The Rogosin Institute Transplant Program in cooperation with NewYork Presbyterian/Weill Cornell involves a thorough pre-transplant evaluation for both organ recipients and donors. During this period, both the recipient and donor are assigned their own team of physicians, nurses and social workers. The process is designed to provide the best possible outcomes for our patients.

• Satellite Evaluation
• Pre-Transplant Evaluation - The Recipient
• Transplantation - The Recipient
• Post-Transplant Care - The Recipient
• Pre-Transplant Evaluation - The Organ Donor
• Transplantation - The Organ Donor
• Post-Transplant Care - The Organ Donor
• All Patients Require Personalized Therapy

Satellite Evaluation

In an effort to make the pre-transplant evaluation as convenient as possible, the Rogosin Institute offers prospective transplant recipients the opportunity to complete most of their pre-transplant evaluation without coming into Manhattan.  Currently available in Queens and Brooklyn, patients may be directed to these satellite centers, for initial audio-video interviews with the the pre-transplant team, including social workers, financial counselor and transplant nephrologists.  The necessary blood testing can be obtained and sent to our central lab and other necessary testing can be arranged locally.  By the time the patient has a single visit to meet our surgical team, the work-up is completed.  Additional satellite centers will be established in Staten Island, Long Island, Westchester and New Jersey.

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Pre-Transplant Evaluation - The Recipient

Prospective transplant recipients are either self-referred or referred by their nephrologists to the The Rogosin Institute Transplant Program in cooperation with NewYork Presbyterian/Weill Cornell. Patients can call the program at 212-517-3099 and make an appointment after a brief telephone interview.  Prospective recipients are seen at the NewYork Presbyterian Hospita/Weill Cornell.  Patients meet with members of the medical team, including a transplant nephrologist, transplant coordinator, social worker and financial counselor.  The visit includes an introduction and teaching. This is the beginning of a close relationship that continues throughout our patients' experience at Rogosin.

During this visit, a number of tests will be performed, including routine blood work, tissue typing, screening for prior exposure to different viral diseases such as hepatitis, HIV and cytomegalovirus (CMV), an electrocardiogram (ECG) and a chest x-ray.  Additional studies that are required for all patients, including an abdominal ultrasound and a skin test for tuberculosis (PPD), will be scheduled before the end of the visit and may be completed at our center or at the referring center (based on patient and physician preference).  Other ‘routine’ age-related studies may be necessary, including a Pap smear, mammogram, and a colonoscopy for patients over the age of 50.

Because patients come to us with a history of different medical problems, their transplant suitability may require additional consultations and studies.   These may include:

• for a patient with a history of heart disease, a cardiac ultrasound (ECHO), stress test, and consultation by a cardiologist.
• for a patient with a history of liver disease, including hepatitis, a liver biopsy and evaluation by a liver specialist.
• for a patient with a history of thrombophlebitis, or repeated hemodialysis access clotting, an evaluation by a hematologist.
• for a patient with a heavy smoking history, a screening CAT scan of their chest.

Prospective transplant recipients may also be asked to see a vascular surgeon if they have evidence of peripheral vascular or carotid artery disease or an ear, nose and throat physician if a thyroid mass is discovered.  This is not meant to be an all-inclusive consultation list.  Our goal is always to maximize the likelihood of providing our patients with a healthy, uncomplicated outcome.

Patients are also evaluated by the transplant surgeons.  They and their families will thoroughly understand the transplant process and know what to expect before, during and immediately after surgery. 

Following these meetings, and after all the pre-transplant testing is completed, the entire transplant team reviews the information and determines whether the patient is a suitable transplant candidate.  Medically and socially cleared, the patient is notified that they have been placed on the UNOS national waiting list, or, if a living donation is planned, surgery is scheduled.

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Transplantation - The Hospital Stay - The Recipient

The transplant surgery is performed at New York-Presbyterian Hospital / Weill Cornell Medical Center.  Recipients of living donor organs are admitted to the hospital, through the Same Day Surgery Center, on the morning of the planned transplant.  Recipients of kidneys from deceased donors will be first admitted to the transplant floor for a final pre-transplant evaluation and dialysis treatment if necessary.

