VA Iowa City Transplant Program

Veterans enrolled in VA Health Care can be referred for transplant evaluation by either their Primary Care Provider or Renal Provider if they feel you are a good medical candidate for transplant.  Each VA has a Transplant Referral Coordinator who can assist with the process of referral or assist with questions related to referral. 

Your local provider initiates the referral process. If you need help getting the process started, you can call us, and we will put you in touch with your local referral coordinator.

The VA requires testing and consultations as part of the transplant referral process. Some of the tests and consults typically requested include a cardiac stress test, social work and psychology evaluation. Testing is similar to that required for transplant evaluation in non-VA hospital but differs in that the VA process collects the information prior to the referral. This speeds up the decision making once you are seen in person for the evaluation.

The GFR or glomerular filtration rate is a measured or estimated determination of your kidney function. Transplant rules in the United States allow you to start accumulating waiting time when your GFR is less than or equal to 20. For this reason, we recommend being referred for transplant when your GFR is near this number or above it when your kidney function is expected to rapidly decline.

We require that patients have a BMI less than 40 prior to coming for evaluation. The BMI is a common (but not perfect) estimate of obesity. It is calculated by dividing weight by height squared (for example Kg/meters2). Additional weight loss may be recommended prior to transplant. 

No, we focus on your stamina and “physiologic age” rather than an absolute number. However, we very strongly recommend older candidates find a live donor as waiting times are long and survival statistics are poor on dialysis for older candidates.

Two or three days. This allows for additional testing if needed while you are here. If you have limitations that require a shorter stay in Iowa City let us know and we will see if we can accommodate your needs.

Research consistently shows recipients that have good social support have better transplant outcomes than those who do not. The support person can make a big difference in helping you cope with any complications and in keeping you safe. The support person will assist you before, during and after the transplant.

Usually between 3 and 4 weeks. The hospital stay is often between 5 and 7 days. Following the hospital stay patients are housed in a local hotel to facilitate frequent appointments needed for monitoring your labs and making medication changes. 

We can start the evaluation process with a telehealth visit. This can streamline the in-person evaluation and allow you to ask important questions before you arrive. However, an in-person evaluation will still be necessary.

The Iowa City VA transplant deceased and live donor kidneys. Referrals for kidney/pancreas transplants or pancreas only transplants are processed through our affiliate, the University of Iowa.

No, unless there is a complication post transplant that is unable to be addressed locally. Post transplant follow up visits are completed virtually by a telehealth visit. 

Yes, your local VA will cover travel expenses to Iowa City for pre-transplant assessment, transplant surgery, and any needed follow up appointments. This includes mileage reimbursement or flights. Iowa City VAHCS will cover lodging expenses.

While on the transplant waiting list maintaining your health should be a priority. Continue to remain physically active, complete annual testing required for transplant, take medications as prescribed, attend follow up appointments and inform your transplant team of any changes in your health status. If actively listed send back monthly HLA tissue typing labs.

Sensitization means that your body’s immune system has a memory of having previously been exposed to human tissue other than you own perhaps through prior pregnancy, transfusion or transplant. Sensitized patients are at higher risk for rejection and have a harder time finding a well-matched kidney. For these reasons your sensitization status is checked as part of the evaluation and periodically while you are waiting.

Most rejections are treatable especially when caught early. However, patients tend to get in trouble when they start or stop immunosuppression or other medications without telling us, there are multiple rejection episodes, or the rejection is diagnosed late in the process. For these reasons it is important to always take the immunosuppression medications on time, inform us of any new medications you are taking (even if they are not immunosuppression medications) and make it to all of your lab appointments.

Yes, post transplant you will be started on medications that will prevent organ rejection and help manage the side effects of immunosuppression.

• Anti-Rejection Medications (Immunosuppressants):  These medications are used to prevent your immune system from attacking and potentially rejected the transplanted kidney. For the life of the transplanted kidney you will be on some form of Immunosuppression. Commonly used are Tacrolimus, Prednisone, Cyclosporine, Mycophenolate or Envarsus.
• Anti-Infection Medications:  Immunosuppressants weaken the immune system and can make you more susceptible to infections. These medications are taken during a period post transplant. Examples: Antibiotics, Antivirals, and Antifungals.
• Continue taking medications as ordered to manage pre-existing conditions. 

No, vaccinations can be administered after evaluation and while you are on the waitlist. Suggested vaccines include Influenza, Tetanus, Diphtheria, and Pertussis (Tdap), Pneumococcal,  Hepatitis B virus vaccines and Covid.

Before transplant it is advised to follow a low sodium and balanced diet. A registered dietitian can help create a plan that specifically addressed your needs and health conditions. 

Post transplant a high protein diet, low sodium diet is encouraged. Adding fiber rich foods and limit added sugar and saturated fats is recommended. Avoid raw or undercooked foods due to your weakened immune system to prevent the risk of foodborne illnesses. 

Yes, you can be evaluated for kidney transplant while smoking. However, you may be required or strongly encouraged to quit smoking before listing to improved overall health and transplant outcomes. Smoking is a significant factor for cardiovascular disease and could impair wound healing after transplant.