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Patient Stories

Weight Loss Surgery Enables Lifesaving Kidney Transplant

Jan. 26, 2021

Lurinda Smith, 57, of Rushville, Indiana, grew up in the 1970s, a different era when food was simpler and more natural, and an abundance of snacks between meals was not at our disposal as they are today.

Meals were home cooked by mothers, and families gathered at the dinner table each evening to dine together. In those days, parents often asked their children to “clean up their plates” before leaving the dinner table. This is where Lurinda’s story begins.

Looking back, Lurinda says that weight has always been an issue for her, even when she was a child.

“Our family are farmers, my mom sewed all my clothes, and she was a good cook,” says Lurinda. While her family ate vegetables and other traditional foods, she says, “Back then, you ate what was in front of you because we did not have special meals or snacks. At the time, people cooked what they had on hand and we didn’t go out to eat. If we did, it was like ‘wow!’”

“The funny thing is that I did not know I had a weight problem until I went to school, when I was in the first grade. They were weighing all the students and calling everyone’s weight out loud. When the nurse weighed me, she whispered it in my ear. But I just didn’t know, and then I was ashamed. That moment stands out for me,” she says. 

Lurinda forged on and lived her life, getting married to her loving husband, Charlie, and building a family and a life together.

In 1988, she was diagnosed with Type 2 diabetes. “I’ll be the first to admit that I denied it for years and years,” she says. “I can’t blame anyone but myself, and since then, I’ve had eye and foot problems as a result.”

Years passed by and in early 2016, Lurinda went to see a nephrologist in Indiana. “I learned that I was in stage 3 kidney failure.”

Within four months, she was told by doctors that she was in late-stage 4/early 5 kidney failure.

Kidney Failure and A New Diagnosis

Chronic kidney disease refers to all five stages of kidney damage, from very mild damage in stage 1 to complete kidney failure in stage 5. The stages of kidney disease are based on how well the kidneys can filter waste and extra fluid out of the blood. In the early stages of kidney disease, our kidneys are still able to filter out waste from the blood. In the later stages, the kidneys must work harder to get rid of waste and may stop working altogether.

Doctors measure how well kidneys filter waste from the blood by the “estimated glomerular filtration rate,” or eGFR, a number based on a blood test for creatinine, a waste product in your blood. The stages of kidney disease are based on the eGFR number.

With her delicate status, Lurinda began receiving dialysis at a local hemodialysis center. Dialysis is a way of cleaning the blood when the kidneys can no longer do the job. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine.

In future months, she would have other surgeries, and then was able to have peritoneal dialysis within the comfort of her home. With this type of dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles. “For me, it was the best thing. I could do the dialysis at night and at home.”

Before dialysis was available, total kidney failure meant death. Today, people with kidney failure can live because of treatments such as dialysis and kidney transplantation.

By October, Lurinda was placed on a kidney transplant list at a hospital in Indianapolis. “I didn’t really hear from them – maybe once a year.” In May 2017, Lurinda was diagnosed with breast cancer. With her cancer diagnosis, she was informed by the Indianapolis hospital that she was removed from their transplant list. It would be five years before she could be placed on the list again.

Lurinda received breast cancer treatment at an Indiana hospital near her home.

In the meantime, she sought out the expertise of UC Health’s transplant team at UC Medical Center. She had an appointment scheduled, but called to update them on her cancer diagnosis. “They said they still wanted to see me! I knew UC Medical Center was a teaching hospital and I could tell the difference,” she says.

Lurinda and Charlie went to the appointment, where UC Health doctors reviewed her medical records and informed her that the kidney transplant could likely be performed in two years. “This really made me feel better,” she says.

The Journey to Transplant

After two years, in 2019, she received a call from UC Health Transplant, who wanted to begin the process. But first, doctors asked Lurinda to talk with a representative of the UC Health TRIMS Program (Transplant-Related Interdisciplinary Metabolic Surgery). With obesity often being a roadblock to transplantation, TRIMS is a surgical program making organ transplants possible through weight loss surgery.

UC Health utilizes the perfect combination of physician expertise in transplant nephrology, transplant hepatology, cardiology, transplant surgery, surgical critical care and minimally invasive surgery, enabling patients to have positive outcomes.

“The TRIMS program offers hope to patients who struggle with obesity – which is predicted to be 50% of the U.S. population by 2030 – and to those who have end-stage organ dysfunction,” states Bobby L. Johnson III, MD, UC Health bariatric surgeon and assistant professor of clinical surgery at the University of Cincinnati College of Medicine. “Patients who have struggled with obesity previously were not candidates for transplantation (due to weight) and were not candidates for weight loss surgery as they were deemed too high risk because of their medical problems.”

Dr. Johnson guided Lurinda throughout the entire weight loss surgery process. “There are only a handful of programs similar to UC Health’s TRIMS program in the U.S.,” he states, “and there are no other programs like it in the Greater Cincinnati region or in this part of the Midwest.”

