Feline
Renal Transplantation |
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General
information for referring veterinarians and owners of potential renal
transplant candidates |
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| Introduction | |||
| Renal transplantation is a clinical treatment
for renal failure that is offered by the Small Animal Surgery Service
at UC-Davis’ |
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| Candidates |
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| Typically, renal transplantation is performed on cats that are in chronic renal failure and are losing weight and/or becoming anemic in spite of medical management (low protein diet, subcutaneous fluids, epogen, etc.). Transplantation is generally not recommended for animals that are able to maintain body weight and hematocrit despite their renal insufficiency. Transplantation is never performed on an emergency basis or as a last ditch effort. Cats that are in acute or oliguric/anuric renal failure usually require a period of intravenous fluid diuresis or dialysis to stabilize them prior to transplantation. Due to all the inherent risks with transplantation it is not considered a prophylactic procedure and those cats that are doing well with medical management are not considered candidates for transplantation. It is important that all potential candidates be stable and in good body condition. There is no age restriction for transplantation as long as the cat is in good condition and all other criteria discussed below are met. | |||
| Statistics | |||
Presently, the success rate is approximately
75-80%. This means that approximately 20-25% of cats may die in the first
year following transplantation. Typically, death is due to one of 4 major
problems following transplantation:
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| Costs | |||
| The cost, barring major complications, for renal transplantation ranges from $9,000-$11,000. If a cat requires dialysis prior to transplantation this could potentially add $3,000-$4,000 dollars to the estimate. A deposit of $11,000 is required at the time of admission of the patient. The cost of the immunosuppressive drugs (cyclosporine and prednisolone) ranges from $50-$100 per month. You will be required to purchase oral cyclosporine for your cat prior to transplantation. Routine cyclosporine assays, initially required weekly and then decreasing to once every 3 months, cost $60 per assay. These blood samples may be drawn by your regular veterinarian and sent overnight by Federal Express to UC-Davis. This pricing information is provided for general information only and can change without notice. |
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| Protocol | |||
| Renal transplant patients are typically in the hospital for 10-14 days from the time of admission. Owners of a transplant recipient are required to adopt the donor cat and provide a life-long home. The donor cat is chosen from colony cats here at UC-Davis based on a blood cross-match. The donor can typically go home 2 days after surgery. Owners of transplant recipients will be asked to sign an authorization/consent form prior to transplantation. It is imperative, if you are considering transplantation for your cat, that you have access to 24-hour emergency veterinary care and a referring veterinarian who is willing and able to help with the process following transplantation. This will mean weekly visits initially, blood tests, submitting cyclosporine assay blood samples via Fed-Ex and being able to hospitalize and treat your cat in the event of an emergency. You must be able to administer pills to your cat as they will require twice-daily medications the rest of their lives in pill form only. Immunosuppression is begun 48 hours prior to surgery. | |||
| Risks/Complications | |||
| A major complication that can arise after transplantation is acute rejection, which requires rapid and aggressive emergency treatment to prevent loss of the new kidney. Many times rejection episodes occur in the first few months following transplantation and can be linked to difficulties with owner compliance in giving the medications appropriately and/or failing to have cyclosporine assays performed on a regular basis. Another potential complication that can occur is infection. Transplant cats are immunosuppressed and therefore are always at slightly higher risk for any kind of infection. Cats that have undergone renal transplantation must not be boarded in crowded boarding facilities and any contact with animals from outside the owner's home should be minimal. Cats that have undergone transplantation are at a slightly higher risk (9.5%) for developing cancer than the average population. About 10% of cats may develop diabetes post-transplantation that requires insulin administration. It typically occurs months to years after transplantation. | |||
| Pre-Transplant Diagnostics | |||
| There are certain criteria that potential transplant recipients must fulfill before being considered as acceptable candidates. In general, although each case will be given individual consideration, all candidates must be free of any systemic disease other than renal failure. Cats that have clinical histories that are suggestive of urinary tract infections or a positive urine culture must first be treated with appropriate antibiotics and then undergo a cyclosporine challenge prior to consideration for transplantation. Cats that have any history of inflammatory bowel disease require intestinal biopsies (endoscopic or surgical) prior to consideration for transplantation. Also, it is very important that cats are not fractious. With the amount of intensive care and handling required for renal transplantation, a cat that is fractious and unable to be handled easily will not be considered for transplantation. | |||
| The following tests must be performed with your referring veterinarian prior to contacting UC-Davis to set up an appointment. Before scheduling an appointment for final evaluation for transplantation we require that a case summary and the test results be faxed to us for assessment: |
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| Please fax the information packet to the Renal Transplant Coordinator along with your name, phone numbers or e-mail address. Typically, consultations can be scheduled within 1 week of reviewing the information. The final consultation does not guarantee that your cat will receive a transplant. To ensure your cat is stable prior to transplantation, some of the tests listed above may be repeated at UC-Davis. | |||
| Disclaimer | |||
| Surgeons at UC-Davis reserve the right to refuse any cat for renal transplantation at any point in the evaluation process. Renal transplantation can place an enormous financial, emotional and physical burden on the owners of a transplant recipient and requires a commitment and devotion to care for both the recipient and the donor that cannot be underestimated. |
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| Contacts | |||
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Or mail to:
University of California, Davis
Veterinary Medical Teaching Hospital
1 Garrod Drive
Davis, CA 95616-8747
Attn: Renal Transplant Coordinator