Findings have important implications for public as well as health care providers.

Christopher Saigal, UCLA

The number of Americans suffering from kidney stones between 2007 and 2010 nearly doubled from 1994, according to a new study by researchers at UCLA and the RAND Corp.

“While we expected the prevalence of kidney stones to increase, the size of the increase was surprising,” said Dr. Charles D. Scales Jr., a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar in the departments of urology and medicine at the David Geffen School of Medicine at UCLA. “Our findings also suggested that the increase is due, in large part, to the increase in obesity and diabetes among Americans.”

The study, “The Prevalence of Kidney Stones in the United States” is being presented today (May 23) at the 2012 meeting of the American Urological Association in Atlanta and will appear in the July print edition of the peer-reviewed journal European Urology.

This is one of the first studies to examine new data from the National Health and Nutrition Examination Survey (NHANES) that was collected from 2007 to 2010. NHANES is a program of studies within the Centers for Disease Control and Prevention to assess the health and nutritional status of adults and children in the U.S.

Scales and his colleagues reviewed responses from 12,110 individuals and found that between 2007 and 2010, 8.8 percent of the U.S. population had a kidney stone — one out of every 11 people. In 1994, the rate was one in 20. (No data about the national prevalence of kidney stones in the U.S. were collected between 1994 and 2007.)

Because NHANES also asks about other health conditions and includes measurements of height and weight, the researchers were able to identify associations between kidney stones and other health conditions. The results suggest that obesity, diabetes and gout all increase the risk of kidney stones.

While the national obesity rate was 23 percent in 1994, more than a third of all American adults are obese today, according to the Centers for Disease Control and Prevention.

The authors assert that these findings have important implications for the public, as well as health care providers.

“People should consider the increased risk of kidney stones as another reason to maintain a healthy lifestyle and body weight,” said the study’s senior author, Dr. Christopher S. Saigal, principal investigator within RAND Health for the Urologic Diseases in America project and associate professor of urology at the David Geffen School of Medicine at UCLA. “But physicians need to rethink how to treat and, more importantly, prevent kidney stones.”

Currently, the primary approach to treating patients is to focus on those who already are suffering from kidney stones. Yet helping patients maintain a healthy diet and body weight can reduce the number of patients with kidney stones.

“Imagine that we only treated people with heart disease when they had chest pain or heart attacks and did not help manage risk factors like smoking, high cholesterol or high blood pressure,” Scales said. “This is how we currently treat people with kidney stones. We know the risk factors for kidney stones, but treatment is directed towards patients with stones that cause pain, infection or blockage of a kidney rather than helping patients to prevent kidney stones in the first place.”

In an accompanying editorial that will also appear in the journal, Dr. Brian Matlaga, associate professor of urology at Johns Hopkins University School of Medicine, writes that the cost of care for this disease is enormous, and there is no indication that the coming years will see any improvement in this trend. He also warns that, since approximately 10 percent of the population has kidney stones, a greater emphasis on prevention is imperative.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (N01-DK70003), as part of the Urologic Diseases in America project based at UCLA and RAND.

The Robert Wood Johnson Foundation Clinical Scholars program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policymakers on issues important to the health and well-being of all Americans. This program is supported, in part, through collaboration with the U.S. Department of Veterans Affairs.

UCSF bioengineer leads team developing an implantable Renal Assistance Device.

Shuvo Roy, UC San Francisco

A nationwide team working on an artificial kidney is hoping to not only improve health with their device, but decrease costs at the same time. Bioengineer Shuvo Roy of the University of California, San Francisco, is leading the team to develop an innovative, implantable Renal Assistance Device, or iRAD.

“In this project, the cost decrease comes almost immediately because we are going to provide many of the benefits of transplant without the cost of the transplant drugs, eliminating the costs associated with dialysis,” Roy said. “So, from that $75,000 per patient for dialysis will probably be at most the cost for a transplant patient – $25,000 or even less because we won’t have to rely on those medications. Obviously there’s some projections here but we feel very encouraged as a team.”

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UCSF, UCLA participate in record donation chain.

