So when Despie suddenly developed a severe congenital kidney disease at age 2, and veterinarians gave him only months to live, Segal vowed to do whatever she could to save the cat. “When I was sick, he took care of me,” says Segal, a software developer who lives in San Jose. “Now it was my turn to take care of him, and that was it.”
Segal, who lived in the Boston area at the time, took the cat to the University of Pennsylvania School of Veterinary Medicine in Philadelphia, where she gave Despie a kidney transplant in 2018. Despie is now thriving, as is Stevie, the cat who received a kidney from a local shelter and whom Segal adopted as part of the kidney transplant. Segal is extremely fond of the two. “They play together, they groom each other, they frolic,” Segal says. “We've become a comfortable, loving family.”
Chronic kidney disease is one of the most common illnesses in older cats and a leading cause of death. The disease is hereditary and can affect even younger cats like Despy, and can also be caused by exposure to toxins, such as eating lilies. (Cats who eat even small amounts of any part of the lily plant can develop kidney disease.) Can cause fatal kidney failure within a few days.
Like humans, cats have two kidneys that filter waste products from their bodies, and can survive with just one kidney if it's healthy.
Although feline kidney transplants began more than 25 years ago, they are still rare, with only three centers performing them. Pennsylvania Veterinarian,University of Wisconsin College of Veterinary Medicine And thatUniversity of Georgia College of Veterinary Medicine.
The Pennsylvania College of Veterinary Medicine has performed 185 transplants since 1998, the Georgia College of Veterinary Medicine has performed more than 40 since 2009, and the Wisconsin College of Veterinary Medicine has performed 87 transplants since 1996.
Not all cats are candidates for the procedure, and even if they are, it's expensive — up to $25,000 to harvest a donor's kidney and transplant it into a recipient cat — but the surgeons who perform the procedure say it's personally satisfying to give people more time to spend with their cherished companions, adding that the surgery and long-term follow-up of cats could also yield knowledge that could benefit human health.
While there are exceptions, most cats survive an average of two to three years — Despai, for example, has been here six years since her transplant. “Our longest-surviving cat was almost 13 years,” says Chad Schmied, the Allison Bradbury Professor of Feline Science at Georgia Veterinary School. “Shiloh was three years old when she had her transplant in June 2009, and she lived until April 2022.”
About 40 percent “die within three years of implantation,” said Robert J. Hardy, clinical professor of small animal soft-tissue surgery at the Wisconsin Veterinary School, adding that survival often depends on whether postoperative complications occur. “Some animals live longer. Some have survived for 10 years.” Pennsylvania Veterinarians say up to 70 percent are still alive and thriving a year after transplant, and two transplant recipients have remained alive for 13 years since their surgery.
“This is a life-extending procedure that can have relatively positive, sometimes dramatic, results in terms of extending life span, and that's very valuable to a lot of pet owners,” Hardy says. What's more, he says, scientists may learn more about immune suppression in cats that could be applied to humans.
Lillian Aronson, a professor of surgery at the University of Pennsylvania School of Veterinary Medicine, who performed Despi's transplant, agrees. “Cats are a natural, living model of kidney disease,” she says, adding that their short lifespans allow for information to be obtained more quickly than in humans.
Many pet health insurance companies will cover some of the cost of a pet receiving a transplant, but typically won't cover the cost of the donor, because “the donor is not an insured pet,” according to the North American Pet Health Insurance Association. The cost of the kidney-removal surgery is about 25 percent of the total cost of $25,000, Aronson said.
Still, some cat owners who truly love their cats aren't deterred. “We wouldn't question someone spending $40,000 on a car,” Aronson says. “One of my clients said, 'I just spent $17,000 on my roof, and I love my cat more than I love my roof.'”
Cats who receive new kidney transplants are typically between 8 and 12 years old, but younger cats without other potential serious illnesses tend to do better and live longer, experts say. Schmidt typically doesn't perform transplants on cats older than 16. Hardy said the oldest cat to receive a transplant in Wisconsin was 18 years old. Aronson once transplanted a nearly 18-year-old cat with no other health problems and youthful behavior, and the cat survived for another two years with the new kidney.
Cats with moderate kidney disease are better suited than those with mild or advanced kidney disease, as the risks and benefits of surgery are balanced. However, age is an advantage for younger cats who may have advanced kidney disease. Cats also cannot have chronic infections or cancer, as they would have to take the immunosuppressant cyclosporine for life, which can worsen both conditions. Severe heart disease is also ruled out. “You want a recipient who has the best chance of surviving surgery,” says Schmied.
Cats only have two blood types, making it easier to match a cat's blood type than a human needing a transplant.
Donors come from cat research breeding facilities and shelters, but for others, the future may be bleak. The families of transplanted cats must adopt the donors. “For the cost of one kidney, [the donor cats] “They move into cat-loving homes and are widely loved by their new foster families,” Schmied says.
Andy and Eleni, financial consultants from Gainesville, Florida, who asked that their last names not be used to protect their privacy, cuddle their second cat, Puppy, after Teenie's surgery at a facility in Georgia six years ago. Teenie was 8 years old when she developed kidney failure and needed a new kidney to survive; now she's 14. Puppy was 2 when she donated her kidney and is now 8.
“Not only has the surgery given us more time to spend with our beloved cat, it has saved her life and given us an amazing new cat who has brought just as much joy and love to us,” Andy says.
During surgery, the team removes the new kidney from the donor and sews it into the recipient's body. The donor's blood vessels (renal artery and vein) are sewn to the recipient's artery and vena cava, and the donor's ureter is attached to the recipient's bladder.
The old kidney is often left in place as a spare in case the new kidney doesn't work right away, but many cats urinate immediately, even during surgery. “The first time a cat urinates, it's always exciting,” Schmied says.
The operation can take up to eight hours. The donor can be discharged after a few days, but the recipient usually stays in hospital for longer, sometimes more than a week. Both animals will be monitored for the rest of their lives.
Non-kidney transplants for pets are impractical because most require the death of the donor, and kidney transplants for dogs can be difficult because, unlike cats, they often have immune suppression issues, says Aronson, who has performed three transplants. (Dogs have survived, but they haven't done as well long-term as cats, she says.)
Post-transplant complications may occur, the study The study suggests that cats with kidney failure may be able to recover if they qualify for surgery. “We believe the only cure for kidney disease in cats is a transplant,” Schmied says. “The goal is to give them back the quality of life they had before.”
That seems to be true for Despi. “He has more energy than he's ever had,” Segal says. “He's living his best life.”
