Transplant Evaluation
The other option for the treatment of ESRD is kidney transplantation. Kidney transplantation is a surgical procedure that places a healthy, donated kidney into the patient with kidney failure. The donated kidney can perform all the functions that the patient’s damaged kidneys are unable to do.
The question of the best method of treatment is a difficult one to answer. There are several issues that need to be addressed. The advantages and disadvantages of each kind of treatment affect each person differently. Renal patients should learn all they can about each method of treatment: consult with medical staff; consult their families; talk to other dialysis patients. Treatment should be tailored to meet the individual’s need so that she/he can remain as self-sufficient as possible and continue to be a productive member of society. However, once a patient decides to go through with a kidney transplant, they would begin the transplant evaluation process.
Types of Kidney Transplants
Kidneys for transplantation come from two sources:
- Living Donors - family members, spouses, or friends, who are at least 18 years of age.
- Deceased Donors - people who have died and donated their organs for transplant.
Living Donors
The Emory Transplant Team encourages living donor transplants for the following reasons:
- The long-term success rate of living donor kidney transplants is excellent.
- The transplant procedure will be a scheduled surgery, thus eliminating the wait for a deceased donor.
- The likelihood of immediate functioning of your kidney after a living donor transplant is greater because of the short length of time the donor kidney is without blood supply.
You may feel uncomfortable asking family members or friends to donate a kidney. But while the subject may be difficult to talk about, you may find that your family and friends are indeed interested in being evaluated as living donors. Remember, the Emory transplant team will evaluate your donor very carefully and only accept him or her as a donor if he or she is healthy and able to donate. You will receive more detailed information about living donors during your evaluation. If you have any questions, please feel free to call your transplant coordinator.
Deceased Donors
If you have been approved for transplant and do not have any living donors, or if you are unsure about living donors, then you will be placed on the deceased donor waiting list. Once you are accepted for transplant, your name is placed on the national waiting list which is maintained by the United Network of Organ Sharing (UNOS).
UNOS is the national agency that regulates organ-sharing. Whenever a kidney becomes available in Georgia, LifeLink Foundation of Georgia reports it to UNOS so their computer can place that kidney with a recipient in need. If a kidney from another state matches perfectly with you as an Emory patient, that kidney will be offered to Emory for you. This policy is called “mandatory sharing” and was instituted because of the improved success rate of perfectly matched kidneys. If no perfectly matched candidate to a Georgia donor can be found anywhere in the United States, then the donor kidney is offered to the person on the Georgia list who is the most appropriate recipient for the donated kidney.
LifeLink Foundation of Georgia is the non-profit agency that evaluates and manages all potential deceased donors in Georgia, following strict guidelines and testing procedures to maximize the safety and success rate of kidney transplantation. LifeLink coordinates the recovery and placement of deceased donor organs within the state or region.
Survival Statistics
Many factors may affect the estimated length of time a kidney transplant will function, including:
- living donor versus deceased donor kidney
- first transplant versus re-transplant
- donor age
- cause of the recipient’s end-stage renal disease
- recipient’s compliance with medications and health care follow-up
PRA level of the recipient – the level of circulating panel reactive antibodies, or preexisting antibodies, that a patient has developed from previous exposure to cells or tissues from other humans, such as blood transfusions, previous transplants, or pregnancies.
HLA (human lymphocytic antigen) match – the degree of antigen match, often referred to as “tissue-matching.”
Cold ischemic time of the kidney - the time the donated organ is in iced storage between the donor and recipient (usually minutes for a living donor, hours for a deceased donor transplant).
Overall, the national one-year patient survival rate after deceased donor kidney transplantation is 94.2%, while the national one-year kidney survival rate is 88.4%. At Emory University Hospital, one-year patient survival rate after deceased donor kidney transplantation is 95.1%, and one-year kidney survival rate is 92.53%. The one-year pancreas survival rate at Emory is 83.33%. New immunosuppressant medications may further improve kidney and pancreas survival statistics.
The following table compares the estimated length of time a deceased donor kidney will survive compared to a living donor kidney, as measured in half-life. Half-life means that half of the kidneys within the particular category will function fewer than the stated years and half will survive longer. For example, with HLA-identical living-donor kidneys, half of the transplanted kidneys will function fewer than 26.5 years and half will function more than 26.5 years.
This data comes from the United Network of Organ Sharing (UNOS) Scientific Renal Transplant Registry as published in Clinical Transplants 2002 and is based on data from 1998-2001:
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Your Transplant Evaluation
Patients considered for a kidney transplant may have kidney failure from a variety of causes. The most common causes are glomerulonephritis, diabetes, high blood pressure, and polycystic kidney disease. Some patients may be considered for a transplant prior to beginning dialysis. Medical condition is a major factor which determines if transplantation is the optimal therapy for a particular patient’s kidney disease. Some patients with severe medical problems such as cancer or active infections may be considered not to be best served by a transplant.
Your transplant evaluation serves two main purposes. First, it provides a chance for you and your family to learn as much as possible about transplantation in order to decide if you could benefit from a kidney transplant. Second, the evaluation offers an opportunity for the Emory transplant team to learn about your medical history and determine your suitability for a transplant. Your transplant evaluation serves the important function of helping both the team and you decide if transplantation is your best treatment option.
Your first visit for the evaluation process will be for an education session. During this meeting which will last 2-3 hours, you will have the opportunity to meet several different members of the team and learn about the medical, surgical, and financial aspects of kidney transplantation. You may bring your family members and you will have ample opportunities to ask questions.
Tests
Testing will begin with a complete medical history and physical exam. We will also perform a chest X-ray and an EKG (heart tracing test). If you are over 45 years old, have diabetes, or have other risk factors for heart disease, a cardiologist (heart specialist) will perform a stress test on your heart.
Then, depending upon the cause of your kidney disease and your age, an ultrasound, CT scan, or MRI of your abdomen may also be performed. If you have diabetes, an ultrasound of the neck will be required, and possibly a blood pressure cuff test to measure blood flow to your legs. An eye examination may also be necessary.
Other tests may include studies of your bladder and lower urinary tract. Women over 35 years of age should have a mammogram, and all women will need a current gynecological examination and PAP smear to rule out infections or other problems. A current dental examination is also recommended for all patients. A colonoscopy is recommended for all patients over 50 years old.
After the transplant evaluation, your tests and lab work will be reviewed by the transplant team. You and your primary nephrologist will be notified of our recommendation by telephone and in writing. If we determine that you could benefit from a kidney transplant, we encourage you to contact the Mentor Project to talk to other patients who have had transplants. They may be able to give you firsthand insights and help you make your own decision about this treatment option.
Meeting the Team
During your evaluation you will meet the transplant team. Each team member brings special knowledge that will help you during all phases of the transplant process. You will be introduced to our kidney transplant surgeon and transplant nephrologist. You will also meet a physician assistant, social worker, transplant coordinators, dietitian, and other medical specialists as necessary.