UC San Francisco kidney transplant patient Gabriel Baty waits for surgery with his two daughters, Augusta Rose, 12, and Vivianna Marguerite, 8.

Gabriel Baty and Olivo Cienfuegos probably never would’ve crossed paths if they each didn’t need a new vital organ to survive.

Baty, 40, is a scientist for the pharmaceutical company Novartis and lives in Albany. Cienfuegos, 61, is a retired factory worker who lives 80 miles away in Stockton.

But on Dec. 7 they were lying just a few feet apart at UC San Francisco Medical Center awaiting kidney transplants as part of the longest living kidney donation chain in history.

Neither man had a donor who was a match. But each had a family member willing to donate a kidney to a stranger, allowing them all to be part of chain which would, in turn, give Baty and Cienfuegos kidneys from other strangers. With 17 participating hospitals in 11 states, including UCSF and UCLA,  the chain consisted of 30 people willing to give up their kidney, matched with 30 more who needed one to survive.

UCSF surgeons Andrew Posselt, M.D., Ph.D., and Ryutaro Hirose, M.D., performed the transplants on Baty and Cienfuegos – just two of the 300 or so kidney transplants performed at UCSF every year, or twice as many as any other transplant program in Northern California, according to the United Network of Organ Sharing (UNOS). Established in 1964, the Connie Frank Transplant Center at UCSF has performed more kidney transplants than any other medical center in the world. The kidney transplant chain, formally known as Chain 124 by the National Kidney Registry, was recently highlighted in the New York Times and the San Francisco Chronicle.

Finding a needle in a haystack

This was Cienfuegos’ second kidney transplant, and according to UCSF transplant coordinator Janine Sabatte-Caspillo, R.N., finding him a donor was like “finding a needle in a haystack.”

“Olivo is at a high risk for rejection because he has a lot of antibodies in his blood, which also makes it difficult to find a match,” she said. “He’s very lucky and it will be at least six months before we’re secure that the kidney won’t be rejected.” The first kidney, donated by his wife, failed due to diabetes and hypertension. He was relisted in 2009. His son Adrian, 29, donated his kidney to a 49-year-old Bakersfield woman on his behalf.

Baty’s story began 13 years earlier when his wife insisted he get a physical. As a seemingly healthy 27-year-old, Baty thought it was totally unnecessary. But that trip to the doctor ended up saving his life. Baty learned he not only had a torn bicuspid valve, but also a rare autoimmune disorder that ultimately results in kidney failure. The nurse, he said, told him she couldn’t believe he hadn’t already dropped dead.

Baty had his heart repaired and later spent two years on dialysis. His wife Christy was unable to be a donor for medical reasons, but her mother, Yvonne Gordon, qualified. A stage four Hodgkin’s lymphoma survivor, Gordon was inspired to donate her kidney after hearing a radio broadcast about another cancer survivor becoming a donor.

“I have a sticker on my refrigerator that says ‘She lives by what is the right thing to do,’” she said. “And that’s what I do every day of my life. It’s given me such a wonderful gift to be able to help my children. I couldn’t love Gaby more if he was my own son.”

While Baty and Cienfuegos waited for their transplants, Cienfuego’s son Adrian was in surgery, donating his kidney to a stranger. Gordon had to wait another week to donate her kidney, which was flown to UCLA. “It’s given me such a wonderful gift to be able to help my children,” Gordon said. “It just takes one bridge donor to set up a lot of good. You can’t get more wonderful than that.”

UCLA discovery has implications for engineering tissues, organs.

Diagonal pattern formed by migrating cells

What if we could engineer a liver or kidney from a patient’s own stem cells? How about helping regenerate tissue damaged by diseases such as osteoporosis and arthritis? A new UCLA study bring scientists a little closer to these possibilities by providing a better understanding how tissue is formed and organized in the body.

A UCLA research team discovered that migrating cells prefer to turn right when encountering changes in their environment. The researchers were then able to translate what was happening in the cells to recreate this left–right asymmetry on a tissue level. Such asymmetry is important in creating differences between the right and left sides of structures like the brain and the hand.

