Hypertensive dialysis patient survives 17 years on the waiting list for a new kidney

Jimmie Jones of Calumet Park, Ill., has beaten all odds to survive 17 years on the waiting list for a new kidney.

Diagnosed with hypertensive kidney disease in his 40s, Jones' health quickly deteriorated to the point where he needed dialysis three times a week.

Physicians at a south side Chicago hospital placed him on the waiting list for a new kidney in 1995 but told him that he needed to lose weight before he could be a candidate.

A former high school athlete, Jones is a large man, and he had difficulty taking the weight off.

"It's a miracle he's still alive," says Dr. Enrico Benedetti, head of surgery at the University of Illinois Hospital & Health Sciences System, who noted that 70 percent of hypertensive dialysis patients survive less than five years.

Jones, now 64, had learned that physicians at UI Hospital were performing robotic kidney transplantation on obese patients who would not otherwise be candidates for surgery. He decided to make an appointment.

Up to half of dialysis patients are obese, defined as those with a body mass index greater than 30. In the U.S., studies have shown that obese patients wait longer for a cadaveric kidney transplant and often have poorer outcomes, including surgical site infections.

As a result, many U.S. transplant centers deny transplantation to very obese patients and will not put them on the waiting list if they have a BMI greater than 35, says Dr. Jose Oberholzer, chief of transplantation surgery at UI Hospital and the C.& B. Frese and G. Moss Professor of Transplant Surgery, Bioengineering and Endocrinology at UIC.

"These transplant centers avoid listing morbidly obese patients for kidney transplantation, because obesity markedly increases the risk of wound infection, which lowers graft and patient survival," said Oberholzer. "However, we know that the benefits of transplantation outweigh the risks in this patient population. Transplantation in obese patients provides a clear survival advantage over dialysis -- and an improved quality of life."

In a traditional "open" kidney transplant procedure, a six- to eight-inch incision is made in the right-lower abdomen to implant the donor kidney. In robotic kidney transplantation using the da Vinci Robotic Surgical System, surgeons transplant the kidney through a 2 3/4-inch incision above the patient's belly button, with four tiny incisions in the abdomen to accommodate the robotic laparoscopic instruments.

"The majority of patients needing kidney transplantation are overweight or obese, and this procedure offers what we believe is a safer, minimally invasive procedure with fewer complications," says Dr. Pier Giulianotti, chief of general, minimally invasive and robotic surgery at UI Hospital and the Lloyd M. Nyhus Professor of Surgery at UIC.

Giulianotti said robotic surgery provides a three-dimensional view and utilizes instruments with 360-degree range of motion, allowing surgeons to complete these more complex procedures.

"The benefits to the patient are reduced surgical trauma, reduced risk for wound complications, and improved patient survival," said Giulianotti.

Jones underwent robotic kidney transplantation on Feb. 17. His new kidney is functioning perfectly, and he no longer requires dialysis.

Jones says he is grateful for his new kidney and "feels like a new man, 100 percent better."

Source University of Illinois Hospital & Health Sciences System