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Kidney Transplantation Offers New Life
Brian D. Shames, MDMedical College of Wisconsin Transplant Surgeon
Kidney disease can slowly destroy a patient’s quality of life. While kidney dialysis may maintain life, kidney transplantation frees patients to fully experience the wonders of the world. Since 1967, Froedtert & the Medical College of Wisconsin have performed close to 3,000 kidney transplants.
Q. What medical conditions would necessitate a kidney transplant?There’s a very wide spectrum of diseases that can affect the kidneys, both diseases that primarily affect the kidney and then other diseases that affect it secondarily. In adult patients, the most common causes of end-stage renal disease are diabetes, hypertension and autoimmune-type disorders, such as glomerulonephritis and focal segmental glomerular sclerosis (FSGS). Congenital problems, like congenital obstruction, can also lead to renal failure.
Q. What is kidney disease?These various conditions basically cause scarring of the kidney. As the kidney scars, it has less ability to get rid of waste products which leads to worsening renal function. It is usually a slowly progressing disorder, but eventually the kidneys can fail. When a patient has end-stage renal disease he or she requires some sort of renal replacement therapy, such as dialysis.
Q. What are the signs and symptoms?Tiredness, nausea and lack of appetite. People may have problems with their potassium and other electrolytes. Their blood counts can be very low. With chronic kidney disease, there’s an overall sense of not feeling well. In acute kidney disease – some sort of acute illness that causes the kidneys to fail – patients may have electrolyte problems and typically stop making urine. Patients with chronic kidney disease may or may not have decreased urine output.
Q. Why would a kidney transplant be needed as opposed to dialysis?Kidney transplantation offers clear benefits over dialysis. Perhaps the biggest benefit of a kidney transplant compared with dialysis is that people who get a transplant live longer. This is true for every age group. If you compare people on the waiting list for transplant with people who get a transplant, people who get transplanted live longer. Kidney transplantation also has multiple physiologic and metabolic benefits when compared with dialysis. Furthermore, transplantation is a significant lifestyle benefit, as patients do not have to go to dialysis any more.
But kidney transplantation isn’t without risks. Patients who are quite old or have a lot of problems with their heart and lungs or have other systemic diseases, such as a cancer, may not be candidates for kidney transplant. But we look at every patient as an individual.
Q. What is the process for having a kidney transplant?When a patient has end-stage renal disease, typically there’s a referral made from the nephrologist to our center. At their initial visit, patients meet a transplant surgeon and transplant coordinator, as well as others, including social workers and financial coordinators, to get everything arranged prior to the transplant. Then there’s a fair amount of work-up that needs to get done. We evaluate their heart, lungs and other organ systems to make sure they’re acceptable candidates for transplant.
Once they’re deemed an acceptable candidate, there are two roads they can go down. One is the deceased donor waiting list. The other is live donation. If they have any live donors available, we’ll start an evaluation of the live donors at that point. If they have a live donor available, typically the transplant will happen within the next three to six months. The wait for a deceased donor is somewhere between three and five years.
In either case, the actual operation is the same. Patients are usually home about five days after receiving a live donor kidney.
Q. What are the long-term outcomes?The one-year graft and patient survival rate is about 98 percent. There is some drop off in graft function as you get farther out, but at three and five years, the graft survival rate is still in the high 80 percent range.
But these kidneys don’t last forever, and I tell patients that. The half-life of a deceased donor kidney is probably only somewhere between 13 and 15 years. The half-life of a live donor kidney is probably closer to 20 years. When the new kidney fails, though, we certainly consider doing a second transplant.
Q. What can I do now to lower my risk for kidney disease?See your primary care doctor and get screened for diabetes and hypertension. There’s an epidemic of diabetes right now. Preventing and treating diabetes and high blood pressure is the best thing you can do to decrease your risk of kidney disease.
Source: Every Day, Interview with Brian D. Shames, MD Date: Aug - Dec 2006 |