The research, a collaboration between the David Geffen School of Medicine at UCLA and the Center for Cell Control at UCLA’s Henry Samueli School of Engineering and Applied Science, appears in today’s (Feb. 17) issue of the journal Circulation Research.

“Our findings suggest a mechanism and design principle for the engineering of tissue,” said senior author Dr. Linda L. Demer, a professor of medicine, physiology and bioengineering and executive vice chair of the department of medicine at the Geffen School of Medicine. “Tissue and organs are not simply collections of cells but require careful architecture and design to function normally. Our findings help explain how cells can distinguish and develop highly specific left–right asymmetry, which is an important foundation in tissue and organ creation.”

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Researchers call for increased screening for patients taking the the medication.

Tenofovir, one of the most effective and commonly prescribed antiretroviral medications for HIV/AIDS, is associated with a significant risk of kidney damage and chronic kidney disease that increases over time, according to a study of more than 10,000 patients led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

The researchers call for increased screening for kidney damage in patients taking the drug, especially those with other risk factors for kidney disease.

In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine — a marker of kidney damage — rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease (CKD) rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors.

For individual patients, the differences in risk between users and non-users of tenofovir for each year of use were 13 percent vs. 8 percent for protein in urine, 9 percent vs. 5 percent for rapidly declining kidney function and 2 percent vs. 1 percent for CKD. “However, these numbers are based on the average risks in our study population, and patients with more risk factors for kidney disease would be put at proportionately higher risk,” said principal investigator Michael G. Shlipak, M.D., M.P.H., chief of general internal medicine at SFVAMC and professor of medicine and epidemiology and biostatistics at UCSF.

[Related: Tenofovir: Q&A for patients and providers]

Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible, said Shlipak. “We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease,” he cautioned.

The implications for patients already on or starting antiretroviral therapy are “mixed,” said Shlipak. “The best strategy right now is to work with your health care provider to continually monitor for kidney damage. Early detection is the best way to determine when the risks of tenofovir begin to outweigh the benefits.”

Shlipak noted that HIV, itself, increases the risk of kidney damage, while modern antiretroviral treatments clearly reduce that overall risk. “Patients need to be aware of their kidney disease risks before they start therapy, and this should influence the medications that they choose in consultation with their doctor,” he said. “For an otherwise healthy patient, the benefits of tenofovir are likely to exceed the risks, but for a patient with a combination of risk factors for kidney disease, tenofovir may not be the right medication.”

Tenofovir is used to decrease viral load and increase immune cell count in people infected with the virus. It is currently considered the preferred first line treatment for HIV because of its potency, overall low toxicity, and convenience of dosing. It is sold under a variety of names, by itself and in combination with other medications.

The study examined the medical records of 10,841 HIV-positive veterans in the national VA health care system who were new users of antiretroviral therapy from 1997 to 2007. It was published electronically in the journal AIDS on Jan. 9.

Lead author Rebecca Scherzer, Ph.D., a researcher and statistician at SFVAMC and UCSF, said that the observational study was the largest and most conclusive indication so far of tenofovir’s association with kidney damage. “There have been a number of previous, smaller studies suggesting that this drug might be associated with kidney disease, but the results were mixed,” she said. “Those studies may have missed this association because they were too small, lacked appropriate lab data or excluded subjects with pre-existing renal impairment or risk factors for kidney disease.”

To be sure that tenofovir was the culprit, Scherzer and her colleagues looked for associations between 18 other antiretroviral medications and the same three measures of kidney disease:  protein in urine, rapid decline in function and progression to CKD. None were associated with higher risk.

Shlipak noted that the study results are particularly strong because two of the risk factors — decline in function and CKD — indicate kidney function, while protein in urine indicates physical damage to the kidney. “These are independent markers,” he said. “To see the same drug cause both types of kidney disease gives you a very objective signal that something real is happening here.”

Shlipak emphasized that, despite tenofovir’s association with progressive kidney disease, it is an important component of effective antiretroviral therapy that may be required in many patients to control viral load.

The VA is the largest provider of HIV care in the United States, said Shlipak. “We could not have done this work without access to the VA’s system of electronic medical records,” he said. “In particular, the data kept by the VA Clinical Care Registry, located at the VA Palo Alto Health Care System, were essential to this study.”

