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My name is Nada Alachkar.
I'm a transplant nephrologist at Johns Hopkins.
I manage and care for patients with kidney transplant and
I do evaluation for patients to receive kidney transplantation.
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Patients with advanced chronic kidney disease, stage four,
stage five, or kidney disease are candidate for transplantation.
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So the major contraindication to receive kidney transplantations
are usually acute or major cardiovascular diseases.
Recent event like MI or stroke or
peripheral vascular disease that's active or recent.
Usually those that we have to wait until they become stable so
we don't transplant them at that point.
The other major contraindication are cancers.
Any acute or recent cancers is contraindication.
There are only few cancers that we can transplant them.
Breathe like shortly after they're treated for the cancer,
otherwise we have to have free cancer waiting time.
Acute or active infection is also a major
contraindication unless they are treated and cleared the infection.
There are couple others but they're usually, once they're cleared,
we can put them on the waiting list and clear them for transplant.
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To manage the recipients before kidney transplantation,
I do their evaluation initially.
I see the patients in the clinic.
I explained to them what they are going through and
then what test need and then I review the medical record, we order
few of the tests that to clear them for kidney transplantation.
Then I review the results of those tests we ordered and
if there is any abnormality or any abnormal test I follow up and
we ask for more investigation.
I sometimes contact their provider, local providers, and
ask for further test or further treatment or management.
Once the patients are on the waiting list I monitor those patients and
we review their record on regular basis with the help
of the waiting list team.
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To manage the recipients after the surgery, I see the patients after
they receive the kidney transplantation in the hospital.
We see them with the surgeons.
We have comprehensive team.
We worked together.
We see the patients on daily basis.
We manage their medical problems along with the surgeons, and
after they get discharged when they are cleared from the surgical stand
point, the majority of the times they're transitioned
to different nephrologists, I receive some of those patients and
I continue to monitor those patients on a regular basis.
I see them in the clinic.
I manage their allograft function.
We manage their immunosuppression.
We manage if they have any infections, blood pressure,
diabetes, their lab works.
So mainly we are the main provider for those patients and
then we work for another providers to care for those patients.
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The quality of life of those patient who receive kidney transplant is
excellent.
They do very well.
They live normal life.
The majority of them, they do very well.
They go back to work.
They live normal life as I said.
Some people with major comorbidities,
they do a little bit worse but they still do much better than patients
who stayed on dialysis or they did not receive kidney transplantation.
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So the prognosis of transplant patients is excellent.
We look at survival of patients and kidney transplant about more than
90% on the majority of the centers so it's really much better than
patients who's staying on the waiting list.
And five years and ten years we look about 80% allograft survival and
more than 50% allograft survival if they've received kidney transplant
from deceased donor.
I would look about 15 years
allograft survival from living donor.
And the survival of the patients is much more than patients staying on
dialysis or on the waiting list.
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Hopkins has a very well-organized comprehensive
kidney transplant center that has significant
expertise in different field of transplantation.
We are one of the only few centers
in the nation that have incomparable program which Transplant patients
who are incompatible with their donors and we do the peer exchange,
and our program is one of the lead in this field.
Adding to the expertise in the incompatible field,
we have very large research program and
we have basic research lab and our transplant program
that work on patients and also on mice in the transplant field.
Adding to the organization of the transplant patients follow up and
caring for patients transplant makes Hopkins one of the lead transplant
centers in the whole nation.
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