During the operation, the surgeon makes a small incision in the lower abdomen and the artery and vein from the donated kidney are attached to the recipient's external iliac artery and vein and the ureter is attached to the recipient's bladder.  Often, the transplanted kidney will start making urine as soon as blood starts flowing through it.  A catheter is placed and will remain in the bladder for 4 days (removed on the day of discharge).

Transplant recipients actually begin receiving their immunosuppressive medications prior to their surgery.  In addition they receive intravenous “induction” therapies, to further suppress their immune response, during the surgical procedure itself.  Intravenous medications are administered for an additional four days, at which time recipients are typically discharged.  Approximately 80 percent of our transplant recipients are judged to be suitable for steroid-free immunosuppression and go home taking only tacrolimus (Prograf) and mycophenolate (Cellcept).  They do not take any prednisone and thus can avoid the side effects that are related to chronic steroid use, including a change in their appearance, hypertension, diabetes and elevated cholesterol levels.

The typical transplant recipient can expect to receive intravenous fluids for 24 to 36 hours, begin taking clear fluids during that time and start solid foods.  They will be walking within 24 hours of their surgery.  The rest of the four days of a typical hospital stay are spent recovering from the surgery, e.g. pain management, managing the large urine output that the transplanted kidney may produce, and completing the induction therapy.  In addition oral medications (valganciclovir [Valcyte], trimethoprim-sulfur [Bactrim] and clotrimazole [Mycelex]) are started to prevent infections that may occur in the early post-transplant period. Other pre-existing medical problems are addressed, including hypertension and diabetes management, and recipients receive individualized instruction from the nursing and pharmacology staff to learn about the care of their new transplant, including the new medications that they are receiving.

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Post-Transplant Care - The Recipient

Patients are typically seen within two days of discharge in the Jack J. Dreyfus Clinic.  The first visit is particularly important because it sets the groundwork for all future follow-up.  It may last several hours and includes intensive instruction and medication review with a transplant nurse and a medical review with a transplant nephrologist or nurse practitioner.  Blood work, including transplant function and medication levels are obtained at the beginning of each visit and the results are often available by the time the visit is completed.  Each transplant recipient is under the care of a specific transplant nephrologist who is responsible for all ongoing post-transplant medical care. New transplant recipients can expect to be seen as often as twice a week for the first few weeks after discharge.  At one month, they are typically seen once a week.  Intervals between visits is increased as their post-transplant course stabilizes.   

These visits are an opportunity to reinforce teaching and fine tune medication dose.  Transplant immunosuppression is adjusted and other medical management is provided.  In addition, a healthy transplant recipient needs to pay attention to ‘wellness’ care.  This includes attention to cholesterol management, calcium and vitamin D supplements and diet and exercise.  All patients have a post-transplant evaluation with a dietician and a social worker.  Our dieticians and social workers are specifically trained and certified to provide post-transplant follow-up.  We want to make sure that every aspect of the recipient’s care is off to a good start.  Additional dietary and social worker counseling is always available.

A transplant recipient is typically able to resume normal activities after approximately one month.   Returning to work may take a little longer, i.e. more typically three months.

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Pre-Transplant Evaluation - The Organ Donor

We recognize the special quality that exists in all individuals who decide to donate their organs.  They make a tremendous difference in the lives of the patients who receive their kidney.  Not only do they directly affect their recipient, but they make another organ available for someone else on the UNOS deceased donor waiting list.

At Rogosin, we recognize the kidney donor as a unique patient - before, during and after their donation.  Each donor is evaluated and cared for by a separate team that includes a nurse-coordinator, a nephrologist, a donor surgeon, a social worker, a psychiatrist, and a financial coordinator.

