The global epidemic of Type 2 diabetes and other causes of chronic kidney disease have led to an ever-increasing number of people with End stage Renal Disease (ESRD). Kidney transplantation is the treatment of choice for transplant eligible patients with ESRD since it improves life expectancy, reduces morbidity, offers better quality of life, and is more cost effective in the long run than dialysis. What was an experimental, risky and very limited treatment option fifty years ago, is now routine clinical practice in more than 80 countries.
In the last 25 years, better understanding of the benefits of combined immunosuppressant drugs coupled with improved organ matching and preservation, as well as chemoprophylaxis of opportunistic infections, have all contributed to a progressive improvement of clinical outcomes. Properly matched unsensitized recipients undergoing live donor or deceased donor kidney transplant can expect a better then 90% patient and graft survival at the end of 1 year. Newer developments have now enabled even ABO blood group incompatible transplant possible by way of better desensitization protocols and swap transplants. Mortality in transplant recipients is up to 68% lower as compared to those on dialysis after 3 years of follow up. Any thing that is both cheaper and better, but is not the dominant therapy, must be having certain limitations that prevent replacement of all dialysis treatment by transplantation.
The barriers to universal transplantation as the primary therapy for ESRD include the economic limitations, the technical challenges of surgery and the consequences of immunosuppression, limited medical, surgical and nursing workforces with the required expertise, and above all the shortage of donated organs. Increasing awareness about organ donation (both deceased and live donor) may help bridge the shortfall of organs. Most of these limitations can be overcome with a social, professional and political commitment to make kidney transplant a routine treatment option available to the vast majority of patients with ESRD.
Written By: Dr. M.S. Jha (Venkateshwar Hospital)
MBBS, MS, M.Ch.
Sr. Consultant, Urology & Renal Transplant