Transplant Medicine

Jan. 28, 2023

It's crucial to make sure you refer a patient for a kidney transplant consult at the right time: not too early, but not so late that intervention is no longer possible.

Patrick G. Dean, M.D., a transplant surgeon at Mayo Clinic's campus in Minnesota, suggests the following criteria should prompt physicians to refer patients for potential kidney transplant:

1. Pre-dialysis time frame. The best timing for kidney failure treatment is preemptive, before any dialysis. This saves money otherwise spent on dialysis pretransplant. Patients with kidney failure who receive transplants first before dialysis also live longer due to this protocol; the more time patients spend in dialysis before kidney transplant, the shorter their survival. Dr. Dean says he also is concerned about the increased risks of heart disease, stroke and vascular disease correlated with dialysis. He believes a life minus dialysis — where a patient goes straight to transplant — is a better quality of life.
2. GFR of 25. When a patient's glomerular filtration rate (GFR) reaches 25, it's a good time for education on transplant and potential benefits. It's also a good time for the patient or loved ones to approach potential living donors. Although patients with a 15 to 30 GFR may not show significant symptoms like those with a GFR of 10, you don't want them to miss their transplant window. Patients with these higher GFR rates may inadvertently wait too long, only to learn that their kidney disease has progressed, and they are no longer candidates for transplant. At that point, their only remaining option is renal replacement therapy: dialysis and filtration.
3. Progressive decline. Renal disease follows a predictable trajectory of decline, according to Dr. Dean. Complete turnarounds rarely occur without intervention. Consequently, if you observe a patient's condition going downhill, the situation will worsen. The patient may need a transplant soon.
4. Before serious comorbid conditions arise. To ensure your patient is not too ill for transplant at referral, send the patient prior to development of comorbid conditions, such as coronary artery disease, advanced frailty, active malignancy or uncontrolled infections.
5. Need for pretransplant pre-habilitation. Sometimes a patient with advanced kidney disease has the potential to be ready for transplant if an intervention occurs first for existing treatable cardiac, bariatric, frailty or other medical issues. You may request in a referral that the transplant center arrange any appropriate pre-habilitation appointments to prepare the patient for a safe transplant.

How patients fare after kidney transplant

Dr. Dean says patients who receive kidney transplants at Mayo Clinic fare quite well, especially compared with those on dialysis. Three-year recipient survival at Mayo Clinic's campus in Rochester, Minnesota, is 97.2%, compared with 94.5% across the entire U.S. Mayo Clinic's three-year survival also is higher than at other transplant centers, at 92.51% versus the overall U.S. survival of 89.28%. He also suggests that the best way to move a transplant forward is for the patient to identify a living donor.

How to refer

Physicians can connect with Dr. Dean and colleagues in the Mayo Clinic kidney transplant group at https://www.mayoclinic.org/medical-professionals/transplant-medicine/referrals.

For more information

Refer a patient to Mayo Clinic.