The specialists addressed achievements and challenges of transplant medicine in Puerto Rico.
Dr. Verónica Meza, Director of the Kidney Program and Nephrologist Hospital Auxilio Mutuo, Dr. Alexis Cruz Chacón, Medical Director of Bone Marrow Transplantation at Hospital Auxilio Mutuo, Dr. Nilka de Jesús, Pediatric Nephrologist and member of the Pediatric Transplant Program at the Auxilio Mutuo Hospital and Dr. Joel López, Hematologist Oncologist at the Auxilio Mutuo Hospital. Photo: Journal of Medicine and Public Health. Fabiola Plaza, the photos of doctors Cruz and López. Photos provided by specialists Meza and Jesús.
With the objective of educating and raising awareness regarding the importance of transplant medicine in Puerto Rico, the Journal of Medicine and Public Health and the Auxilio Mutuo Hospital held a discussion with some of the protagonists of the scope and achievements of transplant medicine.
First of all, it is important to note that this process is not only for adult patients, but that pediatric patients also have a multidisciplinary care team at the health center, as well as a follow-up process for the living donor who wishes to support a donor. patient.
In this regard, the Dr. Veronica Meza, Director of the Kidney Program y Nefrologa Hospital Loansindicated that to date they have performed 2,515 kidney transplants and regarding 150 combined kidney-pancreas transplants.
The specialist stressed that the living donor transplant is ideal for the transplant recipient, “because they will not have to wait and the donor will not have any condition, the survival of this graft is greater. The organ we use is of better quality, and it is superior for the donor, because by doing an exhaustive evaluation the person can have peace of mind regarding their health, because the risks are minimal”.
For this reason, the recommendation is to always do it in a health center that meets health standards for the benefit of the donor and the person receiving the organ, said the specialist, who added that
The causes of kidney disease are the same in the last decade, but what we have seen is that patients are getting older, on average 65 years old or more, “what according to the statistics is that they are older donors, and they have a higher body mass index, which means that we have to spend more time to transplant it.”
For his part, the Dr. Alexis Cruz Chacon, Medical Director of Bone Marrow Transplantation at Hospital Auxilio Mutuo, highlighted that bone marrow transplants have been performed in Puerto Rico since 1998, the first to be performed were autologous, that is, with the patient’s stem cells. “Already in 2017, allogeneic transplants began, giving patients the opportunity to have the procedure done in Puerto Rico and not travel to the United States, thanks to the Hospital Auxilio Mutuo program,” she said.
For Dr. Meza, one of the challenges is patient education regarding early detection of conditions and timely management. Also, the pandemic is a challenge, because access at this time was difficult, but the biggest challenge is to have more donors, “because at this time the donors, for the most part, are brain-dead and cadaveric patients, but this is limited. a year, that is why we must emphasize living donation through programs like ours for safe donation and minimal complications”.
“We are a successful program that is comparable to the American nation, so there is no reason to do this procedure outside the island,” he emphasized.
Meanwhile, his colleague, Dr. Cruz, indicated that there are many challenges, and one of them is that patients can access donation and have more donors, as well as improve research and response to cell therapy.
Regarding the goals, he stressed that medicine is evolving more every day, “and the goal is to have treatments available so that cancer can be fought more effectively. We want to work on the accreditation of the FAT program, because that says that we are at a better level”.
Pediatric Transplant Medicine in Puerto Rico
It is important to clarify, “in general terms, the conditions that lead a pediatric patient to need a kidney transplant, the causes are from birth, unlike adults, that their condition develops due to other pathologies”, as stated by the Dr. Nilka de Jesus, Pediatric nephrologist and member of the Pediatric Kidney Transplant Program at Hospital Auxilio Mutuo.
He specified that from 2017 to 2022, and 22 transplants have been performed where the youngest patient is 3 years old and to date all these patients have evolved very well and that is why we continue to grow to continue offering the service on the Island and to be able to do so for the entire Caribbean.
“When we talk regarding transplants, donors are living or deceased, and in Puerto Rico, pediatric patients wait on that list and thanks to the relatives of the little deceased and offer that person an opportunity,” he explained.
The pediatric nephrologist explained that when a patient goes to the waiting list, “this is handled by an organization that is contracted by the United States Department of Health, and they are the ones who, following us, enter the information of the person who needs a transplant, and the organization is in charge of defining the best donor”.
However, he clarified that a transplant is a treatment and as such one should always act thinking that the benefit is greater than the risks. “When we look at a pediatric patient, the lifespan of that kidney is between 10 and 15 years, and they have to take medicine for life, to prevent the body from rejecting the transplanted organ, but in general terms they can have a lifestyle life similar to that of a person without this treatment”.
Clinical and multidisciplinary patient management
“As a general rule, we want the patient to have as little disease as possible, because current treatments are combined to help the patient have better results, that is, the patient who has less disease before the stem cell transplant, the better will be the result, because these treatments help the transplant procedure to be more successful”, as indicated by the Dr. Joel Lopez, Hematologist Oncologist at Hospital Auxilio Mutuo.
López indicated that there is no cure, “but we are talking regarding the patient having a longer life expectancy, as much as due to the transplants and available treatments.”
He recalled that medical follow-up following a bone marrow transplant requires multidisciplinary care. “They must go through several processes because they are more at risk of other conditions, and of course they must have their cancer screening, since they are likely to suffer from it,” she concluded.
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