By the time Scott Burton had a successful kidney transplant at NYU Langone Health on May 15, 2022, 2 weeks before his 40th birthday, he was long overdue for some good news. Burton, a marketing professional from Winston-Salem, North Carolina, was born with a blockage that damaged his kidneys. The condition was expected to be fatal, but Burton beat the odds. At age 12, he began dialysis, connecting to a machine for 20 hours a week that would do the work of his kidneys, filtering waste products and excess fluid from his blood. By age 16, he had matched for a donor kidney and received a transplant. But just four years later, his body rejected the kidney, forcing him to go back on dialysis.

It would be two decades before he would find another match.

The failure of the previously transplanted kidney, as well as multiple blood transfusions, left Burton’s immune system so highly sensitized that more than 99 percent of kidneys from potential donors were incompatible. The chances of finding a match that his immune system would not immediately reject were slim. Burton felt resigned to endure dialysis indefinitely. Then, in 2021, seeking an alternate opinion, he turned to the NYU Langone Transplant Institute. Within one week of being listed, he received a new kidney, transplanted by Bruce E. Gelb, MD, assistant professor of surgery at NYU Grossman School of Medicine. “I’ve been waiting for this day forever,” says Burton. “I look forward to a new level of freedom and reclaiming all of the time I spent on dialysis.”

Burton’s nephrologist, Nicole M. Ali, MD, medical director of the kidney and pancreas transplant programs, considers it “nothing short of a miracle” that NYU Langone was able to find a very well-matched kidney from a deceased donor in the Midwest so quickly. But in a sense, she wasn’t surprised. Of the 256 programs in the United States that perform adult kidney transplants, the Transplant Institute is one of the few with expertise in finding donor organs for highly sensitized patients. Taking the extra steps to analyze the antibodies in Burton’s blood that might result in rejection requires both patience and expertise—a combination that eludes many other transplant centers.

Massimo Mangiola, PhD, director of the Immunogenetics Laboratory, decided which of Burton’s antibodies should be included in the nationwide organ-matching system. “It says a lot that we were able to find the needle in an oversized haystack, while other transplant centers were not,” says Dr. Ali, clinical associate professor of medicine at NYU Grossman School of Medicine.

That no-stone-unturned philosophy is reflected in the program’s dramatic growth and rising national reputation. Since the Transplant Institute was established in 2016, the number of kidney transplants performed has increased by 972 percent. The kidney transplant program has grown from the smallest in New York State to the largest, saving 1,500 lives in 6 years. It now ranks as the top kidney transplant program in the United States, with the best one-year survival rate in the country and the highest transplant rate in New York City, according to the Scientific Registry of Transplant Recipients. NYU Langone has transplanted more kidneys than any other center in New York State. It is ranked as the top center in our donor service area for the time to transplant with deceased donor organs.

The kidney transplant program specializes in matching hard-to-place donor kidneys—organs that are considered to be of lesser quality or have abnormal anatomy or injuries that would make them untransplantable by other centers. The Transplant Institute is 13 times more likely to say “yes” to such organs, a fact that goes to the core of what sets it apart from other centers.

“When you’re known as a center that can successfully transplant hard-to-place donor kidneys, you’re on the radar of the nationwide organ procurement organizations,” explains Zoe A. Stewart Lewis, MD, PhD, surgical director of the kidney and pancreas transplant programs. For patients who face years on dialysis before a donor kidney may become available, the window for a transplant is very narrow. Too long a wait, and a patient’s health may decline to the point where they’re unable to receive a transplant. “We’ve learned that by fully considering each kidney offered to us, we often can identify a recipient who can benefit from that organ,” notes Dr. Stewart, associate professor of surgery at NYU Grossman School of Medicine. “We don’t look at it like ‘This is a good kidney’ or ‘This is a bad kidney.’ Our mantra is ‘Is this the right kidney for this particular patient?’”

“We don’t look at it like ‘This is a good kidney’ or ‘This is a bad kidney.’ Our mantra is ‘Is this the right kidney for this particular patient?’”—Zoe A. Stewart Lewis, MD, PhD, Surgical Director of the Kidney and Pancreas Transplant Programs

While many transplant centers look at a donor organ to see what’s wrong with it, Dr. Ali explains, “We look at it and say, ‘How can we make this work for someone who needs it?’” Often, that means the transplant team will examine every single specimen slide, not just the biopsy report, or perform its own biopsy. “We’re looking at the integrity of the blood vessels, the amount of scar tissue, whether surgical reconstruction is an option, or how a customized regimen of immunosuppressants can work for this kidney in this recipient.”

Of the 106,000 Americans currently listed on a waitlist for a donor organ, 83 percent are in need of a kidney. As of June 2022, nearly 90,000 people were waiting for a kidney donation, but fewer than 25,000 are likely to receive one. The need for donor kidneys is particularly acute in the New York metropolitan area, where the incidence of end-stage kidney disease is high, but the rate of organ donation is among the lowest in the United States.

“We rely a lot on donor organs from other parts of the country to get our patients transplanted rapidly, with the best possible outcomes,” explains Robert Montgomery, MD, DPhil, director of the Transplant Institute and chair of the Department of Surgery. “To achieve that, we’ve developed a system that is both a science and an art. Compared to dialysis, a kidney transplant more than doubles the life span of the patient. My vision is to get better and better at optimizing our outcomes and the number of patients we’re able to transplant.”