Advancing Kidney and Pancreas Transplants: A Conversation with Dr. Lloyd Ratner

Lloyd Ratner, MD, Director of the Kidney and Pancreas Transplant Program, shares insights into the groundbreaking work happening in the world of kidney and pancreas transplantation, and transplantation at large. With decades of experience and a deep commitment to increasing access to transplant care, Dr. Ratner talks about the program's evolution, key accomplishments, and future goals.

Let’s start with a little history. Can you tell us about the kidney and pancreas transplant program at Columbia?

Sure. The Kidney Transplant Program at Columbia is actually the first transplant program here. The first kidney transplant was done in 1968 or '69, but the program as we know it today really came together in 1975 when Dr. [Mark] Hardy joined. It's the longest-running transplant program at Columbia. Since then, we’ve performed over 6,000 kidney transplants. I came to Columbia in 2004 and helped grow the program to where we consistently perform over 200 kidney transplants each year.

We’ve focused heavily on increasing access to transplantation and getting people transplanted quickly without waiting too long on the transplant list. We’re also known for taking on patients others might turn away due to perceived high risk. In 2008, we launched our pancreas transplant program, and we’ve averaged about a dozen pancreas transplants per year, bringing our total to over 150.

That’s incredible growth. What are some of the clinical trials and research areas that you’ve been involved in?

We’ve been active in many clinical trials, especially multi-centered drug trials. Two big areas of focus have been antibody-mediated rejection – preventing or treating rejection when the immune system attacks the new organ – and trying to improve delayed graft function. Delayed graft function is when a kidney from a deceased donor doesn’t start working right away, which can complicate post-transplant care.

We’ve also been part of a tolerance trial, which is really exciting. The goal is to get patients to the point where they don’t need immunosuppression after their transplant. We’re currently leading one of the few studies in the world focused on this, called the PANORAMA study. It’s a huge step forward, and we’re seeing encouraging results.

Wow, that sounds promising. You’re also working on innovations in organ allocation and donor programs. Can you tell us more about that?

Yes, organ allocation and donor programs are a key part of what we do. I’ve been involved in national organ allocation policy as well and currently serve as the vice president of the National Organ Procurement and Transplant Network. Our team has also been pioneers in kidney swaps in New York, helping expand options for people with incompatible donors. We're also focusing on non-directed kidney donation – people who donate a kidney without a specific recipient in mind.

We’ve seen great potential in non-directed donations. If we could tap into the 172 million people of donor age in the U.S., even a small percentage of them could make a massive difference in meeting the demand for kidneys and livers. I’m excited about the work we’re doing to increase awareness and participation in this area.

It’s great to hear there’s so much critical work happening and making progress! Are there any new programs or initiatives you're particularly excited about?

One initiative I’m really proud of is our Spanish Language Program. We began it about a year ago to make sure that Spanish-speaking patients can receive care from an entirely Spanish-speaking team. From the surgeon to the social worker, all of our providers speak Spanish. This program has been incredibly well-received, and we’ve expanded it to twice a month due to demand. It’s a way for us to better serve our community, especially given the large Spanish-speaking population in the New York metro area.

That’s fantastic. Before we wrap up, can you share a treatment story that sticks with you?

There are so many stories, but one that sticks with me is about a patient who had been turned away from four other transplant centers because he was considered too sick. We took him on in 2006, and his wife donated a kidney to him. They were so grateful that for 18 years, every few months, they sent me and my colleague David Cohen gifts.

He lived to 86 with a fully functioning kidney. That’s a pretty incredible story, especially considering he’d been told he wouldn’t make it.