Areas of Expertise

Kidney Transplantation
A number of diseases can directly damage the kidney. Damage to the kidney can seriously affect the body’s removal of water and waste products; production of red blood cells; regulation of blood pressure; and balance of electrolytes, such as potassium, calcium, and phosphorus.

If kidney damage is severe, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life. During surgery, the patient will be under general anesthesia. The transplant surgeon begins by making an incision on the right or left side of the lower abdomen just above the groin. Once the diseased kidney is removed, the surgical team places the donor kidney into the abdomen and connects the kidney's blood vessels to the recipient's iliac artery and vein. The surgeons then connect the ureter to the bladder. A small drain may be placed into the abdominal cavity to drain excess fluid. Following a kidney transplant, the average hospital stay is about 10 days.

Pancreas Transplantation
A pancreas transplant is required when the small clusters of cells called Islets of Largerhans within the pancreas stop producing insulin – as seen in diabetic patients. When transplanting a new pancreas into a diabetic patient, surgeons also transplant the islet cells to provide a new source of insulin in the body and eliminate the need for further insulin injections. Since renal failure often accompanies diabetes, a pancreas is oftentimes transplanted at the same time as a kidney. There are usually two prime reasons for a pancreas to be transplanted independent of a kidney transplant: When a patient has already received a kidney transplant from a living donor, but is still in need of a pancreas transplant, or when a prior pancreas transplant has failed. Pancreas-only transplantation is also considered in very specialized cases when there is no renal failure but diabetes management is difficult, or when the patient is facing other severe complications, such as blindness.

A pancreas transplant is more complicated than a kidney transplant and takes longer to perform. The operation involves connecting the blood supply of the pancreas to the vessels that take blood to and from the leg, usually the right leg. In addition to connecting the blood vessels, another part of the procedure involves making an incision into a piece of bowel to drain away the digestive juices that the pancreas produces.

There are many benefits to a pancreas transplant, which include eliminating the need for a patient to give him or herself insulin injections, as well as eliminating the need for frequent blood tests and diabetic diets. The biggest benefit is that once a diabetic patient has a pancreas transplant and insulin is controlled automatically, most of the other damage from diabetes is halted. In some cases, many of the problems may improve, although it may take several years to notice the improvement. Following a pancreas transplant, the average hospital stay is about 10 to 14 days.

Kidney and Pancreas Transplantation
Some clinical studies have shown that diabetic patients who receive a combined kidney and pancreas transplant have a higher survival rate than diabetic patients undergoing kidney transplantation alone. In most medical centers, it is common to transplant both kidney and pancreas at the same time and from the same donor.

A kidney and pancreas procedure takes approximately five to seven hours, and most patients are hospitalized for two to three weeks. The kidney/pancreas transplantation team includes transplant surgeons, endocrinologists, and nephrologists, as well as ancillary personnel.

Living Donor Program
For many kidney transplant candidates, receiving an organ from a living donor may be the best option. Currently, there are nearly 35,000 patients on a nationwide waiting list for a kidney, thus making the wait quite lengthy. If a patient elects to receive a kidney from a living donor, the wait time is reduced dramatically. The transplant can take place as soon as both the donor and the recipient have been thoroughly evaluated and a date for the procedure has been selected. Patients who undergo these types of transplants have higher long-term and short-term survival rates.

There are two types of living donors: Living related donors and living unrelated donors. Living related donors are those who are blood relatives of the recipient, such as parents, children or siblings. Living unrelated donors, or "emotionally related donors," are non-blood relatives, such as spouses or close friends. Many times, these types of matches prove to be as successful as living related donors, thus illustrating that the overall health of the donor may be just as important as an exact blood-related match.

Potential kidney transplant recipients are strongly encouraged to consider any and all possible living donors including blood relatives, spouses, and close friends. Living donor transplants are scheduled weeks in advance, allowing both the donor and recipient time to emotionally prepare themselves for the procedure. The donation process is safe and, after a recuperation period, the donor can resume his or her normal activities within three to six weeks. Recuperation time for transplant recipients will vary by each case, but the hospital stay usually lasts about 10 days.

Additionally, there is no cost to the donor. All expenses associated with the medical evaluation and follow-up care for the donation are paid for by the transplant recipient's health plan.

Laparoscopic Organ Donor Surgery
In most cases, living donor kidney removal, or nephrectomy, can be performed laparoscopically. This procedure shortens hospital stays for living donors to about two or three days, minimizes their recovery period, and allows them to return to normal activities very quickly.

The traditional open nephrectomy involves an incision of six to ten inches and division of three muscle layers. The hospital stay is usually four to six days, and the donor is able to return to work in about four to eight weeks. In many instances, a laparoscopic nephrectomy is preferred because it involves only four small incisions through fewer muscle layers, allowing for a short hospital stay, speedier recuperation, and a quicker return to normal activities. For the procedure, a laparoscope (tiny video camera) is inserted through one incision while another incision is made for placement of laparoscopic instruments.The kidney is removed through a small two- to three-inch incision below the navel.

The University of Miami Life Alliance Organ Recovery Agency
(formerly the University of Miami Organ Procurement Organization)

Organ preservation techniques are unparalleled at the University’s organ procurement organization, Life Alliance. This organization is one of the most productive in the country with the rescue of hundreds of organs and tissues annually for patients in South Florida and across the country. For more information, please call 305-243-7622.

Intravenous Infusion of Bone Marrow
The University of Miami/Jackson Memorial Medical Center’s Division of Kidney and Pancreas Transplantation is developing techniques to decrease the likelihood of organ rejection. While the use of immunosuppressants drugs is still required, researchers are experimenting with new approaches. One of the most promising of these approaches includes the intravenous infusion of bone marrow from the organ donor to the recipient patient.

Immunological Monitoring
The Division of Kidney and Pancreas Transplantation has a unique and sophisticated “immunological monitoring” system that allows physicians to continuously determine whether the transplant patient’s body is receiving the correct amount of postoperative medication.