Georgetown: Scheduled and continuous follow-up after a kidney transplant operation is not an option. In fact according to expert kidney transplant surgeon, Dr. Rahul Jindal of the Walter Reed Army Medical Center in Washington D.C., follow-up is a life-long experience patients will have to be subjected to. It is for this very reason he revealed that efforts are made to provide follow-up care to kidney transplant patients at the Balwant Singh Hospital which has been offering the crucial kidney operation to members of the public. Prior to last year operations were done at the Georgetown Public Hospital Corporation. However, the programme continues to be undertaken through a public/private partnership movement. Even persons who had undergone kidney transplant operations overseas are afforded follow-up care at the private institution, said Dr. Jindal who has been spearheading the local kidney operations for a number of years backed by a team comprising of other overseas experts supported by local health workers.
Follow-up care, he pointed out, is essential to determine whether patients are responding well to immunosuppressant medications which are intended to prevent and treat acute rejection. This process is also intended to help medical experts discern whether there is need for a change in the medication regiment. Patients can be required to use medications such as: Cyclosporines (Neoral®, Gengraf®, Sandimmune®), Tacrolimus (Prograf®, FK506), Mycophenolate mofetil (CellCept®), Prednisone, Azathioprine (Imuran®), Sirolimus (Rapamune®), Daclizumab and Basiliximab (Zenapax® and Simulect®), OKT3® (monoclonal antibody), Anti-Fungal Medications (Mycelex Troche®, Nystatin® Swish and Swallow, and Diflucan®), Antiviral Medications (Zovirax® (acyclovir), Cytovene® (ganciclovir), and Valcyte® (valganciclovir)), Diuretics (Lasix® (furosemide)), Antibiotics (Bactrim® (septra)), Anti-Ulcer Medications (Prilosec® (omeprazole), Prevacid® (lansoprazole), Zantac® (ranitidine), Axid® (nizatidine), Carafate®(sucralfate) and Pepcid®), all of which are said to be very costly.
A kidney transplant patient is required to take any number of immunosuppressant medications which is provided here free of cost by the Ministry of Health once the operation is undertaken by the Dr. Jindal-led medical team. It is required that patients use the medications as prescribed by their doctor and at the same time every day which is monitored by follow-up care.
This monitoring process, according to Dr. Jindal, is very evident in the case of retired Army Major, Winston George, one of the first patients to undergo a kidney transplant operation in Guyana. Recently he was diagnosed with a brain tumour, which spurred suspicions that it was as a result of the combination of medications he is required to take. In recognition of the fact that failure to take medication at the prescribed time, which is usually the same time every day, can result in side effects, patients are required to inform their follow-up doctor immediately.
According to Dr. Jindal while in the case of George the suspicion was high that it could have been linked to his medication use, there is also a possibility that his tumour could be linked to his age. George was already in his late 40s when he underwent the operation having secured a kidney from his daughter. “There have been people who developed cancers and it was not because of any medication…but because some medications are known to cause all types of side-effects patients must continually seek follow-up care.”
George during a recent interview with this publication said that the scan was prompted by a numb sensation in his right side, including his leg, arm and face. This was further compounded with severe headaches and distorted vision in his right eye. After several tests and a CT scan, doctors were able to detect a tumor in his brain. George was advised to ease his medication until the return of the overseas based kidney transplant team. In December last the team arrived and an MRI was done confirming that there was a tumor in his brain. The tumour had rendered George incapable of working and it was since recommended that he undergo a surgery to remove the tumour.
However, because George has been heeding the importance of continuous follow-up care, efforts have since been made to reduce the medications which have perhaps been the factor leading to a decrease in the size of his brain tumour, a development which was revealed during a Magnetic Resonance Imaging (MRI) scan during the latter part of last year.
However, since there is no neurosurgeon in Guyana, Dr. Jindal said that additional follow-up care may very well have to be provided in India. “Other than that he is stable and is doing well; his kidney is working well…he is talking and everything…,” Dr. Jindal insisted even as he pointed out that while side effects from medications are possible, the course of health of a kidney transplant patient is usually not very different from a normal healthy person. He pointed out the importance of health professionals seeking to separate cause and effects of a health condition before deriving a conclusion.
It is for this very reason, Dr. Jindal said that intense efforts is made to rigourously screen patients ahead of operating on them. “We have to make sure we are using resources appropriately…we have to ensure we examine patients well to ensure that they can undergo these complicated operations as well as the follow-up.
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