Co-authors of the study are Michelle Estrella, M.D., of Johns Hopkins School of Medicine; the late Andy I. Choi, M.D., M.A.S., of SFVAMC and UCSF; Steven G. Deeks, M.D., of San Francisco General Hospital; and Carl Grunfeld, M.D., Ph.D., of SFVAMC and UCSF.

The study was supported by funds from the National Institutes of Health, the National Center for Research Resources, the American Heart Association and the Department of Veterans Affairs, some of which were administered by the Northern California Institute for Research and Education.

NCIRE — The Veterans Health Research Institute — is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Undocumented transplant candidate remains on waiting list for donated organ.

Josh Adler, UC San Francisco

Recent media reports about one of UC San Francisco’s kidney transplant candidates have contained confusing and incorrect information about the university’s policy for evaluating kidney transplant candidates, in particular for undocumented individuals.

Protecting patient privacy is paramount at UCSF, but today (Feb. 9) Jesus Navarro has authorized release of a joint statement with UCSF Chief Medical Officer Josh Adler, M.D.

UCSF is dedicated to providing the highest quality, safest treatment for all of its patients. The university has tremendous compassion for patients, and their families, who face the very difficult issues related to kidney failure. While for some of these patients transplants can be lifesaving, transplant surgery is the starting point of a lifetime of medical care and treatment, including daily use of costly anti-rejection drugs.

UCSF does not reject transplant candidates based on their immigration status and has performed transplants on undocumented individuals. These patients are not refused treatment. Rather, UCSF refers them to community-based and other external services that can help them address issues related to specific access-to-care hurdles faced by non-citizens. Of particular concern is their lack of easy access to the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.

While the patients resolve those problems, they remain on the transplant waiting list.

Joint statement from Jesus Navarro and Josh Adler, M.D., chief medical officer, UCSF Medical Center

Feb. 8, 2012

UCSF is committed to helping Jesus Navarro and all kidney transplant candidates achieve their goal of a transplant. On Tuesday, we jointly developed a plan that we hope will secure for Mr. Navarro the health coverage he needs for his care during transplant surgery and beyond, including costly anti-rejection medications. While that plan is pursued, he will remain on the transplant list, as was always the case, and will continue to accrue time toward a transplant.

Last May, Mr. Navarro met with UCSF medical, social work and financial staff in preparation for a potential kidney transplant. Like many others, he had been on the UNOS (United Network for Organ Sharing) waiting list for a long time, in his case more than six years. Mr. Navarro still had one year or more until he would reach the top of the UNOS list and UCSF’s standard procedure calls for reviewing patients at that time to ensure they are still good candidates for a future transplant.

As of today, he still is not at the top of the list, but is expected to reach the top in three to six months.

During the May visit to UCSF, Mr. Navarro met with UCSF financial counselors who asked about his immigration status. Mr. Navarro responded that, in fact, he was undocumented. Due to the complexities of the current health insurance industry, this was a concern for UCSF because it increases the risk that Mr. Navarro will not be able to continue to be insured and therefore not receive the follow-up care and medication needed to stay healthy after a transplant.

Per UCSF practice, Mr. Navarro’s status on the waiting list was changed to “inactive” as a result, which means that he would maintain his place on the waiting list, but would not receive a transplant even if he reached the top unless he had a reasonable coverage plan in place. The counselors also referred Mr. Navarro to two community assistance organizations that specialize in resolving immigration issues, as part of our effort to increase the likelihood of transplanted patients maintaining their health coverage for the surgery and critical post-transplant care.

Mr. Navarro has told UCSF that, to him, this meant he would not get a transplant until he resolved his immigration status; this was not what UCSF was trying to convey. Instead, UCSF was following its policy to make sure Mr. Navarro would continue to have the health insurance necessary to receive proper post-transplant follow up. Follow-up care is critical to transplant patients, who otherwise may lose the organ and become less healthy than they were on dialysis.

