Boosting Kidney Transplants in Western New York

BUFFALO, N.Y. – Of all the organs that can be transplanted, the kidney is by far the most in demand. Kidney failure can take years to develop, but there are usually few symptoms until irreversible damage occurs.

The majority of people who want a kidney transplant are on dialysis. This means that several times a week, individuals must undergo a grueling procedure that does what the kidneys normally do: mechanically filter excess water and waste products from the blood.

Of the 500,000 people currently on dialysis in the United States, less than one-fifth are on the transplant waiting list. And half of the 90,000 patients on the list die without ever having a transplant, and this reality is all the more dire given the fact that he has twice the life expectancy after a transplant. is.

as a clinical professor of surgery in the Jacobs School of Medicine and Biomedical SciencesChief of the Department of Transplant Surgery and Program Director of the Regional Center of Excellence for Transplant and Renal Care at Erie County Medical Center, Liise Kayler, M.D., I think about that fact every day. She has focused on ways to transplant more patients with end-stage kidney disease.

Since her arrival, the ECMC transplant program has improved dramatically. Wait times for kidney transplants are now some of the shortest in the country, according to the program’s website.

But like everyone in transplant medicine, Kayler, also a UBMD Surgery surgeon, was keenly aware of the challenges and cruel irony that plague kidney transplants in general. Chief among these is the combination of social and economic disparities that result in a black American being more than three times as likely as a non-black person to experience kidney failure, but making him more likely to undergo a transplant. is 25% lower.

Kayler realized there was an opportunity to make significant improvements.

During the transplant work-up period, patients undergo a series of medical tests to ensure they are safe transplant candidates. To get the tests he needed faster, Kayler hired more staff and standardized tests to make them as consistent as possible for all patients.

Brian Murray, M.D.former ECMC Chief Medical Officer, currently Interim Chair of ECMC Faculty of Medicine Kayler, a physician in the UBMD Department of Internal Medicine at the Jacobs School, said the company took a holistic approach to improve access to kidney transplants for all patients.

“Dr. he says. “She investigated the potential causes of this and suspected that it was often due to social determinants such as difficulty in transportation and access to care. The unit was able to speed up the work-up of all patients.”

By 2018, Kayler and her colleagues built a clinical program that reduced the average time patients spent on the waiting list for ECMC kidney transplants. For the black candidate, the number of days spent on the waiting list decreased from her 540 to her 302.

“Dr. Kayler’s research has focused on improving access to transplantable kidneys, both locally and nationally, for patients suffering from advanced chronic renal failure.” increase. Steven Schweitzberg, M.D.SUNY Distinguished Professor, Director of Surgery at the Jacobs School, and President of UBMD Surgery.

“Life on dialysis is not a picnic,” he continues. “She has improved the quality of life for many people.”

Kayler admits these were big improvements. “We doubled her timely transplant rates for white and black recipients,” she says.

Kayler consulted with UB people Clinical and Translational Science Institute (CTSI), experienced in community-based participatory research. Her challenge was to find a way to make the transplant system more accessible to patients with renal failure. The answer was better patient education through videos and peer-her mentoring.

“We knew that the only way to provide culturally-adapted information to patients was to have them come from people like them,” says Kayler.

Such efforts should include skills not typically covered by the training transplant surgeons receive, such as health communication, patient education, and digital media. Video animation is not cheap, so you also need funds. Keylor identified the animators and the people who allowed the writing so that possible funding could be explored.

Kayler began holding informal focus groups with patients who provided feedback.

she worked with Dr. Thomas FeeleyProfessor of Communications at UB College of Liberal Arts, is researching campaigns to promote organ donation. Together, he applied for and was awarded a $1.3 million grant to the U.S. Department of Health and Human Services’ Office of Health Research Services. This grant funded a pilot test of a video designed to improve what patients know about kidney transplantation and kidney transplantation from living donors.

Noting that only 6,000 live kidney donations are made in the United States each year, the focus on live-donor kidney transplants is critical, says Kayler. “Increasing that number could help solve the donor shortage,” she says. It is the result of knowledge gaps and misunderstandings in

The intervention, jointly developed by Kayler and Feeley, was a series of two-minute animated videos created for sharing called KidneyTIME. The results exceeded our expectations. His 98% of transplant candidates and their social his network members found KidneyTIME informative and engaging. At the 3-week follow-up, 77% revisited on their device and 63% shared.

But to truly understand if the video was having the intended effect, Kayler knew he needed to compare the two groups of patients. One was exposed to video and he was exposed to another, the current standard of care, patient education. She had to apply to her NIH for funding for a randomized clinical trial.

After months of extensive rewriting and revision, the grant application was finally submitted. In August 2021, the NIH awarded Kayler her $3.6 million. The first trial was funded.

The subsidy was a big boost. I was able to use it to test the video and spread it to the community. Kayler knew it was time to add a perspective he could never provide as a surgeon: that of a transplant recipient.

She immediately thought of Barbara Breckenridge, an ardent patient advocate, founder of the Western New York Kidney Foundation, and true kidney transplant success story. More than 20 years have passed since the kidney transplant.

“When I got a kidney from a deceased donor, they told me it might take another five to seven years,” Breckenridge says. I just want to be able to see a transplanted person lead a normal life and say, ‘If she can do it, so can I.'”

In 2021, Kayler and Breckenridge were awarded a seed grant from UB’s CTSI to establish a community advisory board specifically targeted at improving transplantation for black patients. The board, which was established during the pandemic and is comprised of Kaylor, Breckenridge, patients, caregivers, donors and social workers, meets monthly, primarily via Zoom. Members are passionately united by the goal of promoting kidney transplants for black patients.

The primary focus is on identifying barriers to kidney transplantation for black patients and brainstorming potential solutions. As such, we have begun peer mentoring initiatives.

However, the members are familiar with the needs of patients and have found other ways.Breckenridge was created Kidney Health Togetheris a volunteer-run 501c3 organization with a mission to help people living with kidney disease in western New York live healthy lives. It operates a Healthy Living Pantry that provides healthy food options for kidney patients experiencing food emergencies. Many of these patients are of low socioeconomic status and cannot work.

The connections Kaylor and her team, made up of both hospital staff and members of the community, have established and nurtured are a result of the commitment she brings to Buffalo and have only grown stronger ever since.

Despite the many challenges, Kayler says she feels transplant surgery is the most fulfilling type of surgery she can do.

“I want everyone to get a kidney transplant as soon as possible,” she says. Every time we perform a transplant, everyone – patients, families, transplant teams and even hospital leaders – is happy and hopeful.

“This is a celebration of life.”