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Serious Medicine. Extraordinary Care.

Kidney Transplantation Viable Option for Most Chronic Kidney Disease Patients

Clifford Miles, MD Kidney transplantation is a viable option for most patients with chronic kidney disease. The best outcomes are achieved with patients who receive a transplant before they require dialysis, says Clifford Miles, MD, nephrologist and assistant professor of Internal Medicine at the University of Nebraska Medical Center (UNMC). "The pros and cons of kidney transplantation should be addressed with the patient when they reach stage four of chronic kidney disease or about 25 percent kidney function," says Dr. Miles. "If transplantation is an option they want to consider, the patient should be referred to a transplant center so the evaluation process to determine if they are a candidate can begin."

Early stages of chronic kidney disease often do not cause noticeable symptoms and patients are often diagnosed while be evaluated for something else. Symptoms of more advanced kidney disease include: fatigue, loss of appetite, itchy skin and difficulty sleeping. Laboratories may show high potassium, high phosphorus, anemia and acidosis. "We would prefer to see the patient before these signs and symptoms have developed," says Dr. Miles.

Kidney transplants are performed on patients with kidney failure from almost any cause, though the most common etiologies are diabetes or hypertension. While some patients can survive on dialysis for 10 to 20 years, quality of life generally suffers, notes Dr. Miles. "Transplant patients not only live longer, but they routinely score higher on general well-being and quality of life surveys than dialysis patients," he says. "With a transplant, patients can live, work and travel more normally."

Patients who receive a deceased donor kidney, can expect the kidney to function for 12 to 15 years, notes Dr. Miles. A living donor kidney has an average life of 14 to 18 years. "Repeat transplantation is very common," says Dr. Miles. "Twenty percent of those on the kidney transplant waiting list are waiting for a second, third or even fourth transplant."

Once a person is listed for transplant, it can take up to three years to find a deceased donor kidney, notes Dr. Miles. However, the use of living donors has increased dramatically over the last 10 years and now make up about half of all donor organs, which greatly shortens the time between transplant approval to actual transplant.

Before a patient can be listed for a transplant, they must go through an extensive evaluation process with a multidisciplinary team of healthcare professionals, social workers and psychologists. Evaluation includes determining whether the transplant will benefit the patient, lab and imaging tests, assessing the patient’s risk of surgery survival and ability to tolerate immunosuppressant drugs, a psychological evaluation and patient education.

Dr. Miles says communication is key through the entire evaluation and transplant process. "We work hard to keep the referring doctors in the loop and encourage them to maintain follow-up care with their patient after the transplant and resume their role as the primary provider of care," says Dr. Miles.