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%. Only adult transplants are performed at Erlanger.
However, transplant could be harmful and is not recommended for patients with the following conditions:
- HIV (+)
- Active Hepatitis
- Current noncompliance with medical treatment
- Current drug and/or alcohol abuse
- Active infection
- Active liver disease
- Active malignancy
- Severe cardiac and/or peripheral vascular disease
- Severe pulmonary disease
- Morbid obesity, BMI (Body Mass Index) greater than 34
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 18 months to two years. 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.