Kidney Transplant Program

Overview

In 2013, Cleveland Clinic Florida, an extension of the Cleveland Clinic in Ohio, was granted accreditation and support from Florida’s Agency for Health Care Administration (AHCA) and the United Network for Organ Sharing (UNOS) to perform kidney transplants. The kidney transplant program subsequently received approval from the Centers for Medicare and Medicaid Services (CMS) in 2014.

Kidney transplant treatment program

A multidisciplinary team of Cleveland Clinic Florida physicians developed the transplant program in close collaboration with physicians from Cleveland Clinic in Ohio, which has more than 50 years of successful kidney transplant experience. During the first year, physicians at Cleveland Clinic Florida performed a higher number of transplants than expected, making it one of the fastest growing transplant programs in the nation. In 2019, Cleveland Clinic Florida performed a total of 177 kidney transplants.

In addition to quickly growing the practice, Cleveland Clinic Florida boasts some of the world’s most renowned and most recognized physicians in transplant surgery. Dr. Cedric Sheffield leads Cleveland Clinic Florida’s transplant program, with over 25 years of experience, having personally performed more than 1,000 transplant procedures. In addition, transplant surgeons at Cleveland Clinic in Ohio are dually licensed and perform kidney transplants in Florida.

The Scientific Registry of Transplant Recipients includes information about transplants performed at Cleveland Clinic Florida and other relevant transplant data.

Comprehensive care

The Kidney Transplant Team at Cleveland Clinic Florida is committed to providing comprehensive care in a compassionate environment. Kidney Transplant Team members include:

• Transplant Surgeons.
• Nephrologists (Kidney Doctor).
• Transplant Coordinators.
• Dietitians.
• Social Workers.
• Financial Counselors.
• Pharmacists.
• Living Donor Advocate.

Cleveland Clinic Florida is one of only three hospitals offering kidney transplants in the South Florida region, serving patients in Miami-Dade, Broward and Palm Beach Counties.

Outcomes

The Scientific Registry of Transplant Recipients includes information about transplants performed at Cleveland Clinic Florida and other relevant transplant data.

How to get started

As questions surface during the process of finding the right hospital for kidney transplants, we try to make it as easy as possible by providing you with answers to your most frequently asked questions. For more specific inquiries or to speak directly with a representative, please call us at 954.659.5133. Or you can reach us by email at transplantfla@ccf.org.

Am I a Candidate for a Kidney Transplant?

Before being diagnosed as a transplant candidate, patients must meet specific criteria that are based on a number key indicators for a failing kidney. Once diagnosed, patients will be asked to undergo a pre-evaluation with the kidney transplant team. The evaluation provides complete information about an individual's overall health and helps the transplant team identify potential issues. The team can then take steps to mitigate issues before the transplant surgery and avoid potential complications after the surgery.

Indications for kidney transplantation

There are a number of factors that are taken into account when assessing a patient’s need for kidney transplantation. Before patients are considered, there are a few conditions and symptoms that they may exhibit to be considered:

• The patient has end-stage kidney disease and is on dialysis therapy.
• The patient has advanced chronic kidney disease.
• The patient has chronic kidney disease with Type 1 diabetes.

Once indications determine that a patient may be considered for kidney transplantation, he or she will be asked to undergo a pre-transplant evaluation.

How to get started

As questions surface during the process of finding the right hospital for kidney transplants, we try to make it as easy as possible by providing you with answers to your most frequently asked questions. For more specific inquiries or to speak directly with a representative, please call us at 954.659.5133. Or you can reach us by email at transplantfla@ccf.org.

What to Expect

Before the appointment

Prior to the pre-transplant evaluation, a transplant coordinator will contact the patient and doctor if needed to gather important information about the patient's medical history and condition. This information needed includes:

• PAP test – all females age 18 and older.
• Mammogram – all females 35 and older.
• Colonoscopy – all patients age 50 and older.
• Cardiac Stress Test – all patients age 40 and older (any type of stress test is acceptable).
• Chest X-ray – all patients.
• Dental Clearance – all patients. A Dental Clearance Form will be mailed to patient.

