://srtr.hrsa.gov/

https://orcid.org/0000-0003-2360-7078

Please note this is not medical advice. It is meant for entertainment purposes only. 

Send us Fan Mail

Dr. Samra sits down with Dr. Niederhaus who is not only a Transplant Surgeon but a two time Kidney Transplant Recipient. She shares important tips with patients along with the most unique perspective from both sides of Transplantation, care delivery and care acceptance. 

https://www.umms.org/find-a-doctor/profiles/dr-silke-verena-niederhaus-md-1639127293

Please note this is not medical advice. It is meant for entertainment purposes only.