FAQ – Kidney Transplants
Are you a candidate for kidney transplant?
Potentially any patient with late stage 4 or stage 5 CKD (chronic kidney disease) qualifies for kidney transplant. At this point kidney function would be less than 20% and creatinine clearance less than 20ml/min or on dialysis. Only adult transplants are performed at Erlanger. However, transplant could be harmful and is not recommended for patients with the following conditions.
- History of invasive malignancy (excluding in situ lesions) treated within the two years prior to evaluation, except non-melanoma skin cancer and certain incidental renal cell carcinomas.
- Melanoma history other than stage 1 or less
- Uncontrolled major psychiatric disorders such as schizophrenia, bipolar or major depression with psychosis
- Inability to care for self after transplantation or without adequate support systems
- Advanced, non-constructable vascular disease (i.e. uncorrectable coronary or peripheral vascular disease
- Advanced liver disease
- Active renal disease with an unreasonably high chance of recurrence until disease markers indicate quiescence
- Active alcohol or substance abuse, excluding tobacco
- Ischemic cardiomyopathy with ejection fraction >20%
- Pulmonary disease with FEVI <1.0 and/or home supplemental oxygen therapy
- Dependence on nursing home or other long-term care provider
- Inability to complete the transplant evaluation
- Communication that the patient does not want to pursue transplantation at this time
- Co-morbid conditions that would preclude long term organ survival
- HIV if not within guidelines
- A creatinine clearance greater than 20ml/min
- Age >70 years, with candidacy determined on an individualized basis, based on the overall health status of the candidate
- Less than age 18
- Severe chronic lung disease or uncompensated pulmonary dysfunction
- Pulmonary hypertension with pulmonary artery systolic pressure >60mm/Hg unless enchanced cardiology clearance
- Heart failure with left ventricular ejection fraction less than 30%
- Absence of financial resources to support transplant and/or post-transplant follow-up (i.e. medications, living expenses, transportation, and medical care)
- Tobacco use in the setting of:
- Type I Diabetes Mellitus
- Coronary Artery Disease
- Peripheral Vascular Disease
- Chronic Lung Disease
- Evidence of previous substance abuse abstinence less than 6 months
- Significant cognitive impairment of physical limitation without reliable caregiver
- Resources deemed inadequate to support the necessary post-transplant care
- Candidates that have a higher than acceptable surgical risk
- Body mass index >40
- Significant history of noncompliance
What is the referral and evaluation process?
Referral - The patient’s dialysis clinic or nephrologist’s office will refer patients to Erlanger who they believe to be potential transplant recipients. All area dialysis clinics and nephrology offices have an Erlanger referral form. This form is completed, providing contact information, insurance information, and brief medical history. Each referral initially is reviewed by the department manager and social worker to verify that the patient’s insurance will provide coverage for a kidney transplant at Erlanger. After insurance is verified, patients are contacted about an orientation session. Learn more about the referral process here.
Orientation session - Orientations are held in the Erlanger transplant office twice a month to accommodate different dialysis schedules. At each orientation session, there are discussions about the work-up process, contraindications to transplant, and the post-transplant process including immunosuppressant medications. A complete health history is obtained including doctor’s numbers, so that medical records can be gathered. Once medical records are obtained and it is determined that there are no apparent contraindications at that time, the work-up process begins.
Medical work-up and tests - Standard work-up includes routine laboratory work and tissue typing, electrocardiogram, chest radiology, office visits with the transplant nephrologist and surgeon, voiding cystourethrography (VCUG) to check bladder function, pap smear and mammogram for women, dental evaluation, financial assessment, and psychosocial assessment. Patients with a long cardiac history, diabetes mellitus, or advanced age will be sent to a cardiologist for clearance. The cardiologist may require a stress test, echocardiogram, or cardiac catheterization.
Candidate selection and registration - Once a month the transplant team, composed of the transplant nephrologist, surgeons, transplant coordinators, social worker, and dialysis personnel meet to discuss patients who have completed the above requirements. It is decided at that meeting whether or not the patient is a good candidate for transplantation. If there are no concerns from the team, patients are registered and placed on the wait list that day. The average work-up time from referral to listing is three to six months depending on the patient medical history and condition.
What happens while on wait list?
The average wait time on Erlanger’s kidney transplant wait list is 54 months depending on blood type. An annual update is required for everyone on the transplant wait list. Medical records from dialysis clinics and doctor’s offices are obtained. Every person on the wait list will have serologies, a chest x-ray, and an electrocardiogram done yearly. Depending on past medical history other testing and doctor referrals may be needed. This update is done to ensure that everyone on the wait list continues to be a good transplant candidate and that there are no contraindications to transplant.
Could multiple listing shorten waiting time for a transplant?
Multiple listing involves registering at two or more transplant centers in different local areas. Since candidates at centers local to the donor hospital are usually considered ahead of those who are more distant, multiple listing may increase your chances of receiving a local organ offer. Some studies suggest multiple listing can shorten the average waiting times of kidney transplant candidates by several months. This does not guarantee that every multiple-listed patient will have a shorter waiting time.”
Reference: United Network for Organ Sharing, Questions and Answers for Transplant Candidates and Families about Multiple Listing and Waiting Time Transfer
What happens after transplantation?
The average hospital stay at Erlanger following kidney transplant is five days. At discharge recipients return home. There are restrictions on driving and lifting heavy objects, so strong family support is a must. Follow-up is done in the Kidney transplant outpatient clinic at Erlanger. Follow-up is weekly for the first six weeks. At each follow up visit laboratory testing will be complete, immunosuppressant medications will be reviewed and possibly adjusted, and overall health will be assessed. At each visit the patient will be seen by the transplant nephrologist and transplant coordinator. Each patient will have access to the post-transplant coordinator, clinic coordinator, and transplant social worker.