“A kidney transplant…is extraordinarily powerful,” said Jayme Locke, M.D., MPH, director of the UAB Comprehensive Transplant Institute (CTI), in a recent episode of ‘The Checkup’ podcast. “So is a liver, a heart, a lung—they all change people’s lives. They all give life back.”
Locke, a transplant surgeon, researcher, and professor at UAB, sat down with Selwyn Vickers, M.D., FACS, senior vice president of Medicine and dean of the School of Medicine, to discuss the many ways transplant at UAB is saving lives and making a difference in the Southeast.
Locke completed her undergraduate degree in biology and chemistry at Duke University and her medical degree at East Carolina University prior to matriculating to Johns Hopkins Hospital where she received training in general surgery and multi-visceral abdominal transplantation.
“When I finished [training at John Hopkins Hospital] I was looking to be a transplant surgeon and a scientist, but also really looking for a community—a place where I felt like I could see myself working and succeeding. An institution that I felt valued people, because to me, that was more important than really anything else. [I] had several opportunities, but very easily came to the decision that I should be at UAB,” Locke said.
Saving lives through kidney transplant
Next, Locke told Vickers about the difficult life those with kidney disease lead while on dialysis, and how a kidney transplant can restore quality of life to them.
“The path forward for these individuals is to really be able to come off dialysis through the miracle of transplantation, and kidney transplantation without question is the gold standard. With a functioning kidney, these individuals can go back to doing all the things that they were doing before they had to be on a dialysis machine,” Locke said.
In the U.S., there are about 90,000 individuals are waiting for a kidney transplant with about 700,000 on dialysis. UAB CTI performs about 200 to 220 kidney transplants per year in the U.S. and is actively working to offer more transplants to those on dialysis.
“You look at [these numbers] and you realize everybody who needs a kidney doesn’t even make it to the kidney list…There are all sorts of realities that these individuals face, and I think it’s our job as transplant surgeons to figure out how to get to a ‘Yes,’” Locke said on managing the shortage of organ donations.
Putting UAB on the map
Transplant at UAB is unique for many reasons. As one of the busiest transplant centers in the nation, the CTI is nationally ranked and offers thousands of patients care annually.
Alabama’s first kidney transplant was performed at UAB in 1968. During the 1970s, mycophenolate mofetil (MMF) was developed, largely due to clinical trials conducted at UAB. MMF is an immunosuppressant that, when combined with corticosteroids, prevents organ rejection after transplant. It is now the standard of care for maintenance immunosuppression across the globe.
Additionally, a uterine transplant program is being developed by UAB CTI, the Department of Obstetrics and Gynecology, reproductive health professionals, and the support of many nurses, coordinators, and administrators. The program brings the first-of-its-kind service to the Southeast region. The first uterine transplant will occur in the coming months.
Another fact that makes UAB’s program unique is that the institution’s research is cited in the formal research criteria that President Obama mandated in the HIV Organ Policy Equity Act which allows HIV positive individuals to donate organs to HIV positive patients.
Locke shared that UAB transplant doctors are actively pursuing research and innovative approaches that may affect the necessity of their own jobs. “We are so desperate to fix disparities, to fix chronic diseases that we’re even willing to study things that might ultimately prove to not need transplant in the future. But that’s what we really aim to do,” she said.
UAB CTI has performed more living donor kidney transplants for African American/Black individuals than any other program in the country with hopes of reducing health disparities.
Coordinating transplant through COVID-19
The UAB CTI has persevered through COVID-19, remaining open through coordination with UAB Hospital and the Federal Government. The transplant institute has also provided educational resources to encourage vaccination among patients and ninety percent of kidney patients are now vaccinated.
Many surgeons at UAB CTI have cared for COVID-19 patients with pro-longed lung issues. A pediatric patient faced acute liver failure due to COVID-19 but UAB surgeons helped the patient through treatment and they ultimately did not need a transplant.
Vickers and Locke both spoke on the impact of misinformation surrounding transplant and COVID-19, and the need for doctors to gain patient trust.
“I see it as my job every day, in addition to doing transplants and other things, [to find] ‘How do I build trust with my patients with the patients in the community that have yet to make it to UAB?’” Locke said.
Leading the way forward
UAB CTI’s vision moving forward is to continue to grow its annual kidney transplant numbers, expand its liver program, overcome disparities, grow heart and lung programs, aid wounded U.S. veterans through the VCA program, and expand the burn center’s reach.
To achieve these goals, a substantial increase in organ donation is needed.
When asked by Vickers about living organ donation, Locke shared how individuals can live healthy lives with one kidney and are able to donate whether they are a match or not by donating in honor of someone.
She said individuals can leave a legacy through organ donation after death.
“I really see organ donation as an opportunity for someone after life to be able to leave a tremendous legacy of hope, and of life, and of joy, and all the things that organ disease takes away from people that gift gives all of that back,” Locke said.