In this episode of the Let's Talk About Kidneys podcast, Dr. Muhammad Qureshi talks about the benefits of a kidney transplant, why it's a good choice after kidney failure, and what the process looks like before, during and after.

Why should a CKD patient consider a kidney transplant?

Dr. Qureshi talks about the fact that there are both mortality and morbidity benefits of a kidney transplant. In other words, not only do you live longer, but you live better.

Who qualifies for a kidney transplant?

Anyone who has a kidney function less than 20% or someone who has already started dialysis on a chronic basis can potentially qualify for a kidney transplant. At that point they will visit a transplant center for a thorough evaluation to be sure they meet the minimum criteria for a transplant. That includes being sure they have a healthy heart and can handle the immunosuppressive medications, as well as age-appropriate screening for cancer, pre-existing infections, etc.

Who is involved in the pre-transplant process?

A nephrologist, transplant surgeon, dietitian, and social worker will all be involved in the pre-transplant process. They each have a role in evaluating the patient and making sure they have adequate coverage for their medications and care plan.

What happens when a patient is matched with an organ?

Once an organ is available, the first person the patient typically sees is a transplant nephrologist. They will again perform screenings to ensure nothing has changed - no active infections or wounds, blood testing to ensure organ compatibility, COVID screening, etc.

What happens after the transplant is complete?

Dr. Qureshi walks through the importance of immunosuppressive medications. The patient will take some immunosuppressive medications immediately following transplant and some will be lifelong, which are called maintenance immunosuppressive medications.

Once the patient is discharged from the hospital, the nephrology team still follows them very closely. They will see the patient three times a week for the first couple of weeks, twice a week for two weeks, and then once a week for about another month. In that time medications will be monitored and adjusted, the wound will be monitored for infection or complications, and more.

The kidney transplant process is a lifelong journey. The number of appointments and medications will decrease over time, but the patient will have ongoing monitoring and adjustments for the rest of their life.

What types of kidney transplants are available?

Dr. Qureshi talks about both living donor and deceased donor transplants. Living transplant is the better option when it is available since it is a more controlled setting. Both the recipient and the donor are present for the surgery so it happens more quickly and the organ is more immediately transplanted. If necessary, the deceased donor kidney will be connected to a machine that provides it with oxygen and nutrients or it will be stored on ice for a period of time before the patient is ready.

How does a patient find a living donor?

A living donor can be a friend or family member and donate their kidney directly to a patient. But if they aren't a good match, there are also paired exchange programs available. In paired exchange, an incompatible donor/recipient pair is matched with another incompatible donor/recipient pair for a "swap". Each donor gives a kidney to the other person's intended recipient.

Dr. Qureshi wraps up the podcast by encouraging patients to understand that kidney transplant is an option worth considering if they have less than 20% kidney function. He also encourages people to help educate others on the benefits of kidney donation so we can help more patients with kidney disease.