Cleveland Clinic’s Kidney Transplant Program had another landmark year, completing 229 kidney transplants — the most the program has performed in a single year to date. Adding to that, the team led the world’s first single-port robotic kidney transplant in 2019.
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“To put this in perspective,” says Emilio Poggio, MD, Medical Director of the kidney transplant program, “this is a 25.8% year-over-year increase in kidney transplants at Cleveland Clinic.”
Alvin Wee, MD, MBA, Surgical Director of the kidney transplant program, notes that this growth and innovation is, in large part, due to several strategic developments, including increased living donor utilization, more patient and community outreach and new virtual clinics.
Strong living donor program
In 2019, the program had 75 living kidney donors, a number that puts Cleveland Clinic among the most prolific living donor programs in the U.S. “For patients, this means there is a higher chance for doing internal pair exchanges at Cleveland Clinic,” says Dr. Wee.
Utilizing kidney transplant from living donors often shortens wait times and provides access to a better quality kidney for recipients. As for the living donor, Dr. Poggio says, “It’s a very safe procedure and donors often view it as an immeasurable gift for someone whom they love or care for.”
While the external pair exchanges program remains a resource for donors and recipients across the country, there are significant considerations, including the time and logistics associated with organ transportation.
“The bottom line is that internal kidney exchanges give clinicians and patients more autonomy and, as a result, an improved clinical experience,” says Dr. Wee. “Given the volume, we will always try internal exchanges before setting patients for external exchanges.”
Education and outreach for patients
The team has also aligned efforts to bring greater education and awareness about kidney transplant to patients in the community, which has helped create a meaningful dialogue about living and nonliving transplant early on in the process. “When we see these patients in clinic, we encourage them to understand transplant options and share the benefits of living kidney donation,” remarks Dr. Poggio.
To address the uncertainty that often accompanies the process of finding a living donor, Cleveland Clinic hosted an interactive workshop in partnership with the National Kidney Foundation called “The Big Ask, The Big Give.” The event provided strategies and resources for patients on how to educate family and friends about the transplant process. Dr. Wee notes that with more education and discussion around the living donor conversation, the more normalized it will become for both donors and recipients.
The team also hosted a second successful kidney symposium with allied medical partners. The symposium provides education and create partnerships with medical partners about the process and hurdles of transplant. Ultimately, the goal of the collaboration is to make more patients aware of transplantation options.
Virtual clinics support clinical efficiency
Additionally, telehealth initiatives, like virtual transplant clinics, have helped create efficiencies in the evaluation of potential recipients who live away from Cleveland Clinic’s main campus. Historically, this assessment required the entire care team (nephrologist, surgeon, nurse coordinator, social worker and dietitian) to see the patient. Web-based technology, web cameras and electronic medical records allow one team member to interview the patient on-site while the virtual session is made available to the entire care team for evaluation.
“The goal is to continue to harness this technology and expand our virtual platform to provide clinics in different regions around Ohio,” says Dr. Wee.
The leaders of the kidney transplant program note that these initiatives have led to a steady increase in referrals that position Cleveland Clinic for continued success in transplant volumes. They also stress that while quantitative growth is important, quality outcome measures are equally critical.
“Sometimes when you take more risks, quality may get compromised,” says Dr. Poggio. “But in our program, quality was never compromised, we actually improved it by driving the length of stay of these patients to only two days. At the same time, readmission rates decreased by 50% and overall patient satisfaction was significantly up.”
The leaders say that continued clinical and surgical innovations, proactive outreach, and improved access initiatives are key to further expanding the program. Dr. Wee concludes, “It’s all a part of our goal to make kidney transplant accessible for those who need it most.”