Kidney transplant (also called renal transplant) is the placement of a donor kidney into a patient with end-stage renal disease (ESRD). Kidney transplants are classified as deceased-donor (formerly called cadaveric donor) or living-donor transplants depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.
The first diseased-donor kidney transplant in the United States was performed in 1950 on Ruth Tucker, a 44-year-old woman with polycystic kidney disease (PKD), at Little Company of Mary Hospital in Evergreen Park, Illinois. Although the donated kidney was rejected ten months later because no immunosuppressive therapy (anti-rejection medication) was available at the time (the development of effective anti-rejection drugs was years away), the intervening time gave Tucker’s remaining kidney time to recover and she lived another five years.
The first kidney transplant between living patients was undertaken in 1954 in Boston and Paris. The Boston transplant, performed on December 23, 1954, at Brigham Hospital was performed by Joseph Murray, J. Hartwell Harrison, John P. Merrill and others. The procedure was done between identical twins to eliminate any problems from an immune reaction. For this and later work, Dr. Murray received the Nobel Prize for Medicine in 1990. The recipient lived for eight years after the transplant.
Until the 1964 introduction of anti-rejection medications to prevent and treat acute rejection, deceased-donor transplants were not performed.
Kidney is generally considered the easiest organ to transplant: tissue typing is simple, the organ is relatively easy to remove and implant, live donors can be used without difficulty and in the event of failure, kidney dialysis is available (dialysis had been in use since the 1940s).
The development of increasingly effective immunosuppressive therapies has increased the average life of a transplanted kidney to about 20 years, after which the recipient may be considered for a second transplant or require regular dialysis. Anti-rejection drugs suppress the recipients’s immune system to keep it from attacking the transplanted organ as an invader, and must be taken for life to prevent rejection. Suppressing the immune system long term, however, makes the recipient vulnerable to infections and cancers that would not otherwise be a problem. In addition, the drugs themselves have side effects ranging from osteoporosis, appearance changes, cardiovascular disease and kidney damage. The cost of drugs and treatment generally run between $25,000 and $45,000 per year for the life of the patient.
The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. Diabetes is the most common cause of kidney transplantation, accounting for approximately 25% of transplants in the U.S. The majority of renal transplant recipients are on some form of dialysis at the time of transplantation. Individuals with chronic renal failure who have a living donor available, however, may undergo pre-emptive transplantation before dialysis is needed.
Common diseases leading to ESRD include:
- Diabetes
- Malignant infections
- Focal glomerulosclerosis
- Genetic diseases including polycystic kidney disease (PKD) and inborn errors of metabolism
- Autoimmune disorders including lupus and Goodpasture’s syndrome