Welcome Letter from Director

Lloyd E. Ratner, MD, FACS Director, Renal and Pancreatic Transplantation	David J. Cohen, MD Medical Director, Renal and Pancreatic Transplantation

At the Renal and Pancreatic Transplantation Program of NewYork-Presbyterian Hospital/Columbia University Medical Center, our mission is to move patients off the transplant list and back to leading healthy, productive lives. To achieve that goal, we develop and employ innovative solutions that provide transplants for more patients. "The reality is there aren't enough organs to go around for transplantation," says Lloyd E. Ratner, MD, FACS, who became director of the program in 2004. "We have to be creative and come up with new strategies to get as many organs transplanted as we safely can."

As part of a large academic medical center, the Renal and Pancreatic Transplantation Program calls upon the expertise of a wide range healthcare providers, ensuring that our patients receive the most advanced, multidisciplinary care. We actively participate in research and clinical trials with the goal of further enhancing patient care and outcomes.

Transplantation is a life-altering procedure. Organ recipients require life-long immunosuppressant medications and careful monitoring. We partner closely with our patients—donors and recipients—and their referring physicians to provide a seamless continuum of care. In addition, we help patients and their families navigate the inherent emotional, financial, and logistical concerns.

Kidney (Renal) Transplants

The Renal and Pancreatic Transplantation Program offers patients with advanced kidney disease or kidney failure four transplant alternatives. Notably, kidney transplantation has been show to result in a longer life expectancy than dialysis.

• Compatible live donor transplants are the gold standard of kidney transplant procedures. Typically, the organ is donated by a relative. An organ from a perfectly-matched sibling donor can function for an average of 35 years, while less perfectly matched donor organs function for 20 years on average. Ninety-seven percent of live donor kidneys are fully functional upon transplantation.
• Paired donor exchanges anonymously match up compatible donors and recipients, when a suitable donor cannot be found through family and friends. While logistically complicated—requiring four transplant teams and operating rooms—the procedure offers the benefits inherent in finding a compatible live donor. Dr. Ratner performed the first donor exchange at NewYork-Presbyterian/Columbia in September 2004.
• Incompatible live donors can be used if a willing compatible donor cannot be found. This can occur if the donor/recipient are either blood-group incompatible or incompatible due to antibodies against the transplant antigens. In order to accept a kidney from an incompatible donor, the recipient's blood must be repeatedly "cleaned" of mismatched antibodies through a process known as plasmapheresis.
• Deceased donor procedures are reserved for those patients who cannot wait for a suitable live donor. Deceased donor kidneys have a 50 to 60 percent chance of being fully functional immediately upon transplantation and have a 50/50 chance of maintaining their function for 10-20 years post-transplant.

Pancreas Transplants

A relatively uncommon procedure, pancreatic transplants are reserved primarily for type 1 diabetics who cannot effectively control their diabetes through diet or insulin injections, or who have end stage renal disease and require a kidney transplant as well. Additionally, pancreas transplantation is beneficial for diabetics who no longer develop symptoms when their blood sugars get too low. Under some circumstances pancreas transplantations may be utilized for type 2 diabetics as well.

NOTE: The Renal and Pancreatic Transplantation Program is currently awaiting UNOS (United Network for Organ Sharing) approval to perform pancreas transplants. UNOS must approve all new transplant programs. We will provide more information on pancreas transplant alternatives once this approval is confirmed.