by Martha Pavlakis, M.D.
Beth-Israel Deaconess Medical Center
Why do people need kidney transplants?
Kidney failure happens when your kidneys are not working the way they should. Many different diseases can harm your kidneys and cause poor function. Diabetes and high blood pressure are some of the most common causes of kidney failure in the United States.
As your kidneys fail, both usually fail at the same time. You can’t tell that they are failing from the amount of urine you are making, but from blood and urine tests done at your doctor’s office.
As your kidneys get worse, however, you may begin to tire easily, have trouble sleeping; feel itchy or sick to your stomach. If you start to accumulate too much fluid from kidney failure, you may feel short of breath with simple activities. People on pills or insulin for diabetes can notice that their blood sugars are lower as their kidneys fail.
How is kidney failure treated?
Kidney failure can be treated with kidney transplantation or dialysis. Kidney transplantation is a surgical procedure where a kidney comes from either a living donor who donates one of their two kidneys to you, or from a deceased donor (someone dies and the family donates the organs).
After receiving a new kidney, you must take medications to prevent your body from attacking (rejecting) the new kidney. These drugs decrease the body’s ability to attack the new kidney by lowering your immune system (immunosuppressants). The drugs also decrease your ability to fight infections and certain kinds of cancer (mainly skin cancers and a rare lymph node cancer).
So before a kidney transplant and start of immunosuppressant medications, you must have a complete evaluation at the transplant center. This will make sure you are healthy enough to go through a major operation and that the immunosuppressant medications are not too dangerous for you.
Outcomes for Patients with Kidney Transplant
Patients with kidney failure who qualify for and receive a kidney transplant have a better quality of life and, in the long run, a longer life than patients treated only with dialysis. The best way to get a kidney before needing dialysis is to have a willing and healthy living donor. The transplant professionals can help you determine if friends or family members can serve as live donors to you.
Some Basic Facts
1. Kidney transplantation can be done before you ever need to start dialysis (preemptive transplant), but this usually only happens if you have a living donor
2. A live donor does not have to be related to you.
3. Just because someone says they will donate to you does not mean they can. The transplant team has to evaluate the person fully to make sure that donating a kidney will not impact their long term health
4. You can get a kidney transplant after starting dialysis, but the sooner you start the evaluation for a kidney transplant, the better it will be for your health.
5. Some people with diabetes (type 1, not overweight) can qualify for a pancreas transplant as well.
Evaluation in BIDMC Transplant Center
Most patients with chronic kidney disease are referred for evaluation when the kidney function drops to less than 20%.
Before you can have a kidney transplant, a team of transplant specialists will talk with you about what may happen if you get a new kidney. This can depend on your physical health, your mental health, and how easy it will be for you to get and take the transplant medicines you will need.
You, your doctor, a nurse, or a social worker can schedule your initial visit with the transplant center. Please contact the Beth Israel Deaconess Medical Center Transplant Institute at 617-632-9700.
Diabetic Kidney Disease
Page last updated: February 17, 2019