WHAT IS THE PROCESS OF FINDING A DONOR?
Usually, patients speak with family members (related) to see if anyone might agree to be evaluated to be a donor. They may also speak with people who are unrelated (spouses, friends, etc) to them. Once the potential donor agrees, tests need to be done to see if he/she is “compatible” with the patient. This involves blood work to check blood types. Until recently , both the donor and patient needed to have compatible blood type (A, B or O). However, there are some centers like Columbia Presbyterian that have just started doing ABO “INCOMPATIBLE” transplants if a compatible donor cannot be found. However, this is fairly new and most centers do not have experience with this. Once you’re blood type compatible, other tests that are done include tissue typing or tissue matching. You are more likely to be matched if the donor is in your family, with brothers and sisters being the best because they have a 25 percent chance of being exactly identical for transplantation purposes and a 50 percent chance of being half identical.

Based on years of transplant experience, we have learned that the success rate with a transplant with a living donor is often better than that with a cadaveric/deceased donor. In fact, having a living donor is more important than the degree of match, so it turns out that even people who are not related by blood, such as spouses, close friends, or distant relatives, have excellent results with transplantation.

Nevertheless, many people cannot find someone to donate or their potential donors turn out to be incompatible. In this case, there is no other option but a transplant from a cadaver donor. Cadaver kidneys come from people who have died suddenly, usually from an accident or bleed into the brain. These people have previously expressed to their families a willingness to donate their organs.

To reduce the chance of kidney rejection, patients need to take immunosuppressive drugs for the rest of their life. Usually patients are on two medications, some are on three. Some centers are actually using only one medication. Some of the more commonly used medications include mycophenolate mofetil, tacrolimus (prograf/FK506) or cyclosporin, sirolimus (tacrolimus) and steroids. Some of these drugs may increase their risk of developing infections and cancers. However, we have gained much experience in preventing and treating many of these problems. We also check levels of these medications in the blood to see if it is too high or adequate.

There continues to be exciting research trying to figure out new medications or combinations of medications that can be used to prevent rejection with the least side effects. For example, steroids used to always be part of immunosuppression, but we have learned that theyare often not needed soon after the transplant. This is important as steroids can increase the risk of infections, weak bones and problems with sugar control.

WHAT ARE THE SIGNS MY BODY IS REJECTING THE KIDNEY AND WHAT HAPPENS IF MY BODY REJECTS THE KIDNEY?
Most patients do not know that they are rejecting the kidney. Often times, abnormal kidney function detected on routine blood work is the first indication that the kidney may be rejecting. If there is a suspicion of this, a kidney biopsy is usually done to confirm this as they are several other reasons why the kidney function can be abnormal including dehydration, high levels of immunosuppression, and certain infections. If the biopsy indeed confirms this, high dose steroids are often administered alone or in combination with other medications.

CAN EVERYONE RECEIVE THE SAME TREATMENT THAT ALONZO RECEIVED?
ARE THERE CERTAIN FOODS THAT SHOULD BE EATEN THAT HELP DEAL WITH FSGS?
There are no foods proven to help deal with or slow the progression of FSGS. Some doctors advocate a moderate protein diet (as opposed to a high protein diet) if FSGS is advanced but there is no clear cut evidence that this slows damage.

HOW IMPORTANT IS IT TO STAY ACTIVE DURING TREATMENTS?
It is important to maintain a healthy lifestyle with any kidney disease and during treatments. This includes moderate activity as tolerated to maintain a healthy weight, strong heart and also helps to control blood pressure and cholesterol. Eating healthy low fat meals is important to control cholesterol levels. Many patients will need to be on low salt diets if they have high blood pressure or significant swelling. Smoking cessation is also very important.