The incidence of Severe Chronic Kidney Disease or ESRD (End Stage Renal Disease) is increasing worldwide. ESRD is a deadly condition with high morbidity and mortality. The treatment of ESRD is either dialysis or transplantation, the latter being definitely the preferred option .
What is kidney transplant or renal transplant?
The process of surgically transferring a functioning kidney from a person (donor) to another person whose kidneys are irreversibly damaged (recipient) is called renal transplantation. When the donor is a living person it is called live renal transplantation and when the kidneys are taken from a dead person (who is certified brain dead by doctors) called cadaveric renal transplantation. Please note that a person who has died quite some time back cannot be used as a donor because such kidneys never work!
Who needs kidney transplant?
Patients of severe irreversible renal failure, in whom both the kidneys have failed, are candidates for renal transplantation. Patients who have irreversible renal failure, suffer from chronic kidney disease (CKD). In CKD, there is a gradual and progressive decline in renal functions.
Depending on the present function of the kidneys (as per estimated Glomerular Filtration Rate) the severity of CKD is graded from Stage 1 to stage 5 or ESRD. Patients of CKD Stage 5 or ESRD are candidates for receiving Kidney transplantation.
Common Causes for ESRD
- Diabetes mellitus
- Chronic glomerulonephritis
- Uncontrolled hypertension
- With the increasing number of cases of diabetics in India and across the world, the incidence of ESRD is also fast increasing.
- Once the doctor has diagnosed that the patient has ESRD (generally Serum Creatinine is greater than 6.0mg/dl) he or she will suggest that the patient be started on dialysis regularly, and if a suitable donor is available, to undergo kidney transplantation.
What is Pre-emptive Kidney Transplant?
Pre-emptive literally means to act before something bad happens. Hence, in the context of severe renal failure or ESRD, pre-emptive kidney transplantation means to perform kidney transplantation without starting the patient on dialysis.
When should one plan for PKT?
- Current opinion allows ESRD patients to receive PKT when their GFR is 20 mL per minute or less (Stage 4 CKD)
- Preparation for transplantation should be started at the time of diagnosing chronic renal disease
Why is PKT better?
Pre-emptive transplantation confers a significant benefit in terms of both patient and graft kidney survival.
- Avoidance of cardiovascular adverse effects of long-term dialysis as well as the long-term complications of dialysis, like access problems, infections, anaemia, severe hypertension and malnutrition.
- Even after transplantation in PKT patients, there are less acute rejection episodes with better kidney functions. Hence, in these patients there is better long-term graft and patient survival, ensuring a better quality of life, which should be the two major motivators for PKT.
- New and more effective immunosuppressive drugs and growing experience in transplantation surgery are making kidney transplantation a more common and safe option.
Kidney transplantation, especially PKT, should be the choice of therapy in ESRD.
What are the stumbling blocks to PKT?
Unfortunately, while Preemptive Kidney transplantation (PKT) is much more beneficial over transplantation, it seems to be underutilised especially as a result of late referral of the patients to a nephrologist and transplantation centre. Less than 5 per cent of patients undergoing transplants in India opt for PKT due to:
- Lack of awareness on the part of the patient and the general physician
- The preference is to wait and delay dialysis for as long as possible
- Most of the times, dialysis is started when the patient starts developing complications of uraemia
- Dialysis is planned with the hope that the kidneys may improve after a few dialysis
- All this causes a delay in considering transplantation at that time
- Financial constraints add to the delay in most cases
Early referral to a nephrologist by the general physician is crucial if PKT is to be encouraged. Unfortunately, almost about 50 per cent of CKD patients come to a nephrologist in the end stage renal disease.
Early referral not only allows careful preparation for PKT but also evaluation of potential living donor candidates and selecting the exact time for transplantation.
- Kidney transplantation should be the first choice of treatment in ESRD patients
- PKT is an important alternative to avoid dialysis related co- morbidities and complications
- PKT has improved graft and patient survival rates over non pre-emptive KT
- Early referral to a transplantation centre allows proper choice of recipients, appropriate timing of transplantation
- PKT offers lower infection rates, lower cardiovascular diseases and better life quality Every transplantation candidate is also a pre-emptive transplantation candidateTo know more regarding Transplants, visit https://www.apollohospitals.com/departments/transplantation/organ-specific-transplant-care/kidney