Section: Saint Barnabas Medical Center News

How Kidney Transplants Have Changed

08/12/2015

Those of a certain age recall the 1970s—the fashions, the songs, disco. “When you see a car from that era, you wonder: ‘How did that even run?’” says Shamkant Mulgaonkar, M.D.

But then as now, a minor miracle was happening at leading hospitals such as Saint Barnabas Medical Center. People with diabetes-caused end-stage kidney disease and other serious illnesses were being given a dramatic new lease on active life. They were getting new kidneys.

The world’s first kidney transplant had come only in 1950. And the kidney transplant program at Saint Barnabas Medical Center, like kidney transplantation itself, was still in its infancy in 1976 when Dr. Mulgaonkar—who today is chief of the Barnabas Health Renal and Pancreas Transplant Division—came to Saint Barnabas for his nephrology (kidney medicine) residency.

He joined a small transplant department led by the late Dennis R. Filippone, M.D., who had performed New Jersey’s first kidney transplant in 1967. “Pioneering kidney specialists had no formal training in transplants at that time,” Dr. Mulgaonkar says. “Those programs weren’t developed until the 1980s. Surgeons and nephrologists went to larger institutions and observed how kidney transplants were done then started their own successful program here.”

If a patient needed a kidney transplant in those early days, it often meant a trip to a bigger facility in New York City or Philadelphia, and in most cases a long stay there. “Some of the patients I was caring for as a nephrologist had to uproot their families for weeks or even months,” recalls the doctor. “That was one factor that led me into transplantation. I felt that patients should not have to go out of state, and that we could develop a modern transplant program here so there would be no need to go anywhere else.”

The Saint Barnabas transplant team then included the late Martin G. Jacobs, M.D., and two others who are still practicing physicians: H. Stephen Fletcher, M.D., and Robert Shack, M.D. “They were doing a small number of transplants, 15 to 20 at most in a year,” Dr. Mulgaonkar says. Patients were put in various places in the hospital. The living-donor operation necessitated major open surgery that required extensive postoperative care. “In those days the incision was like a shark bite, from under the ribs all the way around to the back,” he recalls. “Complications were more frequent and recovery times longer than they are today. Transplant recipients stayed in the Intensive Care Unit for several days and were often in the hospital for three to four weeks.”

Creating a state-of-the-art transplant program, he says, took more than skilled surgeons and modern technology. It took a hospital administration that understood the huge commitment required and supported it. Saint Barnabas Medical Center’s leaders recognized why having a high-profile, research-oriented, multidisciplinary transplant program that could save many, many lives would be important. Support from the administration, both emotional and financial, was critical.

In foreground are Debbie Morgan, vice president, Transplant Division, and Shamkant Mulgaonkar, M.D., chief, Renal and Pancreas Transplant Division. Back row: Stuart Geffner, M.D., surgical director; Marie Morgievich, A.P.N.-C, CCTC , director, Clinical Services and Living Donor Institute; and Andrea Tietjen, director, Transplant Quality, Finance, Data.

Today, says Dr. Mulgaonkar, the program performs about 250 kidney transplants a year—along with eight to 10 pancreas transplants, which were successfully added in the 1990s. Thanks to modern, minimally invasive surgical techniques, the average living-donor kidney transplant patient’s entire hospital stay is just three days, while patients receiving an organ from a deceased donor stay just five days. “That’s a huge change,” he says.

Indeed, almost everything about transplantation has evolved since Dr. Mulgaonkar began practicing. “The medications have changed a lot,” he says. “We have new medicines to keep the body from rejecting transplanted organs and to combat infections very quickly—these are dramatically different from those of the ’70s.” These meds have helped change the entire mindset of transplantation, he says. “We have learned that hospitals can be difficult places for immune-compromised patients, so now we prefer that patients recover at home with outpatient therapy instead of in the hospital. It’s the opposite now of what it was.”

Another big change has been in education. When Dr. Mulgaonkar started at Saint Barnabas, nurses had no special training in caring for transplant patients, “but now we do extensive training here,” he says. “We educate regional nephrologists about the advantages of keeping their patients local and in many cases managing them. We educate dialysis nurses, who are with these patients three times every week, and other health care providers who care for these patients, about the process of transplant. We now have one of the largest transplant education programs in the country, attended by nearly 500 dialysis health care providers.”

As successful as the past 40 years have been, Dr. Mulgaonkar foresees more remarkable growth ahead. He sees a time, not far in the future, when physicians will be able to pre-test transplant patients to predict how they’ll respond to various medications, when researchers will be able to grow new kidney and pancreas cells from stem cells, and when the new 3D printing technology is used to “print” new organs from the patient’s own cells, eliminating the need for immunosuppressant medication.

With his long memory, Dr. Mulgaonkar appreciates how much the Saint Barnabas Medical Center kidney transplant program has improved over nearly four decades—and also how much he and his present colleagues owe to the pioneers who paved the way. “From the small program we had in the ’70s, we’ve grown to become a large, dynamic group of close to 100 people,” he says. “We have a phenomenal team that puts forth extraordinary effort to help patients through this extraordinary procedure.

To find out more about kidney transplant services available at Saint Barnabas Medical Center, please call 1.888.409.4707 or visit transplantkidney.org.

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