With a list of potential complications that require the use of a scroll bar, and the general unnerving idea of replacing a failing organ with one from a donor, electing to undergo a transplant happens when all other potential avenues have been explored. When it comes to kidney transplants, many patients have been on dialysis, which replaces the normal function of kidneys and requires three, four-hour sessions per week for at least a short time — some for years. The lack of kidney function leads to sodium retention — which causes swelling of the lower extremities — muscle cramps and a severe lack of energy.
Dr. Karamat Choudhry, once a doctor who saved lives on the operating table, experienced many of these symptoms. He is a retired cardiothoracic surgeon who worked with Medical City Fort Worth since the day it first opened in 1976 and served as the second chief of staff at the hospital. But even before going through years upon years of schooling to become a physician, Choudhry lived and dealt with the symptoms of a long-standing kidney deficiency. It began in his childhood in Kashmir, India, when he developed a kidney stone. He recalls being in constant pain with it, as his family traveled to Pakistan as refugees before ultimately making their way to America. “Treatment was just not available,” he says. By the time he could get any medical attention for the stone, the damage was already done. It had destroyed one of his kidneys.
His kidney disease began 30 years ago. “But, my doctors were able to control it until about four years ago when it got bad. I began dialysis treatments in 2017, and it stabilized me,” Choudhry says. “I was still very active, walking a mile a day, playing golf twice a week, playing the piano and playing with my grandchildren. But, I was getting foggy headed before dialysis stabilized my potassium levels and my blood pressure.”
His first choice of hospital to undergo his transplant procedure was the one where he spent a large portion of his life working, Medical City Fort Worth — and for good reason. Medical City has a lot of impressive numbers to share, but Dr. Sridhar Allam, the medical director of Medical City Fort Worth Transplant Institute, never takes the credit for himself. He is most proud of the passionate and dedicated team they have assembled. “We built a solid team, and it’s a multidisciplinary team,” Allam says.
“We are one of only three hospitals in Fort Worth performing kidney transplants,” Allam says. His practice saw patients in need who were enduring long wait times to receive a transplant, and “we thought we could do better,” he says.
“We partnered with Medical City in 2012 and began with two transplants that year. We had one surgeon and three physicians at the time,” Allam says. “In 2018 we performed 105 transplants, and our staff has grown to two surgeons, four transplant nephrologists and a full team of staff that coordinates every step for our patients from pre- to post-transplant.”
Medical City Fort Worth now performs the highest number of kidney transplants in Fort Worth, and the combined kidney transplant volume between both Medical City Fort Worth and Medical City Dallas is the highest in the Metroplex. They performed more than 230 kidney transplants in 2018 combined.
Dr. Karamat Choudhry
It’s hard to believe that organ transplantation itself is still less than 70 years old. The site of the first organ transplant was performed just outside of Chicago at Little Company of Mary Hospital in Evergreen Park, Illinois. It was a kidney transplanted to Ruth Tucker on June 17, 1950. Tucker, who was in end-stage kidney failure prior to the experimental surgery, went on to live another five years.
What’s even more amazing — Ruth Tucker survived without any anti-infection drugs or tissue typing, and the hospital’s website recounts: “That morning, a healthy kidney became available from a woman who had died of cirrhosis of the liver. Not the most ideal patient, but the best we could find,” said Dr. Lawler, the surgeon who directed the transplant, in an interview after the surgery.
A lot has changed since then, and the science has improved dramatically in recent years.
Kidney transplantation is a long process that involves a full team of very specialized doctors and coordinators. The journey begins with evaluating the patient. “It’s very personalized care,” Allam says. “We can identify the individual needs of each patient, which allows us to anticipate problems before they occur.”
Matching the right kidney to the right patient is the first step to a successful transplant. “Our motto is, ‘Every kidney is transplantable until proven otherwise, and, likewise, every patient is transplantable until proven otherwise,’” Allam says. “Individualization is what sets us apart from other programs.”
There are over 800,000 registered organ donors in the state of Texas. When people express their wishes in advance, it makes the decision to donate easier for family members. It’s comforting to know that organ donation was the expressed desire of their loved one.
“Each kidney that comes our way is accessed to see if it might be right for anyone on our list. But, someone who is lower down our waitlist might actually be a better match, so we have to evaluate that carefully,” Allam says.
More than a matter of first come, first served, the kidneys are evaluated for each patient on the list. This is one of the reasons Medical City Fort Worth can boast that 61 percent of patients on its waitlist receive a kidney within the first year.
Follow-up care for kidney transplant patients is intensive. The biggest risk with any transplant is organ rejection.
“When you get a kidney transplant, your body knows that the new kidney is foreign (that is, not originally part of your body),” according to the National Kidney Foundation’s website. “Your body will attack the new kidney and try to damage or destroy it. The immunosuppressant drugs suppress your body’s ability to do this. The goal is to adjust these drugs to prevent rejection and to minimize any side effects of the drugs.”
