Nephrologist Ieva Ziediņa treats kidney diseases and pre- and post-renal transplant patients
This year, the joint award of the Latvian Academy of Sciences (LZA), SIA Latvijas Gāze and RTU Development Fund for achievements in living donor kidney transplantation was awarded to leading researcher at Rīga Stradiņš University (RSU) Laboratory of Transplantology and lecturer at the Faculty of Medicine Department of Internal Diseases Ieva Ziediņa, whose principal place of work is the Transplant Centre at Pauls Stradiņš Clinical University Hospital.
Photo from the private archive of Ieva Ziediņa
“I am a point of intersection of sorts for transplantologists, coordinators, care assistants, patients and their living donors. I bring them together and make the process happen. I assist living donors in order for them to be able to help their relatives”, Ieva Ziediņa starts our conversation, explaining her role and mentions that the first kidney transplantation in Latvia was carried out in 1973 when a father gave a kidney to his daughter.
Ieva Ziediņa frequently takes part in international conferences. For her it is a valuable opportunity to expand one’s professional grasp, learning from experience and avoiding kidney transplantation errors already made by others. The Congress of the European Society of Organ Transplantation in Barcelona has been the most important of recent events. The biennial congress is a forum for European transplantologists to meet. For over ten years the specialists of the Latvian Transplant Centre, Ieva Ziediņa among them, are among the speakers at the event.
In addition to her clinical work, Ieva Ziediņa gives lectures to 4th and 6th year students at the Faculty of Medicine. Because of her English language proficiency, Ieva Ziediņa mostly works with international students. “Every year I hope for a Latvian student group, because they, most probably, will be my future colleagues as international students will leave after graduation. For prospective medical practitioners – with the desire to work at the Transplant Centre, we have to demonstrate the processes and already offer students hands-on experience during their studies.”
Please tell us about living donor kidney transplants in Latvia!
The first successful kidney transplants in the world and in Latvia were taken from living donors – relatives. As soon as nephrologists came to realise that kidney transplants may also be taken from deceased donors, interest in living kidney donors experienced a global decline.
Prior to the financial crisis in Latvia, the demand for deceased donor kidney transplants was met, however the crisis led to large-scale emigration and the number of potential donors decreased accordingly, and we faced a problem which is common in many countries where the number of people who need a kidney transplant is higher than the number of donors.
The use of living donor kidney transplants was resumed at the initiative of RSU Professor Rafails Rozentāls. Being the head of the Transplant Centre for many years, he believed that one should not stick to old-fashioned practices and introduce something new instead. In 2007 we started to inform our patients and the general public of the possibility to use living donor kidney transplants. Initially it was one donor per year, then three and later – seven; which is a very good indicator.
The raising of public awareness on the possibility to transplant a kidney of a living donor is relentless teamwork. For example, last year we had 40 kidney transplantations, 12 of which were from living donors.
Currently there is a shortage of kidney donors in Latvia and the waiting periods are very long. In comparison, in the pre-crisis period the waiting period in Germany was from eight to nine years compared to one year in Latvia. Today the waiting period in Latvia may take 3-5 years and the situation for young patients aged 20-30 years is extremely problematic as there might be one donor in every year or two.
The youngest recent kidney transplant patient in Latvia was six years old. We have spirited ladies around 80 who insist on a donor’s kidney instead of an ”artificial kidney” to avoid the four-hour long haemodialysis treatment at a hospital three times a week. Dutch specialists who were the ones to proceed with living donor kidney transplantation and currently undergo twice as many living donor transplantations than deceased donor transplantations, have come to the conclusion that living donor transplantation results are considerably better. A transplant kidney usually lasts from 10 – 20 years, after which a new renal replacement is required – from a donor or an artificial kidney – dialysis.
What other duties do you have in the living donor kidney transplantation process?
The entire process is far more complex than welcoming the donor and the recipient, followed by surgery and saying farewell to the patient. It is a time-consuming effort involving examination of the donor and the recipient, compatibility testing, scheduling a time acceptable for the donor and the recipient, availability of surgeons, anaesthesiologists and nurses which is a major problem at Pauls Stradiņš Clinical University Hospital. Kidney transplantation from a living donor is a planned surgical operation. I prepare the patient for the operation, provide post-OP care and treat the patient for many years afterwards for the transplanted kidney to function properly.
Over 40 years have passed since the first kidney transplantation. Are there still any things we do not know in Latvia about kidney transplantation?
Most definitely! For example the technological capacity of Latvia is insufficient! We know what kind of tests should be performed to find a better match, however, our laboratories do not have the necessary equipment and specialists to operate them. If the laboratory could present me with all the required data, I could inform the patient of the best match from potential donors and to select the dosage of immunosuppressant drugs, to ensure maximum survival of the transplant and the recipient of the transplant.
When could we expect any technical improvements?
We have been approaching the respective officials with this issue for many years now, but somehow they do not hear us.
What are the global issues regarding kidney transplantation?
Although our colleagues abroad might have access to all technological solutions, science is a never-ending chain of questions and answers, where the answer to one question provokes a number of other questions. The current issue on the agenda is the idea of testing compatibility not against the genetic composition in its entirety as it is done currently, but against small compounds of genes.