UCSF regrets the misunderstanding and is committed to reviewing its processes to make sure that communication is consistent and clear with all patients, including Mr. Navarro. UCSF does not and will not discriminate on the basis of immigration status.

The road to a kidney transplant is long, and it may still take Mr. Navarro months to continue through the process. In the meantime, he continues to maintain his health through dialysis, as he has for the past 6 1/2 years.

This situation underscores the many obstacles all transplant candidates face securing the long-term coverage they need because of the patchwork nature of the health care system. These obstacles can be more difficult for undocumented individuals to overcome.

UCSF Medical Center operates one of the world’s largest kidney transplant programs, with more than 5,240 patients on the list waiting to receive a kidney. Sadly, only 350 of those patients will receive a kidney transplant this year, mainly because of a shortage of organs, either from deceased patients or living-related donors.

We encourage everyone to become an organ donor. For more information, contact Donate Life California, or, to become a living donor, contact UCSF.

UC Davis surgeon uses one small incision for life-saving, living kidney donations.

Angela Whalen didn’t seek out a single-incision nephrectomy surgeon. She simply wanted to save her father’s life. The fact that Whalen was able to undergo a unique surgical procedure to donate her kidney, with a barely visible scar to show for it, was the added bonus of a daughter’s gift of life to her dad.

Until she traveled to UC Davis Medical Center after finding out she was a donor match, Whalen hadn’t even heard of the minimally invasive surgical procedure that Christoph Troppmann, UC Davis professor of surgery, routinely offers kidney donors. Troppmann can remove a kidney through a single port – or incision site – at the patient’s navel. He is among only a handful of surgeons across the nation who perform the unique procedure.

“Dr. Troppmann told me about the procedure during one of our preliminary meetings, but it really didn’t register for me,” said Whalen, an Atlanta-area resident. “When it did register was after surgery, when I joked with the doctor, ‘Have I actually been in surgery?’”

Christoph Troppmann, UC Davis

Over the past year, Troppmann performed approximately 65 living kidney donations using the specialized technique. He says it potentially has multiple benefits compared to the conventional type of laparoscopic transplant surgery, which was a minimally invasive technique pioneered by his colleague Richard Perez at UC Davis Medical Center in 1997.

“The main benefit of a single-incision surgery is that you have just one small opening compared to multiple incisions,” said Troppmann, whose patients usually remain in the hospital for only two days. “These donor patients typically have much, much shorter recovery times. That’s where we’ve really seen the difference. It’s still amazing to us that a week after surgery, when we see our donors in clinic and ask them to get up from the exam table, it’s almost as if they haven’t had surgery.”

Troppmann noted that living kidney donors must be in good health, and that donating an organ is an elective procedure. His goal is to provide the safest possible procedure, with the least disruption to a patient’s family life and job. For donors like Whalen, however, the type of surgical technique is secondary to simply being able to improve the health and well-being of a friend or loved one.

“I didn’t think much about the procedure until close to surgery, and then afterwards when I saw the tiny, tiny scar for the first time,” said Whalen. “The main thing was just making sure that I could donate my kidney. My feeling was, ‘He needs a kidney. He’s my father. It’s no big deal.’”

At the time of the transplant, Whalen’s father, Isaiah Ollison, was on dialysis and on the organ transplant list because of kidney disease. He and his wife had resisted the idea that a family member might donate a kidney. But when Ollison traveled to Georgia for his grandson’s high school graduation in 2010, Whalen immediately noticed how weak and tired he looked. It was at that point that she insisted on finding out if she was a match as an organ donor.

“When UC Davis called and said we were a match, I knew we were going to do it,” said Whalen. “In fact, up until we were driving to the medical center on transplant day, he was still saying, ‘Are you sure you want to do this?’ And I said, ‘Dad, we’re doing this.’”

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Finding by UC Irvine team could help prevent cardiovascular complications.

N.D. Vaziri, UC Irvine

UC Irvine researchers have uncovered an important source of inflammation seen in people with chronic kidney disease, which is increasingly common due to the epidemic of obesity-related diabetes and hypertension.

