Renal Transplants | Small Animal Surgery
The College of Veterinary Medicine at the University of Georgia is accepting feline patients with chronic renal failure for renal transplantation.
Is my cat a candidate for renal transplantation?
Currently, we offer transplantation for cats with chronic kidney disease. We do not have the facilities to transplant cats with acute renal failure (antifreeze toxicity, etc.). To be considered as a candidate, your cat must be relatively healthy other than the kidney disease. Active infections, cancer, and other systemic diseases cannot be present.
Prior to being considered for a renal transplantation, all recipients must be thoroughly screened. Some of this may be done at your local veterinary clinic and some should be done by a specialist either at UGA or elsewhere. Following the initial screening, each cat will be evaluated on a case-by-case basis.
The following tests must be done prior to transplantation:
- Complete blood count (with differential), biochemistry profile, urinalysis, and urine culture.
- Thoracic and abdominal radiographs.
- Abdominal ultrasound — This is performed to evaluate the abdomen for other diseases and to evaluate the structure of the kidneys. If the kidneys are unusual in size or shape, we may elect to perform a renal aspirate or biopsy.
- Cardiac evaluation — This should include cardiac auscultation, thoracic radiograph evaluation and electrocardiogram. If a murmur or abnormal heart rhythm is present, an echocardiogram is required.
- FIV, FeLV, and toxoplasmosis testing.
- Blood pressure evaluation — The average of several Doppler blood pressure readings is required. If a patient has high blood pressure, this should be controlled prior to surgery.
- Thyroid panel.
- Dental evaluation — Bad teeth constantly shower bacteria into the blood. To minimize the risk of infection after surgery, patients should have a dental cleaning done prior to surgery and appropriate dental hygiene must be used after transplantation.
- Blood type — This is used to begin to match a donor. Most cats will be type A, although a few purebred cats are type B.
- Cross match — This test is performed after the recipient has been screened for other conditions. This test is performed between blood from the recipient cat and the donor cat to make sure the donor’s kidney is compatible. This is the only compatibility testing performed in cats.
Can my dog receive a renal transplantation at UGA?
Dogs present a unique problem in veterinary transplantation. Because their immune system differs from cats and people, dogs tend to reject their kidneys very rapidly. Other complications, such as blood clots and infections after transplantation, are also more common.
Additionally, dogs tend to have protein-losing renal disease, which complicates long-term care and lessens the prognosis. To be considered for transplantation, the donor must be young, healthy, and related to the recipient. Additional tests will also be required to minimize the chance of rejection after surgery.
If my cat has chronic renal failure, how do I know when transplantation should be performed?
No one knows the ideal time to transplant a cat with chronic kidney disease. Certainly, not all cats with chronic kidney disease need a transplant right away, as many don’t have significant clinical signs associated with their disease. We prefer the cats to have a creatinine concentration of at least 4 mg/dL.
On the other hand, waiting until late in the course of the disease substantially increases anesthetic risk and is not recommended. This is an individual decision, made on a case-by-case basis.
What about the donor cat?
Donor cats “give” one of their kidneys in exchange for a permanent and loving home. All donor cats must be adopted by the recipient’s family. Clients assume financial and legal responsibility for the donor prior to the transplantation.
We can work with you to find an appropriate donor. Donor cats must be young and healthy. Clients may provide their own donor cats as long as they meet these criteria. After surgery, donor cats are expected to live a normal life.
To be considered as a donor, the following tests must be performed:
- Physical examination.
- Complete blood count, biochemistry profile, urinalysis, and urine culture.
- FeLV, FIV, and toxoplasmosis testing.
How long should we expect the donor and recipient to stay in the hospital?
Donor cats will usually stay in the hospital around 2 to 4 days. Recipient cats stay in the hospital around 2 to 3 weeks.
What follow-up care is required for the recipient after a renal transplant?
Renal transplant recipients must receive oral anti-rejection medication (cyclosporine and steroids) once or twice a day, every day, for the rest of their lives. Blood levels of creatinine, BUN, and glucose are also monitored. Initially blood levels of cyclosporine are checked regularly (weekly to monthly). This is may be done in cooperation with your veterinarian.
As time passes after transplantation, the tests are spaced out to every 2 to 3 months. Owners generally spend around $1,000 per year for medication and testing after the transplantation.
What are potential complications of renal transplantation?
Around the time of surgery, the major risks include general anesthesia, leakage of blood or urine, very high blood pressure, and obstruction of the ureter.
Long-term complications result from the anti-rejection medication. Following renal transplantation, cats are immunosuppressed. That means they are more susceptible to infection compared to other animals. Transplant patients may also be more likely to get cancer, diabetes, or high blood pressure as a result of the anti-rejection drugs.
What are the expected long-term outcomes in cats after transplantation?
Historically, at other institutions, roughly 80% of cats will survive to discharge from the hospital. Based on studies from the University of Wisconsin and University of California, 6-month survival after renal transplantation is around 80% and 3-year survival is around 45%. In the long term, most cats will die of diseases other than renal disease.
What is the cost of transplantation?
Without serious complications, the estimated cost of a renal transplant is $12,000 to $15,000, including the donor and recipient. These costs are subject to change and serious complications do occur in some cats, resulting in increased cost.
Does the Veterinary College have studies which may offset the costs of transplants?
While this is a future goal, currently there are no studies to help with the cost of transplantation at UGA.
Who is responsible for the transplants at UGA?
Dr. Chad Schmiedt is the board-certified surgeon in charge of the transplant program at UGA. He is accompanied by other soft tissue surgeons, anesthesiologists, experts in critical care medicine, and a talented support staff. Dr. Schmiedt was trained in transplantation at the University of Wisconsin.