Transfer of Knowledge in Kidney and Pancreas Transplantation

Over the last three decades, Cleveland Clinic has helped establish four kidney and pancreas transplant programs in three states, and learned a great deal along the way.

In this Q&A, Alvin Wee, MD, Surgical Director of the Kidney Transplant Program, discusses intricacies of the laborious yet immensely gratifying process of setting up affiliate transplant programs. Dr. Wee joined Cleveland Clinic’s Glickman Urological & Kidney Institute staff in 2008 after completing his renal transplant fellowship here.

Consult QD: What qualifies Cleveland Clinic to train other centers in kidney and pancreas transplantation?

Dr. Wee: Cleveland Clinic has been at the forefront of advances in kidney and pancreas transplantation for more than 30 years. Cleveland Clinic performed its first kidney-pancreas transplant in 1985, first laparoscopic donor nephrectomy in 1997, first paired donor kidney transplant in 2004, and first laparoscopic single-port kidney removal in 2007. Ohio’s first adult kidney-intestine transplant was performed at Cleveland Clinic in 2010.

Currently, surgeons at our main campus perform 150 to 170 kidney and 10 to 15 pancreas transplantations each year.

Our goals in setting up affiliate transplant programs are first and foremost to answer patient need, and to maintain standards of excellence through comprehensive knowledge transfer.

CQD: Give us a bit of history of the transplant affiliate program.

Dr. Wee: Cleveland Clinic established its first affiliate transplant program at Charleston Area Medical Center in Charleston, West Virginia, which became operational in year 1987. To date, more than 1,000 transplants have been performed in Charleston. Even after 30 years, we maintain a close collaboration with colleagues there. In fact, we recently performed the first paired kidney exchange the state of West Virginia in Charleston. In paired kidney exchange, two incompatible donor/recipient pairs are matched to allow for a donor from the first pair to provide a kidney to the recipient from the second pair and vice versa. This has boosted the number of living donors in in the Charleston program.

Two additional affiliate programs were established — one in St. Elizabeth Hospital in Youngstown, Ohio, from 1988 to 2004, and another in Akron City Hospital in Akron, Ohio, from 1994 to 2003.

Cleveland Clinic sends physicians and surgeons who have trained here to other medical centers and hospitals, both nationally and internationally, on a regular basis.

That goes for me as well. After completing my fellowship in kidney and pancreas transplantation here, I was sent to Indianapolis to set up an affiliate transplant program. The first kidney transplant at that center was done in 2009 and the first pancreas transplant in 2013. This program continues to rank as one of the few centers in the US with great outcomes.

Two surgeons who trained at Cleveland Clinic went on to set up successful transplant programs —Ho Yee Tiong, MD, returned to Singapore and performed the first pancreas transplantation there in 2012. Former fellow Hannah Choate, MD, just recently performed the first pancreas transplant in New Mexico.

Extending services in this way, and training physicians of future, are vital activities. We feel honored and gratified to help provide life-changing transplant services to patients worldwide.

CQD: How does Cleveland Clinic transfer knowledge in kidney and pancreas transplantation?

Dr. Wee: Initially, the most important aspect of setting up a new transplant program is working with physicians onsite and observing how they work. This person-to-person interaction is critical for successful knowledge transfer. Furthermore, close collaboration between team members is a must. The interdisciplinary team of experts involved in setting up a new transplant program typically consists of physicians and surgeons, nephrologists, pharmacists, transplant coordinators, dietitians, financial coordinators, social workers, and members of the bioethics team.

Funding and sound financial planning are vital too, of course. On several occasions, I witnessed new programs struggle and fail due to inadequate financial planning.

CQD: What advice would you offer centers looking to set up a new transplant program?

Dr. Wee: Building a new transplant program is challenging, but not impossible. It takes a lot of hard work and dedication. The process is very long, but very rewarding. Having a clear direction from the beginning is critical. Close collaboration, including a partnership with established transplant programs, is crucial for the success of the entire process.