Issuance after kidney transplant!

U

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Hey all!

Former poster here with some great news.

I recently received a kidney transplant. Everything seems to be working great so far. I can finally look forward to becoming a student pilot.

Just wondering what sorts of things I need to worry about, any drugs I need to avoid, etc. or anything else I need to do to prepare for what lies ahead. What can I expect to go through as far as the medical process goes? I assume I won't be an AME-issued situation.

Currently on a standard regimen of immunosupressors, anti-infectives, and a small amount of a statin to control cholesterol, as well as some BP meds to control blood pressure (metroprolol, losartan, and hcz). BP was "normal-ish" before transplant. My understanding is some of these will be tapered off in the coming months.

I have heard that there have been a number of kidney transplanted pilots out there who got medicals around 6mo post transplant. That actually puts me square into the time when I'd want to be thinking about beginning my training anyway in terms of weather.
 
Here's what the AME handbook says. DocBruce can explain it further:

Disease Protocols - Renal Transplant
An applicant with a history of renal transplant must submit the following if consideration for medical certification is desired:
Hospital admission, operative report and discharge summary
Current status report including:
The etiology of the primary renal disease
History of hypertension or cardiac dysfunction
Sequela prior to transplant
A comment regarding rejection or graft versus host disease (GVHD)
Immunosuppressive therapy and side effects, if any
The results of the following laboratory results: CBC, BUN, creatinine, and electrolyte​
s
 
I'm pretty sure this is not one the AME can issue in office, but will have to be deferred to Oklahoma City. The two big issues on this are a) make sure you have everything they want all together at the initial application, and b) it won't happen overnight, so make sure you don't have any immediate plans based on issuance. Bruce can tell you the verbiage they're looking for in the "current status report", both what they want to see, and what will scare them. That said, there's no reason you can't start your training once you've applied for the medical so you're ready to solo when it comes through.
 
Okay, start by looking up each or your immunosuppressives. Some are permissible, some are not.

You need six months of stabililty, with no sign of rejection.
Stability means, if you have to discontinue one of the meds because FAA will not permit it due to cognitive effects, the six months start from there.

You need your
Pre op assessment-"why the kidney failed"
Your op note
Pathology note
Six month assessment by the transplanting surgeon, all rebiopsies, etc.
No evidence of Graft versus host disease (which is why it's 6 months).

B
 
bbchien said:
Okay, start by looking up each or your immunosuppressives. Some are permissible, some are not.

B
Click to expand...

I've been having trouble finding any sources for this. I have seen cellcept (mycophenolate) cited but no others. Is cyclosporine modified a permissible drug?
 
Better yet, find Doc Bruces website and e-mail him. For a very modest fee he will guide you through this minefield and help you to not trip along the way. He will be your best chance for receiving a medical. He knows his stuff.
 
Gary F said:
I don't think the anti-rejection drugs are included in that list. This case will likely require Dr Bruce's expertise.
Click to expand...

Some immunosupressives were.

and 100% agreement about Dr. Bruce.
 
There is no comprehensive published list of acceptable/not acceptable meds because things change...email/call Bruce.
 
I can tell you that Rituxan, Siroliumus, and Cyclosporine are approved case by case, if absent side effects, and which absent effecst are listed.... This is one of the cases....

I do have recollection of a case of a heart transplant that was on cellcept, and he did win approval.
 

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Thanks for the info. I am definitely not seeing any noticable side effects now that my cyclosporine and mycophenolate is at a sane therapeutic level, and I am feeling great.

I guess the first question is, how should I time this? At what point do I start gathering paperwork? I am about a month post-transplant now. I am curious as well to how long it would be after I submit everything to the FAA that I would get some sort of answer. I am eager to start my training but don't want to be throwing my money into a hole if I'm not going to get a decision on my medical for another year. My issue is I already have certain experience with small aircraft operation and my feelings are that if everything goes OK, I will probably be soloing a bit earlier than other students would, which obviously I will not be doing without an issued medical.

The other question I have is: should I perhaps be waiting for a DL medical exemption to go through? If I get a denial, that would mean that no matter what law passes, or what exemption passes, I wouldn't be able to fly, correct?
 
Unregistered said:
Thanks for the info. I am definitely not seeing any noticable side effects now that my cyclosporine and mycophenolate is at a sane therapeutic level, and I am feeling great.

I guess the first question is, how should I time this? At what point do I start gathering paperwork? I am about a month post-transplant now. I am curious as well to how long it would be after I submit everything to the FAA that I would get some sort of answer. I am eager to start my training but don't want to be throwing my money into a hole if I'm not going to get a decision on my medical for another year. My issue is I already have certain experience with small aircraft operation and my feelings are that if everything goes OK, I will probably be soloing a bit earlier than other students would, which obviously I will not be doing without an issued medical.

The other question I have is: should I perhaps be waiting for a DL medical exemption to go through? If I get a denial, that would mean that no matter what law passes, or what exemption passes, I wouldn't be able to fly, correct?
Click to expand...
You have to be long enough out that the transplant team can testify that you don't have GVH disease. That practically means, 6 months out, minimum.

IT's IN POST #5.
 
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OP.

Dr Bruce does this sort of thing frequently, you should contact him directly. His fee is completely reasonable.
 
That brought kinda awareness in me i mean i wasn't knowing this all and its making sense completely.Basically knowing this type of subjects can really be a useful thing when it comes to discussing that all.


physical therapy
 
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Unregistered said:
The other question I have is: should I perhaps be waiting for a DL medical exemption to go through? If I get a denial, that would mean that no matter what law passes, or what exemption passes, I wouldn't be able to fly, correct?
Click to expand...

My advice would be to assume that the current law will continue to apply, and if Bruce (or another expert in medical certification you care to consult with) thinks that you can get certified, without endangering your health (by changing to an anti-rejection drug that isn't effective for you for example), go for it.

There may be major changes in medical requirements coming, or there may not. They might happen in a year, or they might happen in a decade. The changes might take the form that has been proposed by the AOPA and EAA or proposed in H.R. 3708, and they might take a dramatically different form. Life is precious and short, and I wouldn't delay doing something you love for years if you don't have to, out of hope that the FAA or Congress will fix the Third Class issue.

But, to answer your question, I wouldn't assume that the problem that you point to, where a denial means you can never fly without a medical in the future (the so-called Sport Pilot "Catch-22") will exist under the DL medical exemption or any other future change to medical certification rules. The Sport Pilot Catch-22 is found in 14 C.F.R. 61.3 and in 14 C.F.R. 61.23. The AOPA/EAA petition for the DL medical exemption expressly seeks a exemption from 61.3 and 61.23. If the FAA were to grant the AOPA/EAA petition as written, then a pilot whose last application for a medical was denied would still be able to fly under the exemption. I.e., there would be no Catch-22. Now, admittedly the AOPA/EAA proposal will almost certainly be modified in some form by the FAA, if they ever grant it, but who knows if they would put the Catch-22 back in?

The proposed General Aviation Pilot Protection Act, H.R. 3708, would also do away with the Sport Pilot Catch-22 ("an individual may operate as pilot in command of a covered aircraft without regard to any medical certification or proof of health requirement otherwise applicable under Federal law if—(1) the individual possesses a valid State driver’s license and complies with any medical requirement associated with that license"). But who knows when or whether H.R. 3708 will ever pass, or what changes might be made to it before it does?

In short, seize the day. If you can get certified under the existing rules, go for it and don't look back.
 
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