Advancements have increased the ability for doctors to, more precisely, adjust these medications for each individual patient. “Immunosuppressant (anti-rejection) medications have improved drastically over the past 15 to 20 years with less side effects,” Allam says.
Medical City Fort Worth Transplant Institute is at the top of the nation in survival rates and outcomes. Of the 276 kidney transplant programs in the country, only six programs received the highest rating — better than expected outcomes — and Medical City earned that elite ranking.
Dr. Sridhar Allam with a patient
The first successful living-donor kidney transplant occurred in June of 1965 in Boston. Ronald Herrick donated one of his kidneys to his dying twin brother, Richard, who lived another eight years after the surgery. Their surgeon, Joseph Murray, won a Nobel Prize for the breakthrough.
Medical City Fort Worth has made a push to increase living kidney donations. “When we first began seven years ago, living donors made up only 10 percent — that has now doubled. About 20 percent of all transplants we perform are from living donors.” And, there is good reason for that.
With a living donor, transplant patients can bypass the waitlist. This factor alone could be a lifesaving benefit. It also allows patients and their donors to schedule their transplant surgery more conveniently.
With a kidney transplant from a deceased donor, the success rate is between 94 to 95 percent, with a life expectancy average of nine years. But, with a living donor, that success rate hits 97 to 98 percent with an increased life expectancy of 14 to 15 years. So, living donors are an option patients should explore.
Most healthy people can live with only one kidney. Allam says it is all about the evaluation process to be sure it’s a good fit. “We have streamlined the process for our donors. We understand that they all have work and families, so we try to accommodate our evaluation to fit into their busy schedules,” he says.
When a transplant recipient applies to the waiting list at Medical City, they are counseled on the option of finding a living donor. “Most patients need to be educated about it, and this alleviates the fear factor or feeling guilty about asking a loved one to go through surgery,” Allam says. Most donors miss about two weeks of work and are released to go home after one night in the hospital.
Dr. Allam is excited by a new piece of legislation — The Living Donor Act of 2019 — that was introduced in Congress this February. The act would make donation more affordable for living donors who are willing to miss two weeks of work in order to save someone else’s life. “This would benefit living donors who are functioning with families but who currently do not qualify for family medical leave as donors,” Allam says.
The legislation would also make it illegal for insurance providers to deny coverage to or raise premiums on these donors who choose to live with only one kidney. “If this becomes law, it would remove those disincentives and would encourage donation,” he says.
Choudhry’s kidney walk team, Pappy’s Pals.
The prefix to his name isn’t the only thing that makes Dr. Choudhry a nontraditional patient. Choudhry is also 80 years old — with transplants for patients above the age of 75 being deemed uncommon by University of Wisconsin School of Medicine. According to a 2009 article published by Seminars in Nephrology, less than 6 percent of patients who were placed on the deceased donor waiting list were 65 years or older. This despite the fact that over 38 percent of those suffering from end-stage renal failure fall within this age bracket.
Following his medical degree from King Edward Medical University in Lahore, Pakistan, Choudhry has called Fort Worth home since 1972. “I have a unique experience, having served on the board of directors and on the quality assurance committee of Medical City Fort Worth,” Choudhry says. “I am quite familiar with what kind of care a patient needs.”
While he hoped to undergo his transplant procedure at Medical City’s Kidney Transplant Institute, unfortunately, they were out of network with his insurance. He applied, instead, at Texas Health Harris Methodist Hospital in June of 2017. After waiting a few months, he got on the waiting list at UT Southwestern in Dallas, as well. Then, Dr. Choudhry’s insurance began accepting Medical City, and he transferred his wait time there in September 2018.
Four months later, on Jan. 21, he got the call that a kidney was available, and after a pre-surgical dialysis treatment, his surgery took place the following day. “At my age, if I were in Europe or somewhere like that, I suppose, they would have just told me to go home and die.”
Like an episode of “Undercover Boss,” Choudhry had a keen eye on the care he and other patients received while in the hospital. “When I called for assistance, someone was there immediately. I had a very positive experience as a patient,” he says.
After six nights in the hospital, Choudhry was released, and this interview took place just a few weeks later — appearing spry, loquacious and fortunate.
“Preservation of the kidney prior to transplant is the key,” Choudhry says. “There have been spectacular improvements in kidney transplantation. For example, my kidney was maintained on a cold perfusion pump for 29 hours while it was being transported to Medical City for my transplant. That was unheard of a few years ago.”
“I believe this transplant team is more aggressive and creative than most,” he says.
This aggression pays off, as patients and doctors must have some crucial elements fall perfectly into place with every kidney transplant. “You need a good kidney. You need a good surgeon. And, you need a protocol that fits your age, weight and needs specifically.”
“It was the best hospital experience of my life,” he says. “I was impressed with the entire team.”
* All data compiled from the Scientific Registry of Transplant Recipients