Pre-transplant evaluation

A pre-transplant coordinator will be assigned to the patient before testing begins. The coordinator will:

• Answer all questions about the transplant process and educate the patient in areas unfamiliar to them. 
• Assist with obtaining medical records from previous testing. 
• Assist with any arrangements for the pre-transplant testing requested by the transplant doctor.
• Communicate with all of the members of the transplant team.
• Compile a summary of your transplant evaluation and test results to present to the transplant selection committee for approval to add you to the transplant list.

The pre-transplant coordinator will submit your name to the United Network of Organ Sharing (UNOS) upon completion of your evaluation if you are approved to be added to the transplant list. 

The Scientific Registry of Transplant Recipients includes information about transplants performed at Cleveland Clinic Florida and other relevant transplant data.

Meet with our doctors

Patients will then meet with the nephrologist (kidney doctor) and the transplant surgeon. They will discuss the transplant options, including living donation and inform the patient of what to expect after transplantation. They will review the patient's medical history and records and perform a physical exam. Based on the patients past medical, history, age and physical exam findings, the doctors will request further testing to complete the transplant evaluation.

Patients will also be encouraged to use this evaluation period to ask any questions they may have. 

Getting the call

If a patient is approved to be placed on a waiting list for a kidney transplant, he or she must wait for a donor to become available, unless they are able to identify a living donor. If a kidney becomes available and the patient is not in the hospital, they are immediately contacted by their Kidney Transplant Coordinator. Most kidney patients are at home and live locally. In some cases the coordinator may arrange for transportation to Cleveland Clinic Florida or tell them to stand by for further instructions.

Arriving at Cleveland Clinic Florida

Some patients may need to be dialyzed when they arrive at the hospital. Upon arrival at Cleveland Clinic Florida, the patient will be admitted and will wait in a hospital room for the suitability of the kidney to be determined. If it is determined that there is a match, the patient is then prepared for surgery. A complete physical, chest X-ray, blood tests, and an electrocardiogram (EKG) will be completed and the doctor will review the results.

Kidney transplant surgery

Once the patient is in the operating suite, the actual kidney transplant procedure can take two to three hours.

Discharge, planning and recovery

After the surgery, patients stay in the recovery unit and are subsequently transferred to a room in the transplant unit. The Intravenous tubes (IVs) in the patients arm and neck will still be in place, and they will still have a dressing over the incision site.

A catheter to empty urine will remain in the patients bladder for several days. Before the catheter is removed, the health care provider will make sure that the patient has sufficient urinary output.

Patients will have stockings on both legs that deflate and inflate at intervals to promote adequate circulation. When the patient walks on his or her own, the stockings will be removed.

Patients might have a dry, sore throat after surgery due to the breathing tube that was in place during the transplant procedure. The soreness will go away in a few days.

Healthcare providers will frequently check the pulse, blood pressure, urine output, and IV fluid intake levels. The nursing staff will help get patients out of bed to move and walk around. Walking regularly in the hallway helps prevent lung and heart complications, and helps the digestive system work properly again.

Going home after kidney transplant surgery

Soon after surgery and after the patients stay in the hospital, the Transplant Team will teach them more about general protocol at home. This includes:

• Patients taking temperature and blood pressure.
• Keeping track of patients fluid intake and urine output.
• Knowing who to call for emergency appointments.
• Understanding what problems should be reported to the transplant coordinator.

The patient’s doctor and other transplant team members will be monitoring the patient’s health closely after the transplant and during follow-ups. Therefore, it is very important that the patient keeps their scheduled follow-up appointments.

Tips for a healthy transplant recovery

The most important tips you should know for a healthy transplant recovery. Remember these are fairly general tips and if you have any specific questions please talk them over with your transplant coordinator.

