SUMMARY
The research of Aleksandra Kukla, M.D., involves treating people with chronic kidney disease and studying kidney and pancreas transplantation. She trained at the University of Wisconsin Transplant Program in 2006 and worked at the University of Minnesota for 10 years before joining Mayo Clinic.
Dr. Kukla's special interest is helping people with advanced kidney disease and comorbidities such as obesity, diabetes and hypertension. When advanced kidney failure develops, individuals may need kidney or kidney and pancreas transplantation to treat the renal failure and diabetes. Dr. Kukla collaborates closely with endocrinologists and transplant surgeons to identify those who might benefit from kidney and pancreas transplantation. She also follows these people to maintain their health after transplant.
Some people can't get new kidneys because of their excessive weight because they are not able to lose weight or because they have other health problems. People who have type 2 diabetes mellitus (T2DM) and are overweight — conditions that often happen together — may not do well after a kidney transplant.
Dr. Kukla and Ty S. Diwan, M.D., a Mayo Clinic surgeon, started a program that brings together experts in kidney problems, transplantation and diabetes to help people lose weight.
Dr. Kukla's transplant program is at the forefront of efforts to make it easier for people who are overweight to get kidney transplants. Mayo Clinic doctors frequently do this by performing a type of surgery called sleeve gastrectomy.
The goal of Dr. Kukla's current and upcoming research is to learn more about how sleeve gastrectomy can help these individuals. Her team studies the advantages and risks of this surgery to make sure it leads to the best possible results. The surgery allows people to be healthier before they get kidney transplants.
Dr. Kukla's research investigates after-surgery effects in individuals with both obesity and diabetes who have received kidney transplants. She assesses the impact of novel diabetes medicines in these transplant recipients. This group is often overlooked in medical research studies. These new medicines have proved beneficial for kidney function and overall survival in people who haven't had transplants. But the effects of these medicines in transplant recipients have not been thoroughly examined.
Focus areas
PROFIT study. Obesity and related health problems can harm the kidneys and lead to kidney failure. People with severe kidney problems often have other health concerns such as diabetes, high blood pressure and sleep apnea. These problems can make them sicker. Losing weight can help with these conditions and slow down kidney disease. However, there haven't been enough studies to prove this in people with kidney failure.
Surgery to help with weight loss, called bariatric surgery, is effective for losing weight. It's not commonly used in people with kidney failure due to worries that it might make them weaker and sicker. The Kidney Transplant Metabolic Bariatric Program at Mayo Clinic in Rochester, Minnesota, is special because it brings together kidney experts, diabetes specialists, surgeons, dieticians and physical therapists to help people with kidney problems and obesity.
A goal of Dr. Kukla's research is to find out how to make bariatric surgery, and especially sleeve gastrectomy, safe and helpful for people who are overweight and need kidney transplants. She explores how weight-loss surgery affects physical health, the heart, metabolic health and kidney function. Dr. Kukla studies whether people become weaker after weight-loss surgery. The PROFIT study is currently enrolling all people who are having sleeve gastrectomy at Mayo Clinic in Rochester.
- Glucose control in kidney transplant recipients. Kidney transplant recipients who have T2DM make up about 40% of all kidney transplants. Unfortunately, they don't do as well as those without T2DM. Heart problems and infections are the main reasons for this. Dr. Kukla found that half of recipients with both obesity and T2DM have recurrent kidney problems within five years of the transplant.
Significance to patient care
Recent studies suggest that how much blood sugar levels go up and down, which is called glucose variability, might be a big part of why diabetes causes medical problems. This issue has not been studied extensively in people who receive kidney transplants and have complex sugar problems due to diabetes, kidney problems and medicines taken after transplant, such as tacrolimus and prednisone.
Dr. Kukla's research improves the lives of people with T2DM and kidney transplants. She strives to understand kidney problems caused by diabetes. Her studies examine how blood sugar control and insulin issues affect people's health and how they feel after transplant.
Professional highlights
- Kidney Pancreas Community of Practice, American Society of Transplantation:
- Pancreas workgroup, 2021-present.
- Policy workgroup, 2021-present.
- Member, Collaborative on Obesity Research in Transplantation, Multicenter Initiative to Expand Research in Kidney Transplant Candidates with Obesity, 2021-present.
- Participant, International Multicenter Immune Checkpoint Inhibitors Consortium in Kidney Transplantation, 2021-present.
- Medical leader, Kidney Transplant Metabolic Program, Mayo Clinic, 2023.
- Invited expert, interest group, International Pancreas and Islet Transplantation Association, 2023.
- Invited expert, National Pancreas Transplant Workshop Meeting, 2022.
- Invited expert, Third International Post Transplant Diabetes Consensus Meeting, 2022.
- Organizing committee, Transplant Oncology Conference, American Society of Transplantation, International Society of Nephrology and American Association of Kidney Patients, 2022.
- Invited expert, co-sponsored Scientific Workshop on the Management of Obesity in Adults with Chronic Kidney Disease, National Kidney Foundation and The Obesity Society, 2021.