Hi,
Kidney transplantation can prolong and improve the lives of patients with kidney failure, in comparison to their outlook if remaining on dialysis forever. Kidney transplantation can also give patients a better quality of life by allowing them to regain their freedom to do many of the things that they used to do or they used to enjoy before developing kidney failure and needing dialysis.
Thus, kidney transplantation appears to offer patients the best chances for rehabilitation in many aspects of their lives, including the medical aspect, work life, school, social life and leisure, and gives freedom for traveling, with less dietary and fluid restrictions, even having better fertility; thus increasing the chances for higher degree of personal fulfilment and a happier personal, family, and work life.
However, kidney transplantation is not free of potential complications or side-effects of the anti-rejection medications, which broadly speaking could be high chances of infections, metabolic problems like diabetes and increase risks for cancers; but this does not happen in all patients.
And despite they are significant side-effects to consider, the majority of patients undergoing a kidney transplant live longer and fuller lives than if remaining on dialysis, which brings by itself many complications, especially cardiovascular, with a shortened lifespan and lesser quality of life.
Obviously, there are always extreme cases, patients who can lose the transplant on the same day of the surgery or have a major surgical complication, or dialysis patients who live for many years, but the majority of kidney transplant patients do better than the majority of dialysis patients.
There are different types of kidney transplants depending on the types of donors, and the outcomes greatly depend on this. For instance, kidney transplantation through life donation, especially from family members, provides more benefits in comparison to transplantation from deceased donors because the degree of organ compatibility is greater in the former; therefore, fewer chances for rejection and higher chances for a more prolonged life of the kidney transplant. A transplant from family members might also need lower doses of the medications to prevent rejection, and less need to use rescue anti-rejection medications, which are more toxic; therefore, fewer chances for side-effects.In living donation, the quality of the donated kidney is higher as it comes from a healthy family member (or a close person), with more chances to function for longer than kidneys from deceased donors.
In addition, in living donation, in contrast to the donation from deceased donors, the kidney transplant can be performed promptly without the need to remain for years on a waiting list for a kidney from a deceased donor.
This is very important as during those years on a waiting list, many complications can occur that can lead to patient's loss of health and loss of fitness to undergo kidney transplantation in the future, or even worse things.
These benefits can be even greater if kidney transplantation is performed before undergoing dialysis, what is called pre-emptive transplantation, or as soon as possible after starting dialysis; which avoids the side-effects of prolonging the kidney failure status and the side effects of ‘partially effective’ dialytic therapies, as they cannot clean the blood as well as the transplanted kidney.
In addition, the transplanted kidney, as it is a natural kidney, provides to the patient with all the other important functions the kidneys have, which no dialysis machine or therapy can do.
Thus, for patients who can choose between all these options, a pre-emptive kidney transplant for a living family member offers the best outcomes, leaving deceased donor transplantation and dialysis as last resorts.
However, not every patient is suitable for kidney transplantation plus the kidney transplant surgery is bound to cardiac, surgical and anaesthetic risks as any other major surgery. Patients with kidney failure tend to have several co-existing illnesses and some or many medical complications.
If the summation of all the complications together with age and frailty increases the risk of kidney transplantation, doctors might advise patients against transplantation. Similarly, patients with active or recent cancers or infections or other medical contraindications might not be suitable for transplantation. Thus, in some patients dialysis might be safer than kidney transplantation.
Therefore, all decisions must be individualised, so my recommendation is to get yourself assessed by a kidney specialist who can address in more detail and more specifically all your queries, so you can take the best possible decision for your future wellbeing.
There are many other factors involved, for instance financial. Overall, kidney transplantation is cheaper than dialysis, though there is a big bill to pay following the surgery. But dialysis is more costly in the long run, not only for the wallets of the patients but for their health. Many governments have very kind subsidies for dialysis what make the patient pay much less for dialysis than for transplantation, but that does not mean it is cheaper and, as exposed above, eventually their health ends up paying it back.
So, dialysis is a bridge for transplantation or second best option if transplantation is not possible. But there are patients who simply prefer dialysis in comparison to transplantation, even if eligible, which is respectable, or patients who have no available or suitable donor to give them a kidney…it is just matter to accept that reality and take good care of their health so they can live free of complications for as long as possible.
My patients on dialysis who decided to follow the medical recommendations, the diet and fluid restrictions and to live a more frugal life, tend to live longer and better with fewer complications than other patients.
Kidney transplantation is a beautiful experience and the costs are a huge investment in the health of the patients and their wellbeing and the wellbeing of their families, because this is the method that can hold them together for the longest in the fittest and possibly happiest way.
There are still many big and little things to discuss. Visit your nephrologist and bring all your queries to his/her clinic.
Dr Francisco, wishing you the best possible health.