• Take all medicines exactly as prescribed.
• Keep all scheduled appointments with doctor and/or nurse.
• Call doctor or nurse for any questions, concerning recovery.
• Do not ignore any signs of symptoms during recovery.
• Follow recommended dietary plan.
• Follow recommended fluid intake.
• Follow recommended exercise plan.
• Avoid being around anyone with an infection.

What You Need to Know About Kidney Transplant Rejection

What is kidney transplant rejection?

Rejection is the patient’s body’s way of not accepting the kidney transplant. Although rejection is most common in the first 6 months after surgery, it can occur at any time. Fortunately, the Transplant Team can usually recognize and treat a rejection episode before it causes any major or irreversible damage. It is very important that the patient takes medications as prescribed and have their blood work drawn as scheduled.

What are the warning signs of possible kidney rejection?

It is vital for the patient to be aware of possible signs of kidney rejection. If the patient is experiencing any of the symptoms, contact the Transplant Team immediately:

• Increase in Serum Creatinine.
• Fever higher than 100° F (38° C).
• “Flu-like” symptoms: chills, aches, headache, dizziness, nausea, and/or vomiting.
• New pain or tenderness around the kidney.
• Fluid retention (swelling).
• Sudden weight gain greater than 2 to 4 pounds within 24-hour period.
• Significant decrease in urine output.

How is rejection identified?

The Transplant team will be able to determine if kidney rejection is present by performing scheduled protocol kidney biopsies at approximately 3-6 months and at 1 year post-transplant as a diagnostic screening tool, or if the patient is experiencing any of the warning signs and symptoms of rejection listed above.

How is rejection treated?

If a diagnosis of rejection is made, the patient’s doctor will prescribe medication to treat the rejection and prevent further complications. The patient may be admitted to the hospital for 3 to 5 days for treatment or be treated for 3 days in the outpatient setting. Treatment is dependent on the severity of the rejection and is determined by the doctor. The usual treatment is to give higher doses of anti-rejection medication.

Types of Transplant

Types of donor organs

After the pre-transplant evaluation, the transplant team will help the patient begin the search for a new kidney. Kidneys for transplantation come from two sources: living donors and deceased donors.

What is a deceased donor transplant?

A deceased donor kidney is one that comes from a donor with an irreversible brain injury, and a kidney that is deemed satisfactory for donation.

If the patient is waiting for a kidney transplant and a suitable living donor is not available, the patient will be placed on a waiting list to receive a deceased donor kidney. The transplant coordinator will enter the name of the patient and blood test results on the United Network for Organ Sharing’s (UNOS) national list.

When a deceased donor kidney becomes available for transplantation, it is given to the best possible match, based on blood type, tissue (HLA) type, and cross match compatibility. If a perfect match (six antigen match) is identified through the national list, the recipient matching the donor will be notified. By chance, if there is more than one individual identified as a match for the deceased donor kidney, the person whose name has been on the waiting list the longest will be considered first.

What is a living donor transplant?

A living donor transplant is a procedure during which a kidney is surgically removed from a healthy person and transplanted in a person with kidney failure.

Kidney Transplant Waiting List

After the patient evaluation is complete and the transplant committee has determined that they are a suitable candidate, the patient will then be placed on the kidney transplant list. The patient will then have regular blood tests, and the results will be sent to Cleveland Clinic Florida. These regular samples are needed to do the preliminary match for deceased donor kidneys. When the first sample is received, the patient will be notified in writing that they are officially listed on the UNOS kidney transplant list.

Living Kidney Donors

Living kidney donor candidate

For a healthy person, donating a kidney is a safe operation with a quick recovery. There is usually no need for additional medicines or diet restrictions after the kidney is donated. Donors often find organ donation to be a rewarding experience. Donors should not be discriminated against by insurance companies.

