reprinted from Issue 18, Spring 2014 of Frontiers of Medicine (PDF)
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The most important thing about building a program is putting things in place that will continue long after you've left," says Stephen Tomlanovich, MD, medical director of the UCSF Kidney Transplant Program.
For almost three decades, Tomlanovich has helped improve patient outcomes and access to one of the world's leading transplant programs. UCSF currently performs about 350 kidney transplants annually, and has developed many innovations that have increased patient survival and quality of life.
In 1983, he began his nephrology fellowship at Stanford University, which had recently closed its transplant program. "It was an incredible stroke of good luck that Stanford was sending nephrology fellows to UCSF for part of their training," says Tomlanovich, who did clinical rotations with UCSF transplant nephrologists William Amend, MD, and Flavio Vincenti, MD. "The program here was the biggest in the United States, and was a model of surgery and medicine working closely together to take care of patients."
Cyclosporin A, a game-changing immunosuppressant, had just been approved. It helped prevent rejection of transplanted organs, but could also cause kidney damage. Since UCSF did not yet have the tools to monitor cyclosporine levels, Tomlanovich would drop off a cooler full of patients' blood samples at a Stanford lab on his drive home each night.
Tomlanovich joined the UCSF faculty in 1985, and helped lead clinical trials of many new medications. "In the '90s, there was an explosion of new immunosuppressive drugs, and the field needed studies to understand how they would work best and what were the right combinations," says Tomlanovich. "Because of the large volume of transplants we performed, we became a large center for clinical research, and were involved in all the sentinel studies." This research helped improve patient outcomes significantly – in the early 1980s, only half of kidney transplant patients still had a functioning kidney one year after transplant, a figure that has now risen to about 95 percent.
On the Road
Tomlanovich also made kidney transplant accessible to more patients. He established outreach clinics in Walnut Creek, Stockton, Fresno, Monterey and Hawaii where patients can meet with a physician, nurse and social worker to discuss transplant as an option. Although patients still come to UCSF for the transplant and follow- up, these clinics make it easier to start the process, and half of new patients are referred through them.
In 2007, Tomlanovich also launched a partnership with Kaiser in which UCSF performs kidney transplants for Kaiser patients, and then provides follow-up care onsite at Kaiser San Francisco through a combined team of Kaiser staff and UCSF transplant nephrologists.
Kaiser recently expanded this model to its South Sacramento facility. "The patient gets the best of both worlds: they have a highly integrated health plan, as well as expert transplant nephrologists who are managing them," says Tomlanovich, who serves as medical director for both Kaiser clinics.
He credits his "incredibly dedicated" colleagues at both UCSF and Kaiser for the success of all the program's efforts. "The team approach has been the hallmark of this program from the start," he says.
Inspired by Patients
Among Tomlanovich's career highlights is receiving the 2012 UCSF Exceptional Physician Award. "I consider Steve to be one of the finest physicians at UCSF," says John P. Roberts, MD, chief of the Division of Transplant Surgery and the UCSF Medical Center Transplant Service. "His clinical acumen, administrative judgment and dedication to both his patients and the field have allowed UCSF to become the premier transplant program in the United States, if not the world."
"Steve is a superb clinician, and a passionate advocate for improving the care of patients with end stage renal disease," says Vincenti, holder of the Endowed Chair in Kidney Transplant- ation. "He is recognized nationally and internationally for his expertise in the field of transplantation."
Tomlanovich plans to retire next year to spend more time with his wife, retired immunologist Susan Hudak, and increase his community involvement. "One of my goals is to be arrested for some social justice cause," he says with a laugh.
Above all, he appreciates caring for patients. "My sanctuary is to go to clinic and see the fruits of our hard work," Tomlanovich says. "The patients are amazing – they are the heroes. To get that hug or see a picture of a grandkid that they would never have seen is the ultimate gift."