Dr. Sood

According to the 2018 U.S. Renal Data System’s Annual Data Report, more than 400,000 patients with chronic kidney disease (CKD) are being treated with dialysis. Nearly 200,000 patients in the United States are now living with a functioning kidney transplant and no longer require dialysis.

Although a kidney transplant offers a longer life expectancy and an improved quality of life for most patients, it is not for everyone. In this Q&A with Puneet Sood, MD, medical director of kidney and pancreas transplantation at UPMC, we discuss dialysis, kidney transplant, and how to determine a proper treatment path.

Q: How Does Dialysis Compare To Having a Functioning Kidney?

A: When patients with kidney disease progress to kidney failure, their organ function is about five to 10% of healthy levels, leading to a build-up of waste in the body. To help reduce the level of waste, patients can undergo dialysis, a procedure that filters the blood, cleans it, and returns it to the body. Dialysis can perform about 10 to 15% of the work of a healthy kidney. By comparison, a transplanted kidney is significantly more efficient at cleaning waste from the body.

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Q: How Does Life Change During Dialysis? How Does It Change After a Transplant?

A: Patients in kidney failure experience excessive drowsiness and fatigue, nausea, confusion, and swelling in the legs. They are also more likely to have heart attacks and strokes. These symptoms lead to not only a reduced quality of life but also a shorter lifespan. The real benefit of dialysis is that it can give patients a renewed sense of energy in their day-to-day life.

But dialysis is a huge time commitment. It requires most patients to sit for three or four hours in a clinic two or three days every week for the rest of their lives or until they receive a kidney transplant. Being on dialysis also accelerates any underlying cardiovascular disease.

After a kidney transplant, patients can typically return to their normal, healthy lives within a few months. However, they will need to take anti-rejection drugs for as long as their new kidney continues to function.

Q: Who Is Eligible For a Transplant? How Should Patients Decide Which Treatment Route to Take?

A: Developing your care plan is a complex and important task that is done in partnership with your doctor.

A lot of variables can determine the best path for you, including your age, medical history, and general health. For some patients, dialysis is not a suitable option, while others are not medically able to receive a transplant.

At UPMC, we carefully evaluate all our patients with CKD as potential candidates for a transplant. Our rigorous evaluation process includes a battery of tests, blood work, and meetings with the entire transplant team — all designed to ensure that a patient is physically, medically, and psychologically ready to undergo surgery.

Q: Do All Patients With Progressive CKD Need to Undergo Dialysis Before Receiving a Transplant?

A: Yes and no. The answer really depends on your specific circumstances.

For many CKD patients, dialysis will be necessary to maintain a certain level of health until they can receive a transplant. Due to the shortage of available deceased-donor kidneys, patients can remain on the transplant waiting list for an average of three to five years.

That’s a long time to wait if your kidney function is already poor.

For patients receiving regular care and in the right medical state, doctors may recommend a preemptive transplant before starting a patient on dialysis. Recent research shows that for the right patient, a preemptive transplant can lead to better long-term outcomes. Keep in mind that the majority of preemptive kidney transplants are made possible because of living donors.

Q: What Is a Living-Donor Kidney Transplant and What Benefits Does it Offer?

A: During a living-donor kidney transplant, a surgeon removes a kidney from a healthy, willing donor and transplants the organ into the patient with end-stage kidney disease. Although the body has two kidneys, only one is needed to provide all kidney functions. To undergo this operation, patients must first identify a willing donor who can pass our rigorous physical and mental health exams.

Decades of research clearly show the benefits of living-donor kidney transplant.

Patients who identify a living donor can be transplanted before their condition worsens, resulting in a faster recovery and fewer complications. And living-donor kidney transplant recipients, on average, have better long-term outcomes because the donor kidney is fully functional right up until the surgery.

For more information about living-donor kidney transplant, please visit UPMC.com/LivingDonorKidneyTransplant.

About Transplant Services

Established in 1981, UPMC Transplant Services is one of the foremost organ transplant centers in the world. Our clinicians have performed more than 20,000 organ transplant procedures, including liver, kidney, pancreas, single and double lung, heart, and more. We are home to some of the world’s foremost transplant experts and have a long history of developing new antirejection therapies—so organ recipients can enjoy better health with fewer restrictions.