Nephrologist Samy Riad, MD, MS, likes a challenge.
Riad joined University of Minnesota Health recently to care for kidney and pancreas transplant patients. He handles complex healthcare needs and is focused on helping patients who have received kidney and/or pancreas transplants maintain their wellbeing after the procedure.
“It can be a challenging area of medicine, but seeing patients improve and watching them get back to living their lives again [following the transplant] inspires me rise to the challenge,” Riad said.
We talked with Riad about dual kidney-pancreas transplants, the risks following a transplant and how he helps pediatric transplant patients as they get older.
I’m a transplant nephrologist. I work with kidney and pancreas transplant candidates to evaluate them before, during and after they receive a new organ. Before transplant, we need to ensure patients are good candidates and healthy enough for the procedure. After transplant, we follow them to make sure we’re properly suppressing their immune system so the body doesn’t reject the new organ, while also managing other problems that can occur when your immune system is weakened.
Most post-transplant patients do well, but some are susceptible to infections, diabetes and even cancer. In post-transplant care, we work to strike a good balance between suppressing the immune system and keeping the patient healthy. Some medications can cause recipients to become glucose intolerant or insulin resistant, which can lead to diabetes. Thankfully, University of Minnesota Health has a program to treat patients without steroids, which significantly reduces the chance of post-transplant diabetes. In a small number of cases, patients develop post-transplant lymphoproliferative disorders (PTLD), a spectrum of complications that can develop when the the immune system is suppressed.
I like these areas because they’re challenging. In transplant care, the transplant recipients and the nephrologists have a unique relationship. Our doctors are with each patient every step of the way, from the first appointment to long after they receive their new organ. Seeing our patients’ lives change for the better ignites me to keep thinking, keep learning and keep doing what’s best for each person under my care.
As they age, pediatric transplant recipients must learn how to become their own caregivers and assume responsibility for their continued health. They have to fill and take their own medications, for example. They also have to learn to navigate the adult healthcare system. I work with these patients to help them understand some of the decisions they’ll need to make and I reinforce with them the importance of maintaining on their medications and routine care visits. It’s critical that they understand all aspects of their health situation so they’re making well-informed decisions on their own.
We perform dual kidney-pancreas transplants for type 1 diabetes patients and certain type 2 diabetes patients who experience kidney failure. In type 1 diabetes patients, the pancreas doesn’t produce enough insulin—if any at all. Insulin controls the blood sugar level in your body. Over time, diabetes can damage the kidneys, causing them to fail and stop filtering out waste in the body. By replacing both organs simultaneously—literally, in the same surgical procedure—we can alleviate a patient’s diabetes. We transplant about 180 to 200 kidneys a year at University of Minnesota Medical Center and about 25 to 35 simultaneous kidney-pancreas transplants. Some people that need a simultaneous transplant can be sicker and may take a longer time to recover. But once both organs are working, their diabetes is gone and the patients no longer need dialysis. The first pancreas transplant was actually performed at the University of Minnesota in 1966, so it’s an honor to work at institution that has been a pioneer in the field.
We also conduct pancreas transplants for type 1 diabetics with a functioning native kidney—or for those who have already received a living donor kidney transplant.
The relationship between nephrologists and transplant surgeons is key and is unique here at University of Minnesota Health. We’re one team. The patient-centered management that we as one unit provide becomes a continuum of care for a patient’s entire treatment journey. We make sure that everybody who needs to be involved in the patient’s care is on board and an active participant. The patient always comes first.