For Kidney Transplants, Timing Is Everything

Patients with kidney disease have better long-term transplant success when they avoid dialysis and receive a kidney from a living donor. But a new study shows that these “timely transplants” remain elusive.

3:01 PM

Author | Melanie Padgett Powers

For patients with kidney disease, long-term transplant success improves when they can avoid dialysis and receive a kidney from a living donor.

SEE ALSO: For Pediatric Transplant Patients, Adherence Is Key

Unfortunately, new University of Michigan research shows only about one-third of patients with living donor transplants received their new kidney before starting dialysis.

Ankit Sakhuja, M.B.B.S., assistant professor and director of the kidney paired donation program at the University of Michigan, was the paper's co-author with colleagues from the Mayo Clinic. We spoke to Dr. Sakhuja about his findings, published in the American Journal of Transplantation, and about what physicians can do to improve these "timely transplants."

Q. Research shows that the less time patients spend on dialysis, the more successful their kidney transplants will be. Why?

Dialysis, though a life-saving therapy, is a less-than-perfect modality to treat kidney failure. Therefore, the longer the patients wait on dialysis for a transplant, the longer they are exposed to chronic effects of kidney failure and dialysis, including things like heart problems and infections. Poor nutrition and chronic inflammatory state associated with dialysis could also predispose patients to worse outcomes after transplant.

Timely referral is the key —timely referral to a nephrologist when kidney disease is suspected and later to a transplant center for evaluation of transplant.
Ankit Sakhuja, M.B.B.S.

Q. You examined data of 68,128 patients who received living donor kidney transplants from 2000 to 2012. What did you find?

Preemptive transplants (before a patient starts dialysis) constitute a small portion of total transplants in the country. One of the reasons for that is that there aren't many patients who have a living donor. Patients with no living donor may need to wait for a deceased donor organ, but those receiving transplants from compatible living donors, theoretically, should not need to wait on dialysis at all. But in reality, in the study, we saw a wide variation in the timing of transplants. In fact, only about a third (32.6 percent) of living donor transplants were performed preemptively, and less than two-thirds (61.9 percent) of transplants were done either preemptively or within a year of starting dialysis.

Q. Why do you think that is?

Our study was not designed to look into the reasons of lack of utilization of timely kidney transplants, but the factors that influence a person's chance of receiving a timely living donor transplant are thought to include delayed diagnosis of kidney disease, delayed referral to a nephrologist and transplant center, lack of education and knowledge about transplants and preemptive transplants, lack of insurance,and lack of timely availability of living donors.

Q. Your data also showed that transplants before dialysis and within one year of starting dialysis grew between 2000 to 2006, but stalled from 2006 to 2012. Why do you think they stalled?

That's a great question. This is a finding that surprised us. It is very difficult to speculate the reasons behind it, but it is nonetheless an important finding that at this point I can only say merits further research.

Q. What can practitioners do to improve these numbers?

Dialysis should be seen more as a bridge to transplant.

Though there are many aspects that need to be improved on, timely referral is the key — timely referral to a nephrologist when kidney disease is suspected and later to a transplant center for evaluation of transplant. I believe educating people on the benefits of living donor transplants, in comparison to deceased donor transplants, and communication with family and friends about their need for a kidney transplant is also a very important aspect in which practitioners can help.


More Articles About: Lab Report Kidney Transplant Transplant
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories microscope cells glioma
Health Lab
Researchers circumvent radiation resistance in subtype of brain tumors
University of Michigan Rogel Cancer Center researchers find ZMYND8 gene plays a critical role in conferring radiation resistance on brain tumors with IDH1 mutation.
tavr stroke blue cardiovascular red inside blue background
Health Lab
Hospitals without highest stroke care designation may miss them after heart procedure
Using stroke as a measure of quality after TAVR could put stroke centers at a disadvantage, the study suggests
cancer cells microscope blue green
Health Lab
Certain gene signaling rewires tumors after immunotherapy
For some patients, immunotherapy furthers tumor progression instead of halting it. What distinguishes those who benefit from those who don’t?
Brain wiring diagram prosthetic hand
Health Lab
Simple neural networks outperform the state-of-the-art for controlling robotic prosthetics
Simple neural networks outperform the state-of-the-art for controlling robotic prosthetics
Vein-Red-Blood-Cells-Plaque.jpg
Health Lab
Massive international study uncovers genes involved in heart disease
Scientists link dozens of new genome sites to coronary artery disease risk and pioneer a powerful method for illuminating the biological roots of common disease.
Health Lab
Peek inside a bank full of priceless gifts
Blood banks need constant supply of deposits to meet the needs of patients with cancer, traumatic injuries, failing organs, blood diseases and more.