An organ donor must be in excellent health.  Donors do not have an absolute age limit.  They undergo a thorough medical and psychosocial evaluation to determine suitability and ability to safely donate their kidney.  The donor’s health is evaluated in a step-wise manner, by a number of tests, including:

• Baseline blood work for blood and tissue typing and screening for hepatitis and HIV
• 24 hour urine collection to measure kidney function
• Electrocardiogram
• Chest X-ray
• PAP smear and mammogram (women)
• PSA (men)

If the results of all of these tests suggest that the prospective donor is acceptable, they will undergo a CT scan of their abdomen that will also determine the anatomy of the arteries and veins to and from both kidneys as well as the ureters that connect the kidneys and the bladder.  It is not uncommon to discover that a normally functioning kidney has more than one artery, vein or ureter.  This final study helps the donor surgeon select the best kidney to be used for a transplant and anticipate the optimal surgical approach.

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Transplantation - The Hospital Stay - The Organ Donor

Kidney donation surgery is performed at New York-Presbyterian Hospital / Weill Cornell Medical Center.  On the morning of the transplant, donors are seen and admitted to the hospital from the Same Day Surgery Center.


Donor surgery is performed laparoscopically and typically takes approximately two hours, typically during a time that coincides with the recipient’s surgery.  This minimally invasive surgical technique reduces post surgery scarring and pain.  Traditionally, three, small (1/4 inch) incisions are made to receive instruments for visualizing and performing the procedure.  But now our surgeons perform the procedure though only one small incision.   The incisions are closed using suture material that is absorbed and does not need to be removed.  A catheter is placed in the bladder and will remain for 24 to 48 hours.

The donor will receive intravenous fluids until a liquid diet is tolerated and solid foods are introduced 24 to 36 hours after the procedure.  Pain medication is administered as needed.  They will be up and out of bed within the same time period.

The donor typically experiences a two to three-day hospital stay and is able to resume normal activities, including returning to work, within two to four weeks.

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Post-Transplant Care – The Organ Donor

Patients are seen by the donor surgeon approximately two weeks after surgery.  A separate visit is scheduled with the donor team at 3 months, 6 months, one year and yearly there after.

Organ donors are an integral part of the transplant program.  They have been selected because of their excellent health and they are returned to the care of their own physicians.  Nonetheless we like to have donors follow up with us at least once a year.

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All Patients Require Personalized Therapy 

Rogosin is a pioneer in ‘personalizing’ transplantation therapies, which for most recipients means minimizing the immunosuppression that they will receive as they adapt to their new kidney.  For others, who are sensitized against their donors, i.e. they have demonstrated antibodies that would attack the transplanted organ, ‘personalization’ means providing individualized pre-transplant conditioning to eliminate those antibodies so a successful transplant can be performed.  Examples of the latter include preparing a transplant recipient to receive a blood group, i.e. ABO incompatible, kidney or a kidney from a donor to whom the recipient has other demonstrated antibodies.

Approximately 80 percent of our kidney transplant recipients are discharged from the hospital on only two immunosuppressive medications, tacrolimus (Prograf) and mycophenolate (Cellcept).  These patients will not receive chronic steroids, e.g. prednisone.  Their steroid-related risk of developing complications, e.g. diabetes, worsening diabetes control for pre-transplant diabetics, hypertension, atherosclerosis and osteoporosis is significantly decreased.  Whether or not a patient will continue steroids after a transplant is individualized and based on their past medical history, including their response to prior transplants.

Some of our patients may have prospective donors who are found to be incompatible for reasons already mentioned, i.e. ABO incompatibility or a positive cross-match.  Rather than automatically declining to proceed, we analyze each incompatible donor-recipient pair to see if individualized pre-treatment will change their immune balance.  We specifically look to see how reactive a recipient is against their donor and design a treatment to decrease the number of cells that are producing these antibodies and then lower the levels of the remaining putative antibodies until it is safe to proceed.

Similarly, advances in transplantation technology have created opportunities for older patients to be transplanted.  We commonly transplant patients in their eighth decade of life, i.e. 70’s and also consider and have transplanted patients in their 80’s.  Additionally patients who are HIV-positive, hepatitis B-positive, or hepatitis C-positive may also be considered for a kidney transplant.

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