Department of Surgery
Transplant Surgery Research
Division of Transplant Surgery Research Faculty
Associate Professor of Surgery
Satish Nadig, MD, PhD
Division of Transplant Surgery Research Interests
Currently, there are over 17,000 people on the waiting list for a liver transplant. Unfortunately, slightly over 5,000 livers are available yearly to satisfy this need, leading to hundreds of needless deaths each year. Worsening this problem, nearly one third of donor livers cannot be used due to high levels of fat (steatosis) within the organ. When transplanted, livers with high amounts of steatosis undergo a phenomenon called primary non-function (PNF), which is liver graft failure for reasons other than surgical error or rejection. There is massive hepatocyte necrosis, and ultimately, there is not enough remaining liver mass to sustain life. The current practice is to discard donor livers with high amounts of fat. However, studies have also demonstrated that if these livers are supported well early after surgery, they will have excellent long-term function.
At the MUSC transplant laboratory, we have conducted preliminary studies on how to protect these fatty livers from early damage, allowing their safe use for transplant. This will permit our center and other transplant programs around the country to safely use these fatty livers and dramatically increase the number of donor livers available for people on the waiting list. Our current research focuses on using several promising medications to prevent two toxins from causing injury to fatty livers.
Research in Disparity on Organ Donation. There exists a great disparity between the number of African-Americans on the transplant waiting list and those who undergo living donation. Of the more than 600 patients waiting for kidney donation in South Carolina, 80 percent are African-Americans. After applying the national average to South Carolina, only 15 percent of live organs are donated by African-Americans. It is estimated that more than a quarter of the waiting patients will never receive their much-needed organs. Living organ donation has several important advantages over cadaver donation. Through live donation, the transplant can be scheduled ahead of time, live donated kidneys begin to function immediately after transplantation, and there is improved long term survival.
Transplant research at MUSC has been devoted to determining the reason why the disparity between African-Americans needing kidneys and those donating kidneys exists in addition to developing strategies to reduce this discrepancy. This research has been funded for over a decade by the NIH grant “A Program to Increase Living Donations in African Americans”. The current goal of this grant is to test the hypothesis that live kidney donation in African Americans will increase with (1) the utilization of educators who are professionally trained to work with African Americans, (2) early identification and education of African American donors in potentially “high yield” settings, and (3) improved navigation of the African American donors by these educators. Increasing the number of living donors in the AA community will result in more transplants in this racial group which will ultimately improve graft and patient survival and lower waiting times. A past postdoctoral fellow was most recently involved in this work.
Quality Outcome in kidney transplantation. A multidisciplinary quality improvement initiative was developed at MUSC that targeted eliminating these issues. The team developed key initiatives including improved medication reconciliation, development of a diabetes management service, and improved discharge medication dispensing, delivery, education, and scrutiny. Follow-up analysis demonstrated reduced medication discrepancies by >2 per patient and obtaining 100% adherence with reconciliation. Pharmacists reviewed discharge medications, reaching 100% by study end, leading to a 40% reduction in medication safety issues. LOS remained short, and delayed discharges were reduced by 14%; 7-day readmission rates decreased by 50%. Acute rejection and infection rates also significantly decreased. In conclusion, a multidisciplinary quality improvement initiative has improved medication safety in kidney transplant patients, which lead to improved clinical outcomes.