May 9, 2008
Repeat transplants are on the increase
Lucky recipients are living longer, wearing out their donated kidneys
Brenda LaPorte, with granddaughter Brianna Wentker, 2, has undergone three kidney transplants and takes a pill regimen twice a day, every day. (Sun photo by Andre F. Chung / February 1, 2008)
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She knew the words were coming. For a few days shy of 20 years, Charlotte Wolfe had lived with her mother's kidney, transplanted when she was just 9 years old.
No matter. She still burst into tears that day in October 2000 when Dr. Edward Kraus put his hands in his lap and leaned in. "Well," he told her, "it's time. We'd better start looking." Looking, that is, for another kidney.
Like a growing number of transplant recipients, Wolfe would need a second new kidney - retransplantation, they call it. Kidney transplants have come a long way since the first was performed more than 50 years ago. Today, more than 90 percent of kidney transplant patients are alive a year after surgery and most of those kidneys last a decade or more.
As a result, the lucky recipients are now wearing out their donated kidneys - and going on to need second and sometimes third surgeries.
"When transplantation first started out, it was often not successful," said Dr. Mark Stegall, chief of transplant surgery at the Mayo Clinic in Rochester, Minn. "Now it's not uncommon for patients to go 10 to 20 years on a kidney."
In 2005 in the United States, 1,846 repeat kidney transplants were performed, up 40 percent from a decade earlier, according to a report by the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. About 20 percent of those on the ever-growing list of more than 70,000 waiting for a kidney have been transplanted before.
With the operation all but perfected, doctors are trying to figure out why transplanted kidneys don't last longer and what can be done to increase their life span. Chances are, the kidneys would have worked for decades more in their original hosts.
But some kidneys are rejected slowly after transplantation, leading to decreased function over time. Others are damaged in small ways when doctors transplant them, chipping away at the organs' effectiveness.
"Why is it that we transplant, and it's not fine?"
Regardless of how long a transplant lasts, without one, most patients will die. "The number of people who live 15 years on dialysis is almost zero," Stegall said.
Charlotte Wolfe, a physical therapy assistant from Frederick, knew all that when she walked into Kraus' office at Johns Hopkins Hospital in 2000. She knew her doctors weren't pleased with her blood work and had warned her that a kidney transplant is actually a temporary fix. And hers had lasted 20 years.
"In the back of my mind and in my heart, I knew what he was going to say," she recalled. Still, she said, when she heard those words, "I lost it."
Wolfe was fortunate. Her oldest brother, Craig, was willing to donate. He turned out to be an identical match, meaning his kidney might last even longer than her mother's did. Still, she wasn't sure if she could take it. What if something happened to Craig and he needed the kidney?
After some prayer, she decided to accept her brother's kidney. On Jan. 5, 2001, doctors transplanted it.
Since the match was perfect, Wolfe hoped that she would no longer need the medications she had taken all those years - the ones that caused the weight gain, the insomnia, the depression, the arthritis. Instead, she said, "I came home with 19 new prescriptions."
A kidney transplant requires constant care to keep it going. The immunosuppressants - often a handful of drugs, twice a day, every day - must be taken religiously.
The medications also are expensive. Medicare pays for only a three-year supply, and co-pays from private insurance can run hundreds of dollars a month.
"I have a credit card that will never be paid off, because all that's on it is the medicine," said Wolfe, now 36. "I don't make enough to pay for all the prescriptions I have to get."
Copyright © 2008, The Baltimore Sun
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