Dr. Johnson is proud to be part of the TRIMS program, sharing that it allows non-transplant candidates to become transplant candidates. “We have the expertise and resources available to provide this service and offer hope and a lifeline to people who feel like they have no other options.”

While Lurinda initially was not going to have the bariatric surgery, she decided to go to the appointment and listen to what the TRIMS team had to say. “My husband is the most supportive person – he has been by my side through this whole thing, never complaining and always has been uplifting. So we went and we listened.”

After the appointment, Charlie told her, “You have to decide – I cannot decide for you.” While driving back home that day, Lurinda says, “I just decided that I wanted to have the surgery.” And that was that. Lurinda says she never looked back – it just clicked in her mind. “I had to do it all the way or not do it at all. If someone was offering weight loss surgery to me with the result that I might get a kidney, I was going to do it.”

Dr. Johnson says that when he first met Lurinda, she had a body mass index (BMI) of 38 and weighed 216 pounds. “She had obesity-associated conditions, including hypertension and diabetes, and her weight was prohibitive for transplantation at that point,” he says.

Gastric Sleeve Surgery and A New Kidney

In June 2019, Lurinda started the pre-bariatric surgery process to prepare her body for the procedure through nutrition and diet, and to receive important lifestyle management education, including exercise and behavior modification.

On Sept. 12, she had laparoscopic gastric sleeve surgery at UC Medical Center.

Lurinda did well after the surgery—she lost enough weight to be placed back on the transplant list, and in May 2020, she received a new kidney, with her surgery performed by Madison Cuffy, MD, UC Health transplant surgeon and associate professor at the UC College of Medicine.

According to Dr. Cuffy, more than 100,000 people are currently waiting for an organ transplant in the U.S. “While this number seems high, there are a significant number of patients who cannot get access to the wait list to receive a lifesaving organ due to various barriers,” states Dr. Cuffy. “One specific barrier to being listed for a kidney transplant in many programs around the U.S. is morbid obesity. Without being listed for kidney transplantation, many patients often remain on dialysis, which has a high incidence of negative consequences, including death. Lurinda’s story is inspirational because of her commitment to our TRIMS program; she worked hard and was able to lose the weight in order to be placed on the transplant list, and ultimately, received a kidney.”

He continues, “Lurinda’s story represents UC Health’s mission to identify barriers in medical care and find solutions. We work very hard to ensure that all patients who step through our doors are given a chance to receive access to advanced care, whether that be for morbid obesity, dialysis treatment and liver, kidney or pancreas transplant surgery.”

To say that recovery was easy for Lurinda after the kidney transplant would be a false statement. “She had difficulty maintaining proper levels of hydration and developed some body weakness, however, after some time, she persevered and fully recovered,” Dr. Johnson stated.

Lurinda’s final weight one year from surgery is 137 pounds, and her health conditions have dramatically improved or disappeared. “Prior to surgery, she required an average of 90 units of long-acting insulin and approximately 44 units of insulin throughout the day,” said Dr. Johnson. “She now requires only 10 units of insulin at night and 9 units throughout the day. Additionally, since surgery, she no longer needs to take blood pressure medication. She is no longer having problems maintaining proper hydration and her strength has returned. And best of all, she is no longer on dialysis.”

Transformation, Love and Support

Today, Lurinda is healthy, happy and grateful. 

“I’ve noticed that when I used to go shopping or take a vacation and do a lot of walking, I had a lot of achiness and would have to sit down. Today, my legs and hips feel tremendously better.”

While she admits that there are still some ups and downs, overall she feels much better about herself. “I didn’t look in the mirror after my sleeve surgery for several months, and then when I did look, I thought, ‘Oh my gosh, I don’t know her!’”

After her weight loss, some of her friends also did not recognize her. Two instances of this happened in one day.

“We ran into a couple who both looked at me and then looked at Charlie, and said, ‘Where is Lurinda?’” Lurinda said. Then, when walking out from a store to the parking lot, they saw another old friend. “He was talking to Charlie about me. So, I walked over to him with my mask on. He still didn’t really see me. He said to Charlie, ‘Tell Lurinda I said hi’. And Charlie said, ‘Why don’t you tell her yourself, she’s standing right here.’”

Lurinda adds that one of the best things throughout her weight loss and transplant journey has been the love and support from family and friends. “There is a whole community that has been behind me all the way. All of the church congregations in our community have been praying for me. That’s a wonderful feeling.”

Lurinda has four grandchildren, all under age 7. She says, “For a while, I really didn’t think I would make it, I just felt so bad. But I’m going to be here to be with them. My family has been so supportive, helping where they can and bringing meals in.”

There is one more thing. “Charlie and I are talking about getting an RV and seeing the country. There is so much to see in the U.S. This is a goal we have now, and I’m going to be able to spend a lot more time with him.”

Her message to others who find themselves facing obesity and organ failure is simple. “I would encourage them to look into the surgery and do all the research they can. For me, I just wanted to try. Weight loss surgery has changed my life. It gave me a chance to get my kidney.”