Health Topics: Kidney Transplantation

The Transplant Team

The Loyola University Kidney Transplant Program was started in 1971 and is dedicated to achieving three principle goals:

1. to restore a sense of well-being and energy level to normal in patients with end-stage renal disease

2. to carry out research that helps other transplant doctors take better care of their patients

3. to participate in educating the next generation of doctors and nurses who will be providing care to renal transplant recipients in the decades to come.

Our team of surgeons, physicians, nurse coordinators, social workers, dieticians, financial counselors, and office personnel are dedicated to achieving the best possible long-term outcomes for our patients. We realize that sorting through all of the new information presented to you, not to mention dealing with kidney disease itself, can be overwhelming at times. We put a high priority on personalizing our care and making ourselves available to our patients at all times whether the transplant was one month or ten years ago.

Evaluation

Most patients with kidney disease can be considered for transplantation. Your evaluation begins at the Loyola Intake Clinic, where you attend an information session about transplantation given by a nurse coordinator and have a physical exam performed by the transplant physician. You also meet individually with each member of the transplant team to discuss the impact of kidney disease and transplantation on your life. Based on your physical condition, the transplant physician will determine which tests you may need to complete your evaluation. The nurse coordinators will guide you through the testing process. When your evaluation is complete, the team meets again, considering all of the information, to determine if transplantation is the best option for you. A summary of the team's discussion and recommendations is then sent to you and your nephrologist.

Kidney Donation

Kidneys can come from two types of donors. A living donor can be a relative, such as a sibling or parent, or an emotionally related person, such as a spouse, friend, step-parent or in-law. Individuals interested in donating a kidney may want to accompany you to your initial evaluation, or they can call the transplant office for further information. A blood test for compatibility is the first step in determining if a donor is suitable. This is followed by a series of physical tests, which the nurse coordinator will arrange, as well as a history and a physical exam and meetings with other team members.

Patients who do not have a live donor with the correct blood or tissue type can choose to receive a cadaver donor kidney. These donors were healthy individuals who suffered irreversible brain damage so their families gave consent for organ donation. You must get on a waiting list, and be available to come in on short notice for a kidney transplant should an organ become available for you. During your waiting period, you will be contacted periodically for updates on your status. You will also receive informational materials through the mail to help you prepare for your transplant. In addition, the Loyola Transplant Team has a patient support group that meets periodically to provide information and answer questions that you or your loved ones may have. You are welcome to join the group on a regular basis or as needed.

Outcomes

National statistics show that 90% of transplanted cadaveric kidneys are still functioning at one year. The success of living donor transplants is even better with over 95% of these kidneys functioning at one year. While older projections suggested that 50% of cadaveric and living donor kidneys functioning at one year would still be functioning at 12 years and 23 years, respectively, more recent data suggests that patients reaching one year without an acute rejection episode (an injury to the kidney caused by the body's immune system and requiring extra medication to reverse it), have a 50% chance of keeping their kidneys for 30 years or longer.

For the past six years, over 90% of patients in our practice have reached one year free of an acute rejection episode. To prevent acute rejection episodes, transplant recipients have to take immunosuppressive drugs every day. By working closely with the transplant team, most rejection episodes that do occur can be reversed.

Process

The transplant process begins with a phone call to the Kidney Transplant office for further information, or to schedule an appointment with the transplant team.

Frequently Asked Questions

Q: Do my own kidneys have to be removed?

A: Because of the placement of the transplanted kidney in the lower abdomen, the native kidneys are left in place. They are very rarely removed before transplantation. Medical problems leading to consideration of removal of the patient's kidney(s) prior to transplantation include severe hypertension that is poorly controlled by multiple medications, recurrent hospitalizations for infection in the kidneys that require intravenous antibiotics to treat, tumors, severe and ongoing protein loss in the urine, and symptoms related to markedly enlarged kidneys.

Q: How long will I have to take the anti-rejection medications?

A: For as long as you have the kidney. Although the doses decrease with time, your immune system will always be able to recognize the kidney as a foreign object in the body, and, as such, is highly likely to destroy it in the absence of anti-rejection medications.

Q: What is the age limit for a kidney transplant?

A: The Loyola Kidney Transplant Team believes that each candidate should be evaluated individually. The decision is based on his/her physical condition, rather than chronological age. There are special risks associated with the older candidate, and these are discussed in detail so that the candidate, family members, and the transplant team reach a consensus that everyone is comfortable with.

Referrals: Should be called in to the Kidney Transplant Office (708/216-3454). A pre-transplant coordinator will take basic information, schedule the appointment for the Intake Clinic, and explain the procedure to the candidate.

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