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The wait is over: a kidney transplant after 24 years


People are impatient; we are always in a hurry and we rarely pause. To work, to school, to anywhere we are going. We also want immediate answers. Cesar Duran didn't have the good fortune of having an answer at the touch of a smartphone or at the speed of his accelerator. The Puerto Rico native waited 24 years for a new kidney. It's a feat doctors rarely see.

Cesar was first diagnosed in 1986 with chronic glomerulonephritis, a condition that causes gradual inflammation of the tiny filters in the kidneys that remove excess fluid, electrolytes, and waste from the bloodstream and pass them into the urine. This condition can often leads to chronic kidney disease and, consequently, dialysis treatments.

He was able to get a kidney transplant in Puerto Rico in 1990, but within two years, his doctors say the anti-rejection medications failed and killed the new organ. Back to dialysis Cesar went, from 1992 until 2016. Three days a week for 24 years, he drove to a dialysis center in the capital of San Juan to be hooked up to a machine for hours. He ultimately had to use a neck catheter because none of his other veins were accessible. In recent months though, he grew despondent about his future.

"I've seen more than a hundred people in dialysis with me die waiting for a new kidney, and lately, I had given up," Cesar says. "I didn't think they would find a kidney."

Transplant nephrologist Jose "Tony" Castillo-Lugo, MD, on the medical staff at Methodist Dallas Medical says most prolonged dialysis can cause complications and damage to the heart. Cesar did need open heart surgery in 2007 because of calcium build-up.

"It's very rare to have a patient who can survive dialysis for 24 years; it's practically unheard of," Dr. Castillo says.

When Dr. Castillo first met Cesar at his clinic in Puerto Rico five years ago, he had already been on the transplant list for years, but doctors told him his antibody levels were too high for most available kidneys. Dr. Castillo believed Cesar could get a new organ based on recent protocol changes.

In December 2014, the Organ Procurement and Transplantation Network changed the rules for how patients could be ranked in priority to receive a new organ. For the first time in nearly three decades, Cesar would receive credit for the amount of time he spent on dialysis. Plus, his high antibody levels helped him, moving him up the list.

On Saturday, March 12, 2016, Cesar and his wife got the call saying a perfect match kidney had been found. Naturally, he was in shock, then jumped on a plane to Dallas. Hours later, transplant surgeon Richard Dickerman, MD, FACS, also on the Methodist Dallas medical staff, gave him that long-awaited organ.

Six months later, he enjoys the beach sunrise and sunset without pain or worry.

"I was hopeful but never thought I would get another transplant, and now I feel so much better."

The kidney transplant program at Methodist Dallas Medical Center is a model for success. It's one of only 11 programs in the United States - and the only in Dallas-Fort Worth - selected as a Best Practice Model Hospital by the United Network for Organ Sharing (UNOS) for its good outcomes, even while accepting higher-risk kidneys.

As a Best Practice Model Hospital, Methodist Dallas joins the Collaborative Innovation and Improvement Network (COIIN) to help kidney transplant centers nationwide have better outcomes. Through site visits and conference calls, hospitals in COIIN and UNOS representatives share effective practices and are developing a tool kit of interventions designed to impact change in kidney programs nationwide.

Methodist Dallas is proud to raise the bar for transplant services in North Texas and nationwide. Learn more about the Methodist Dallas Transplant Institute at

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