Requirements of a potential living kidney donor

The kidney donor must be healthy, want to donate voluntarily without coercion or financial gain, and be made aware of the risks and benefits of kidney donation. The donor must have a compatible blood type with the kidney recipient and have a series of tests to determine whether, the kidney will be tolerated by the recipient. All costs associated with donating are covered by the recipients insurance through post operation.

If a patient has difficulty finding a potential donor, the living donor coordinator can help. In some families, everyone would like to be considered as a potential donor. Yet sometimes, family members or others are very reluctant or refuse to have tests to determine if they are potential donors. The kidney transplant team will offer educational materials and encourage a family discussion to help in these situations. In addition, all donor blood test results will remain confidential upon the person’s request.

Pre-transplant kidney donor evaluation

The pre-transplant donor evaluation provides complete information about the donor's overall health and helps to identify any potential problems. During the evaluation, the donor will have several tests performed, including a renal arteriogram, which examines the vascular system of the kidneys. There will also be several additional tests to make sure they are physically ready for surgery.

Living Kidney Donor Surgeries

There is an ever-increasing demand for living kidney donors. Until recently, kidney donation from a living donor could only be accomplished through a surgical procedure called open nephrectomy (kidney removal). This procedure requires a large, muscle-cutting abdominal incision; removal of a rib; and a relatively longer hospital stay and recovery period. However, advances in laparoscopic surgery have made an advanced surgical procedure called laparoscopic donor nephrectomy possible. This procedure has significant benefits over the traditional open surgery for kidney donation.

What is laparoscopic donor nephrectomy?

Laparoscopy – also known as “keyhole surgery” – is a minimally invasive surgical procedure during which a special camera, called a laparoscope, is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a real-life picture of the internal organs to a video monitor, to guide them through surgical procedures. The laparoscope magnifies these images many times their actual size, providing surgeons with a superior vide of the abdomen.

Laparoscopic Nephrectomy is a minimally invasive procedure that uses a laparoscope to remove a kidney for donation. Laparoscopic kidney removal is considered minimally invasive because it only requires three or four small non-muscle-cutting incisions rather than one large muscle- cutting incision in the abdomen.

What are the advantages for laparoscopic donor nephrectomy?

Because Laparoscopic Donor Nephrectomy is a minimally invasive procedure, donor patients experience significantly less discomfort, have a shorter recovery period, and return to work more quickly than donors who had traditional open surgery.

Our Doctors

FAQs

What are the visiting hours?

The Transplant Unit does not enforce strict visiting hours. However, the staff recommends no more than two visitors at one time since rest is an important part of recovery.

Will there be pain after kidney transplant?

The patient will feel some pain at the incision site. In most cases, a patient-controlled pain pump will be used to manage the pain. The pain pump has a hand-held button that will allow the patient to deliver pain medicine( as prescribed by the doctor) directly into the IV on demand.

What is an incentive spirometer?

An incentive spirometer is a breathing aid the patient will use after surgery to help keep the lungs clear and active during recovery from surgery.

What is a surgical site infection (SSI)?

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about one to three out of every 100 patients who have surgery.

Some of the common symptoms of a surgical site infection are:

• Redness and pain around the area where you had surgery.
• Drainage of cloudy fluid from your surgical wound.
• Fever.

Will there be diet restrictions after the transplant?

For the first 24 hours after the transplant, the patient will be limited to ice chips and/or clear liquids. The diet will gradually increase to solid food. If the patient’s transplanted kidney is not working properly right after the surgery, they will have a diet similar to the diet they had when they were on dialysis.

What is CMV?

CMV is short for cytomegalovirus and many people are CMV positive. It is a common virus within our population and often causes infection after transplantation. If left untreated, it might cause a more severe disease by infecting organs and parts of the body, such as the liver, colon, eyes, and others. Within the transplant population CMV is closely monitored and can be controlled with anti-viral medicines. 

