Dr. David Shaffer
Shaffer aims to enhance kidney program
Dr. David Shaffer, the new chief of the Division of Kidney and Pancreas Transplantation, came to Vanderbilt with a specific purpose—to enhance an already first-rate program.
To do that he has outlined goals that he feels are necessary to enrich the program in the areas of accessibility, novel approaches, immunosuppressive trials and patient volume.
“Becoming one of the top centers in the country means more than just expanding the numbers of transplants we do here,” Shaffer said. “It means offering various transplant options which includes pancreas and kidney/pancreas for example.
“It means adapting newer transplant techniques like laparoscopic donor nephrectomies. It also calls for us to explore and actively participate in new immunosuppressive protocols along with our transplant nephrology colleagues that might improve graft survival and reduce post transplant morbidity.
“There is a commitment throughout the institution to improve access and we are eager to serve the needs of nephrologists in Nashville and provide a full range of transplant services for their patients.”
Shaffer, who also serves as the surgical director of the kidney and pancreas transplant program at the VA Medical Center, has been actively recruiting transplant nurses and surgeons to augment the existing program at the Vanderbilt Transplant Center. Since his arrival, there has been a marked increase in the number of kidney transplants performed at both sites.
Although a pancreas transplant program has not been an option for patients at Vanderbilt, Shaffer points to the need for such a program. He says the center has 10 patients currently on the waiting list and hopes to perform between 10 and 20 pancreas transplants a year.
Shaffer said the increase in the volume of kidney transplants performed both at Vanderbilt and the VA would be a result of the expansion of the living-donor program in the area.
One way of expanding the living-donor option for patients is to introduce the laparoscopic kidney donor procedure. This technique of using a laparoscope to make a small incision to remove a donor kidney will have a positive effect on both the recovery and economic outcomes for the donor.
While this will be a first for Vanderbilt, as well as the region, this technique has been successfully used in other centers in the United States for several years.
“The main reasons to use this new approach are because of a reduced analgesic requirement for the donor, reduced hospitalization and an earlier return to work,” Shaffer said. “It would be a big advantage for patients in this area to have this as an option.”
The typical hospital stay for donors is three to four days using the traditional surgical procedure to remove the kidney. Hospitalization is cut nearly in half using the laparoscopic method. Traditionally, donors return to work four to six weeks after surgery, but with the use of the new technique doctors are seeing patients back at work in two to four weeks.
Although proving to be an excellent alternative for many donors, it is not an appropriate option for everyone. There are certain anatomical situations where there is an increased risk of complications with laparoscopic donor nephrectomies. In those situations a traditional, open approach would be preferable and could lead to a better graft outcome, Shaffer said. But, he adds, the procedure will probably become the primary option used by physicians who have established a history with the technique.
Shaffer commended Vanderbilt for its solid infrastructure in the area of research and clinical practice and said his goals are attainable because of the organization’s commitment to excellence.
Shaffer came to Vanderbilt in July from Beth Israel Deaconess Medical Center in Boston where he was the surgical director of the Kidney Transplantation and the Pancreas Transplantation programs. He also served as the associate professor of Surgery at Harvard Medical School. Shaffer is a graduate of Yale University. He received his medical degree from Columbia University College of Physicians and Surgeons.