What has more weight in your transplantology work – research activity or medical knowledge and experience?
Medical knowledge and experience is the principal asset, however, certainly, research activity is very important. In the absence of the proper registration of data and research, it is hard to understand which are the things you have done correctly and which are incorrect. As for myself, the proper course of action to come to important conclusions, would be the involvement of each patient in a study, at least in observational study.
Do you often go on business trips?
If you do not attend conferences and lack knowledge on the latest global developments, you are not broadening your horizons. All innovations that have been introduced in Latvia in recent years, including renal transplantations across different blood groups and by overcoming HLA antibody barriers, is knowledge gained at conferences.
At times people have a negative perception and a wrong opinion of medical practitioners going to conferences. People tend to think that we only eat, drink and go on excursions although in actual fact, I sit in the conference from early morning until late at night and carefully listen to everything that is said, as otherwise I have no opportunity to acquire such an amount of information in my daily life working full time.
Moreover, the acquired information is vital as it is based upon the experience gained by doctors from all around the globe. The valuable lesser skills to be used back home I usually acquire at conferences from listening to other speakers and asking questions.
Why did you choose to study medicine?
This is a rather sad story. My mother was ill for a long period of time and spent a lot of time at Stradiņš hospital…
The nephrologist Uldis Brūvers is a distant relative of mine. During my childhood, he used to visit my grandparents and share stories about kidney treatment. Later on when I was already a student, we once paid a visit to the kidney unit and I remember thinking that this is the place where kidney failure occurs and people die and I reassured myself that I could treat anything but the “kidneys”. Nevertheless my life has taken some unexpected turns and I have become a nephrologist. While working at the Transplant Centre I have understood that this is the place of hope and life, which gives people the chance to get a new kidney and increase their life expectancy.
What are your memories of the study years at RSU?
Very good! I enjoyed my studies! At that time the university still bore the name of the Medical Academy of Latvia. All my classmates were extremely motivated and dedicated already from the first study year, we all worked nights and on the weekend and volunteered in order to get the desired job after graduation, however we also managed to spend our free time effectively and intensely.
Is there any lecturer you remember most vividly?
The lecturer Jānis Raibarts. He was very strict but we learned a lot from him. If a teacher is not strict, you commonly do not learn much from him and forget him quickly. I am very demanding of my students and every morning, equally as we had with Jānis Raibarts, my students are sitting a test, because this way the students know that they have to learn.
Have you ever thought of leaving Latvia to work abroad?
Yes, every six months. It is sad when you work and strive hard but do not get financial satisfaction. I know people who occasionally sell some items and can provide their children with things I cannot even afford, notwithstanding my doctoral degree in medicine and work at the university hospital. However, because of my husband who does not want to move away, we are still here. At the same time I do encourage my children to study abroad, because it expands your perception of life.
Are there any everyday issues at RSU that should be improved?
I find it cumbersome when it comes to filling out different forms or documents. Then I contact colleagues from the human resources or the project department to understand where I could find the proper form. I am commonly advised to consult the intranet, as all forms are published there. The thing is that I do not work with the intranet on a daily basis and I cannot find the required document that easily and this is also the reason for approaching my colleagues with the given request. Is it that hard to help find the right form and to tell which box I have to fill in? If you would visit me as a patient, I cannot advise you to consult the internet, as all information on kidney diseases can be found there, but instead I will explain everything to you.
I like the courses organised by the Centre for Educational Growth. I have attended several of them.
It is great that the university offers English language courses, however as for myself, I would suggest to reschedule the day on which the courses are held, as for several years the courses for my English language proficiency level are held on the day when I have outpatient visiting hours.
Do you believe that in the future scientists will grow kidneys in the lab?
Considering what I have recently heard at conferences, I think it is rather credible, although most probably the kidney will not be the first laboratory-grown organ. I presume that this will be the heart, as it does not have such a complex structure as the kidney and has more homogeneous cells. The kidneys require at least 26 different cells. The scientists who managed to grow small kidneys (up to 1 cm in size) arrived at four, six and even twelve various cells, however cannot succeed in differentiating from the stem cells the number of cells required. America and Japan are forerunners in this field.
Some facts about Ieva Ziediņa
- RSU 1999 graduate
- Since 2017 assistant professor at RSU Faculty of Medicine, Department of Internal Diseases
- Since 2005 nephrologist at Pauls Stradiņš Clinical University Hospital
- Since 2012 the lead researcher at RSU Laboratory of Transplantology
- Since 2012 external expert at the State Agency of Medicines
- 2011 – doctoral degree in medicine awarded by RSU, doctoral thesis “Polyoma BK Virus Infection for Patients with a Kidney Transplant”
- 1999–2002 residency in internal medicine
- 2002–2005 residency in nephrology
- Co-author of the booklet “Kidney transplant recommendations”
- Research interests: kidney transplantation from living donors, antibody-mediated rejection following organ transplantation, nephrology: the importance and impact of viral infections, anaemia in chronic kidney disease
- Study courses taught at RSU: Topical issues in Gastroenterology and Nephrology, Internal diseases I (Gastroenterology, Nephrology, Endocrinology), Differential Diagnosis of Internal Diseases and Novelties in Treatment.
- Supervision of three student research theses