Dr. N.D. Vaziri, professor emeritus of medicine and physiology & biophysics, found that CKD causes massive depletion of the key adhesive proteins, called the tight junction, that normally seal the space between the cells lining the intestines. This breakdown in the colon allows the leakage of microbial products and other noxious material into the body’s internal environment, accounting for the persistent systemic inflammation that frequently occurs in CKD patients.

“In fact, low levels of bacterial endotoxins are often noted in the blood of individuals with advanced chronic kidney disease,” Vaziri said. “However, the source and place of entry of these toxins were previously unknown.”

Understanding the connection between CKD and tight junction disintegration, he added, could lead to novel treatments to curb this inflammation and its many adverse consequences. Study results appear online in the journal Nephrology Dialysis Transplantation.

It’s estimated that nearly 25 million people in the U.S. have CKD, and more than 400,000 have end-stage kidney disease requiring dialysis. Many CKD patients develop accelerated cardiovascular disease — the primary cause of premature death in this population — linked to persistent inflammation.

“The relentless inflammation seen in chronic kidney disease has devastating effects on the cardiovascular system and other parts of the body,” Vaziri said.

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HealthGrades honors UC Davis for third straight year.

UC Davis' Richard Perez during a transplant surgery

For the third year in a row, a leading, independent health-care ratings organization has recognized UC Davis Medical Center as one of the top hospitals in the nation for kidney transplantation.

The medical center’s Kidney Transplant Program was one of only eight of 221 hospitals evaluated in the United States to receive a 2012 Kidney Transplant Excellence Award from HealthGrades, a Colorado-based firm that analyzes publicly available data in order to rate hospitals and their programs based solely on clinical outcomes.

To determine the best hospitals for organ transplants, HealthGrades examined the clinical quality outcomes of hospital transplant centers using the most recent Scientific Registry of Transplant Recipients (SRTR) data for 2011. UC Davis’ ranking was based on data from criteria calculated from the national database of transplantation. Compared to the kidney transplant programs evaluated, UC Davis had better-than-expected three-year patient survival rates. The medical center’s program also had a significantly lower wait-list mortality rate, which tracks patient deaths while awaiting transplantation, and a significantly higher-than-expected deceased-donor transplant rate, which reflects improved transplantation opportunities for individuals.

“The award for excellence reflects our continuing goal of providing the very best in kidney transplantation care and services,” said Richard V. Perez, professor of surgery and director of the UC Davis Kidney Transplant Program. “Our comprehensive team includes surgeons, nurses, anesthesiologists, nephrologists, donor coordinators, pharmacists, dieticians and social workers. Everyone is dedicated to providing the full range of transplant care, both before and long after surgery. And our ability to collaborate with other UC Davis specialists, such as immunologists and cardiologists, helps ensure that every transplant patient receives great care and can enjoy a long life after their transplant.”

Along with low wait-list mortality and higher patient-survival rates, the HealthGrades ranking analyzed the rate at which wait-listed patients received transplants. It also reflects the medical center’s strong one- and three-year graft survival rates, which tracks how long the transplanted kidney is still functioning after transplantation.

UC Davis Medical Center has provided care to transplant patients from throughout Northern California and Northern Nevada since 1985. In recent years, UC Davis also has made it easier for individuals to donate a kidney. A unique, minimally invasive procedure known as a single-port donor nephrectomy, led by Christoph Troppmann, a professor of surgery, enables surgeons to extract a kidney through a tiny, two-inch incision, greatly reducing scarring and often speeding the recovery times for donors.

UC Davis Medical Center has one of the largest kidney transplant programs in the country. In 2011 alone, it has already performed more than 240 kidney transplants.

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The miracle of organ transplantation on UCTV.

Transplantation is accepted as optimal therapy for patients with end-stage organ disease. Successful replacement of the heart, lung, liver, kidney, pancreas and small bowel can now be achieved. As a consequence, more and more patients are availing themselves to this therapy. Currently in the United States, there are more than 110,000 patients listed with the national registry awaiting transplantation; last year there were just over 28,500 transplants performed, underscoring the major disparity between need and supply.

