Table of Contents
Caroline Word
Kidney disease is a growing public health problem, and the need for transplants continues to increase. Currently, more than 85% of people on the national transplant waitlist are particularly in need of a kidney transplant.
As health professionals strive to improve both outcomes and quality of life for patients with end-stage renal disease, one option to consider is pre-approaching kidney transplants, where they undergo kidney transplants before dialysis is required.
Several studies have suggested that experience at the VCU Health Hume-Lee transplant center may be modest in benefits, but positive results were found in patients undergoing preemptive kidney transplants.
“The goal is to preempt kidney failure and not only respond to it, but also to preempt kidney failure,” said Gaurav Gupta, MD, co-director of kidney transplantation at Humeley Transplant Center. “Pre-employment transplants can provide patients with a stronger and healthier future.”
We sat down with Gupta and his fellow co-medical director, Direnkumar, Maryland, to answer common questions about preemptive kidney transplants.
What is a preemptive kidney transplant?
A preemptive kidney transplant is when a patient has a kidney transplant before dialysis needs to be started. This approach aims to prevent complications and poor health that are often associated with dialysis. Patients are usually referred for evaluation before reaching terminal disorders that require dialysis, although they have a significantly reduced renal function.
Who is the best candidate for a first-run transplant?
Anyone with advanced chronic kidney disease approaching kidney failure may be a candidate. This includes patients with severe kidney disease (renal function <20%) and may require dialysis immediately. Patients with known causes of kidney disease, such as polycystic kidney disease or diabetes, may be closely monitored and referred early. If the need for dialysis is looming, it is a key moment to explore transplant options.
What complications can occur due to long-term renal dialysis?
Long-term dialysis can really hurt your body. Frequent treatment and fatigue can lead to poor quality of life, which can significantly limit daily activities.
The survival outcomes have also deteriorated. According to the National Kidney Foundation, many patients on dialysis are less than 50% of patients who have undergone a transplant, compared to over 80% of patients who have undergone a transplant. There is also the risk of medical complications, such as heart disease, infections, and vascular problems. Over time, dialysis can weaken patients until they are no longer good candidates for implantation.
“When we can avoid dialysis completely, we don't just add a potential year to someone else's life. We're adding quality to that year,” Kumar added.
So, do you think it might be difficult to get a long-term kidney transplant after undergoing dialysis?
Unfortunately, this is correct. The longer the dialysis, the higher the risk of complications, making transplant more difficult or unsafe. Some patients become medically too frail. Therefore, it is extremely important to explore transplants, especially preemptive transplants, before dialysis is needed.
How can someone get a preemptive transplant if the deceased donor kidney is waiting very long?
Preemptive transplants from deceased donors are possible, but they are less common due to the long waiting period. The most reliable way to get a preemptive transplant is to donate your living kidneys. Even friends, family, or even altruistic donors can avoid dialysis completely, as it helps to shorten the timeline. The Hume-Lee Transplant Center team can guide patients and families through the process.
“Life is a game changer,” Kumar said. “It not only shortens the wait, but also gives you even better shots with long-term success.”
What are the benefits of receiving kidneys from living donors?
Kidneys from living donors are the best organs for transplants. First of all, they last an average of 15-20 years compared to 10-15 years from the deceased donor. They will start working quickly, reducing recovery time and complications. Kidney transplants for living donors can be scheduled. This means that it's a smoother surgical process with less time in the limbo, and there's no need for emergency dialysis.
Living contributions are not only more predictable, but also lead to improved overall recipient outcomes.
Do I need to talk to my doctor about preemptive transplants and livelihood donations?
As soon as your doctor says your kidney function is getting worse, it's time to start a conversation. There are the most options in early planning, so be sure to advocate for your health and ask questions. Even if you're not ready for a transplant yet, our porting team can assess you, identify potential living donors, and start supporting you throughout this journey.
Hume-Lee also works closely with rehabilitation facilities and other parts of the Health Science School at VCU Health and Virginia Commonwealth University to help patients prepare for transplants. For example, we are working with the VCU's Department of Kinesiology and Health Sciences to provide a dedicated renal rehabilitation clinic. The program supports patients with underlying health conditions, including obesity, diabetes, and heart problems that may need to be addressed before surgery. That way, when the time comes, you will be in the best possible form for a successful kidney transplant.
“It's not too early to start a port conversation,” Gupta said. “Early referrals can open the door to options patients didn't even know they were impossible.”
Looking for more information on daily life kidney donations? Please read this Q&A.
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