Resources

The following is a list of resources and support services:

American Association of Kidney Patients
2701 North Rocky Point Drive, Ste. 150
Tampa, FL 33607
1.8000.749.2257
Email: info@aakp.org
www.aakp.org

American Association of Tissue Banks
1320 Old Chain Bridge Road, Ste. 450
McLean, VA 22101
703.827.9582
Email: aatb@aatb.org
www.aatb.org

American Kidney Fund
11921 Rockville Pike, Ste. 300
Rockville, MD 20852
Help Line: 1.800.638.8299
Email: helpline@akfinc.org
www.kidneyfund.org

American Society of Nephrology
1510 H Street, NW Ste. 800
Washington, DC 20005
202.640.4660
Email: email@asn-online.org
www.asn-online.org

American Society of Transplantation
15000 Commerce Pkwy. Ste. C
Mt. Laurel, NJ 08054
856.439.9986
Email: ast@ahint.com
www.myast.org

American Society of Transplant Surgeons
2461 South Clark Street, Ste. 640
Arlington, VA 22202
703.414.7870
http://asts.org

American Urological Association
1000 Corporate Blvd
Linthicum, MD 21090
410.689.3700
Email: aua@auanet.org
www.auanet.org

Association of Organ Procurement Organizations (AOPO)
8500 Leesburg Pike, Ste. 300
Vienna, VA 22182
703.556.4242
Email: aopo@aopo.org
www.aopo.org

CenterSpan
A collaborative project of the American Society of Transplant Physicians and the American Society of Transplant Surgeons features Transplant News Network, an online broadcasting service that publishes monthly news reports on recent developments in transplant medicine
asts.org/resources/connect-with-peers/centerspan

Children’s Organ Transplant Association, Inc.
2501 West COTA Drive
Bloomington, IN 47403
1.800.366.2682
www.cota.org

Coalition on Donate Life America
701 E. Byrd Street 16^th floor
Richmond, VA 23219
804.377.3580
Email: donatelifeamerica@donatelife.net
www.donatelife.net

International Society of Nephrology
340 North Avenue, 3^rd floor
Cranford, NJ 07016
567.248.9703

Musculoskeletal Transplant Foundation
125 May St.
Edison, NJ 08837
732.661.0202
Email: Information@mtf.org
www.mtf.org

National Foundation for Transplants
5450 Poplar Avenue #430
Memphis, Tennessee 38119
1.800.489.3863 or 901.684.1697
Email: info@transplants.org
www.transplants.org

National Kidney Foundation
30 East 33^rd St., Suite 1100
New York, NY 10016
Phone: 1.800.622.9010 or 212.889.2210
Email: info@kidney.org
www.kidney.org

National Kidney Foundation of Ohio
2800 Corporate Exchange Drive, Ste. 360
Columbus, OH 43231
1.800.242.2133
Email: nkfoh@kidney.org
www.nkfofohio.org

National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892
1.800.891.3580
Email: nkudic@info.niddk.nih.gov
www.niddk.nih.gov/

National Transplant Assistance Fund
150 N. Radnor Chester Road, #F120
Radnor, PA 19087 800.642.8399
www.transplantfund.org

Nephron Information Center
www.nephron.com

SRTR
The Scientific Registry of Transplant Recipients includes information about transplants performed at Cleveland Clinic Florida and other relevant transplant data.
www.srtr.org

Transplant Recipients International Organization (TRIO)
Cleveland Chapter
P.O. Box 210053
Cleveland, OH 44121
440.473.8979

United Network for Organ Sharing (UNOS)
P.O. Box 2484
Richmond, VA 23218
1.800.24.DONOR (1.800.243.6667)
Hotline provides general information on transplants, current statistics, and listings of transplant centers
www.unos.org

United States Renal Data System (USRDS)
USRDS Coordinating Center
914 South 8^th Street, Suite D-206
Minneapolis, MN 55404
612.347.7776 or 1.888.99.USRDS
usrds@usrds.org