The University of California provides half of all transplants in the state, and UC San Francisco has one of the world’s largest and most successful transplant programs. In this UCTV series from the UCSF Osher Mini Medical School for the Public, UCSF specialists share the whys, hows and what happens of organ failure and transplantation, live donor transplantation, alternative therapies, organ distribution, and organ engineering. In sum, the series will give you an understanding of how spare parts are used to produce miracles.

Programs include:

What Organ Shortage? Just Make Your Own! Stem Cells and Organ Engineering
First air date: Nov. 7

HIV Transplant: The Good, The Bad, The Unexpected
First air date: Nov. 14

Kidney Transplants: Who Needs One? How Do We Do It?
Nov. 21

Immunosuppressive Medications for Transplantation: The Good, The Bad and The Ugly
First air date: Nov. 28

Related links:

More Mini Medical School videos on UCTV

More about the UCSF Osher Mini Medical School lecture series

UCSF: Improving outcomes in organ donor transplantation

UCLA: Index devised for predicting survival after liver re-transplantation

UC San Diego: Domino liver transplant treats two rare diseases

UCLA: Donor heart arrives ‘warm and beating’ (video)

UC Davis: The gift of life: Thanking organ donor families

UCLA launches program to provide face, hand and abdominal wall transplants

UCLA’s first hand transplant patient adapting well (video)

UCSF liver transplant team shares expertise in Latin America

UC San Diego: Two hearts beat as one (video)

UC San Diego: West Coast’s first total artificial heart implanted

UC Davis: Extraordinary larynx transplant restores voice to California woman

UC Irvine recognized for its commitment to organ donation

UCSF bioengineer working to create tiny devices that can treat diabetes or kidney failure.

Tejal Desai, UC San Francisco

The same technology used to create integrated circuits may one day be applied to the body to deliver medicine or serve as implants that act as an artificial organ. Tejal Desai, a bioengineer at the University of California, San Francisco, is working with microelectromechanical systems, or MEMS, to create tiny devices that can treat diabetes or kidney failure. But Desai says they’re also looking at different devices which one could potentially inject via catheter.

“Eventually, the goal is to create an implant that actually would just be a simple injection and that injection would be able to have a device,” Desai said. “It’s made out of a really thin film of polymer material and has small channels that can deliver drugs for many months. “

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Rheumatoid arthritis drug reduces kidney cyst growth in mouse tests.

Thomas Weimbs, UC Santa Barbara

Scientists at UC Santa Barbara have discovered that patients with an inherited kidney disease may be helped by a drug that is currently available for other uses. The findings are published in this week’s issue of the Proceedings of the National Academy of Sciences.

Over 600,000 people in the U.S., and 12 million worldwide, are affected by the inherited kidney disease known as autosomal-dominant polycystic kidney disease (ADPKD). The disease is characterized by the proliferation of thousands of cysts that eventually debilitate the kidneys, causing kidney failure in half of all patients by the time they reach age 50. ADPKD is one of the leading causes of renal failure in the U.S.

“Currently, no treatment exists to prevent or slow cyst formation, and most ADPKD patients require kidney transplants or lifelong dialysis for survival,” said Thomas Weimbs, director of the laboratory at UC Santa Barbara where the discovery was made. Weimbs is an associate professor in the Department of Molecular, Cellular and Developmental Biology, and in the Neuroscience Research Institute at UC Santa Barbara.

Recent work in the Weimbs laboratory has revealed a key difference between kidney cysts and normal kidney tissue. They found that the STAT6 signaling pathway — previously thought to be mainly important in immune cells — is activated in kidney cysts, while it is dormant in normal kidneys. Cystic kidney cells are locked in a state of continuous activation of this pathway, which leads to the excessive proliferation and cyst growth in ADPKD.

The drug Leflunomide, which is clinically approved for use in rheumatoid arthritis, previously has been shown to inhibit the STAT6 pathway in cells. Weimbs and his team found that Leflunomide is also highly effective in reducing kidney cyst growth in a mouse model of ADPKD.

“These results suggest that the STAT6 pathway is a promising drug target for possible future therapy of ADPKD,” said Weimbs. “This possibility is particularly exciting because drugs that inhibit the STAT6 pathway already exist, or are in active development.”