Transplants on the double

UW Medicine’s innovation could yield better results for kidney patients.

If you happened across the two couples tucking into fish and chips last spring inside Duke’s on Lake Union, you wouldn’t have given them a second thought. Nothing about Pat and Laurie Boatsman, of Maple Valley, or Steve Engholm and his sister, Janis Dougan, of Acme, a tiny Washington hamlet near the Canadian border, would tip off a casual observer that these four Washingtonians represent a miracle of modern medicine.

On January 4, ninety days before their first meeting at Duke’s, all four were booked into operating rooms at UW Medical Center. Four attending surgeons and nearly two dozen operating-room staff were ready to move ahead with the UW’s first internal-match, double kidney transplant. Pat Boatsman and Steve Engholm desperately needed kidney transplants, but Boatsman’s wife, Laurie, wasn’t a match for Pat. And Engholm’s sister, Janis Dougan, couldn’t donate to her brother for the same reason. But thanks to a new program that strives to match patients who are receiving care at the same time at UW Medicine instead of seeking a donor from the outside, Dougan donated a kidney to Pat, and Laurie donated one to Engholm.

The biggest advantage: patients receive a kidney transplant from a living donor. These kidneys will function twice as long and may be available without the three- to five-year wait time required for a cadaver kidney, according to Nicolae Leca, medical director of the UW’s Kidney and Pancreas Transplant Program.

This development couldn’t have come at a better time. More than 10 percent of adults in the U.S.—more than 20 million people—may have chronic kidney disease, according to the Centers for Disease Control. For minorities, the numbers are even worse. African Americans are about three and a half times more likely to develop end-stage renal disease than Caucasians, while Hispanics are about one and a half times more likely. Currently, 600,000 people are on dialysis and 100,000 of those are on the waiting list for a kidney transplant.

“There are six times more people waiting on the transplant list than kidneys available each year,” says Leca. “In addition to participating in a national donor exchange program, our recently created internal exchange program allows much faster transplantation, as in Pat and Steve’s case.”

UW Medicine has a storied history treating kidney disease. Back in 1960, UW Medicine professors Belding Scribner and Albert Babb and bioengineer Wayne Quinton, ’58, developed the shunt that made dialysis possible. In 2016, UW Medicine surgeons performed 136 kidney transplants. Currently, the UW kidney transplant program is the only one in the country that has a statistically superior patient and graft survival rate at both one and three years after transplantation. That means approximately 95 percent of kidney transplants performed at the UW are functioning at three years after the surgery. This represents a 50 percent lower likelihood of failure compared with the national average.

In addition to better post-transplant results, UW Medicine continues to perform more kidney transplants than any other institution in our region, which comprises programs in Washington, Oregon and Hawaii. Since 1988, UW surgeons have performed 2,986 kidney transplants. Of those, 342 were combination kidney-pancreas transplants.

Why are there so many people in end-stage renal disease? Leca explains that the obesity epidemic is driving diabetes numbers­—and diabetes is a primary risk factor for kidney disease. Diabetes is the leading cause of kidney failure; 44 percent of people starting dialysis suffering from kidney disease caused by diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

And there’s more. When people are obese, their blood pressure often spikes. High blood pressure is the second-leading cause of kidney failure in the U.S. after diabetes.
Interestingly, Boatsman wasn’t obese, diabetic, nor did he have high blood pressure. Engholm wasn’t obese and didn’t have high blood pressure either, but he had type I diabetes, which has an autoimmune cause.

Boatsman suffered kidney infections as a kid. While today’s antibiotics could have cleared up the problem, in the late 1950s, the only antibiotic doctors could offer was penicillin. It didn’t stop infection from ravaging his kidneys.

For years, Boatsman ate well, kept his weight down, walked everywhere he could and bicycled regularly. But his kidneys finally began to shut down. Then came dialysis.

“I had a decent career,” he says. “I owned a little rental car company but during three years of dialysis that went by the wayside. You get a dialysis hangover. It’s like drinking two or three glasses of wine. Your energy level is really low for two to six hours. They say if you take a blood sample from someone who has just run a marathon and then from someone who has just had dialysis, it’s similar.”

He says people don’t realize how muddled a person’s mind can become due to dialysis. “You also lose your thermostat, too, which is why some older people who are in some form of kidney failure are always wearing sweaters,” he explains. Sometimes, just going to a dialysis center can be downright alarming. Once, during a trip to Denver, Boatsman went to a dialysis center that had 22 occupied chairs. He was the only patient there with two legs. The loss of limb? Caused by diabetes, a nurse told him.

But life today is a happy contrast to those low-energy days of dialysis. Six months after his kidney transplant at age 62, Boatsman says, “I am a spring chicken, good for another 30 years. I’m already hiking 3 1/2 miles, swimming and doing yoga.”

Laurie Boatsman spent two nights in the hospital after donating her kidney and was feeling like herself within a week. She feels profound gratitude that she was able to donate a kidney to Engholm. “It’s nice to see him (Steve) doing so well,” she says. “It’s weird to think a part of your body is in a total stranger but I’m glad I was a part of that.”

As for Engholm, his life was grinding to a halt after three years of dialysis. He was yoked to a dialysis machine from 6 p.m. to 6 a.m. every day. “I hadn’t been out of my house at night in almost four years,” he says. Not only did diabetes wreck his kidney function but in 2011, he suffered a major stroke at the age of 51, followed by two smaller strokes.

He could no longer work at the Lynden Tribune, where he spent 17 years, first as a copywriter and then as general manager of printing operations. He had to learn how to walk and talk again as well as contend with his ongoing diabetes and kidney problems.

In addition to his kidney transplant, he has a new insulin pump that monitors his blood sugar and issues a warning alarm when his sugar is too high or too low. During his time on dialysis, Dougan once passed out on his wooded property outside of town.

Today, between better blood sugar control and a new kidney, Engholm is a veritable fireball of energy. “He’s doing great right now,” Dougan says. “The last time I saw him, he was out on his riding lawnmower, taking care of business. He has a vibrancy for life now.” Now recovered from her surgery, Dougan is back at work at Costco in Bellingham, decorating 40 cakes per day. She had her employer’s full support and good medical insurance to cover the procedure. The tightknit village of Acme, a community of about 250 souls wedged between the North Cascades and Lake Whatcom, supported a GoFundMe page to supplement additional expenses. Without his neighbors’ help, Engholm wouldn’t have been able to afford the blood-sugar monitor.

Today, Dougan and Boatsman keep track of each other on Facebook. Before she had the surgery, she named her kidney “Wilson” because she is a diehard Seahawks fan who particularly loves quarterback Russell Wilson.

“Patrick makes notes on my Facebook page saying, ‘Wilson is hiking’ or ‘Wilson really likes the sun.’” On his birthday, she teased Pat about the ‘birthday present’ she gave him.