Kidney failure is a common symptom of multiple myeloma, a rare blood cancer that affects the body's plasma cells. That's exactly what happened to Joan Kukla, a 70-year-old Cleveland, Ohio, native who was living in retirement on the North Carolina coast when her illness prompted her to return home and seek treatment at the Cleveland Clinic.
Joan became the first person in the United States to undergo a bilateral kidney transplant using a minimally invasive robotic surgical system. The surgery, performed by surgeon Dr. Mohamed Eltemamy in March 2024, was a success. Joan recovered quickly and has returned to enjoying her daily life, including spending time with her sister Bernadette and her dog Buddy.
“Everything went well and there was very little pain from the incisions,” says Joan.
Joan enjoys spending quality time with her dog, Buddy. (Courtesy of Joan Kukla)
Urological surgeons at Cleveland Clinic's Kidney Transplant Program perform more than 300 transplant procedures a year, about 10 percent of which are performed with a robot, a percentage that will continue to increase as the technology becomes more widespread. According to program director Dr. Alvin Wee, robot-guided surgery is primarily performed through one small incision, which is a minimally invasive procedure that generally results in less pain and a faster recovery for patients than traditional surgery.
Joan's surgery was unique in that doctors used robotic surgical techniques to transplant two kidneys from a single deceased donor, an innovative approach that expands the use of kidneys with limited availability from a list of expanded criteria donors who would normally be ineligible. With the need for life-saving organ donations, a two-kidney transplant helps expand the donor pool. This approach also shortens the wait time for patients to receive their organs.
Joan during a follow-up appointment with Dr. Wee, Dr. Eltemamy and transplant coordinator Caitlin Flanagan. (Courtesy of Cleveland Clinic)
“After receiving a donor kidney, further analysis sometimes reveals that one kidney is small and not functioning well,” Dr. Wee explains. “In those cases, we request both donor kidneys, which, when combined, provide over 100% function. And thanks to the robot, we were able to transplant both kidneys into Joan through the same tiny incision.”
Dr. Eltemamy, who used an advanced multi-port robot for Joan's surgery, adds that robotic technology offers more flexibility than traditional surgery. “Other advantages of the robot are that we can use magnified 3DHD vision. The joints at the tips of the instruments exceed the range of motion of the human wrist. We can work in tight spaces and it's more ergonomic,” Dr. Eltemamy says. “Instead of using two incisions or a large midline incision, we can place the kidneys on either side of the torso through one small incision.”
Dr. Eltemamy during surgery at the Cleveland Clinic. (Courtesy of Cleveland Clinic)
Joan was in good health and enjoying retirement, but in 2021 she began to experience severe back pain and fatigue. She thought she had pulled a muscle, but when she visited the doctor, she was shocked to find out that she had multiple myeloma, something Joan had never known about. Since a specialized hospital in North Carolina was a few hours away from her home, she decided to receive treatment at the Cleveland Clinic Cancer Institute's Multiple Myeloma Program.
Her treatment plan, overseen by hematologist and medical oncologist Lewis Williams, MD, included chemotherapy to reduce the amount of abnormal plasma cells, followed by a form of bone marrow transplant called an autologous stem cell transplant, which replaces damaged or unhealthy stem cells with healthy stem cells taken from Joan's body.
The treatment was effective and Joan's cancer went into remission, but her kidneys had already been severely damaged by the disease, so she enrolled in the Cleveland Clinic Kidney Transplant Program. United Network for Organ Donation (UNOS) Transplant list.
Joan is grateful to her donor and his family, and to her care team. (Courtesy of Cleveland Clinic)
Within a few weeks, a kidney was available, but Joan had a respiratory condition at the time that made the surgery too risky. After a few weeks, it was determined that the second donor kidney would not be viable. Ultimately, two small kidneys from a deceased donor were found to be suitable, and Joan underwent a successful multiport robotic double kidney transplant. Joan was released from the hospital within three days with minimal pain.
“The hardest part is the waiting, but you have to trust that something will work out eventually,” says Joan. “I'm grateful for my donor, my family and my care team, and I'm amazed at what doctors are able to do today to treat people.”
Affiliated Institutions: Glickman Urology and Kidney Institute, Cleveland Clinic Cancer Center
