|Kidney Transplantation in the Cat - Information for Pet Owners|
Article Written by Dr. Daniel A. Degner, Board-certified Veterinary Surgeon (DACVS)
Kidney transplantation can make a world of difference in the quality of life for your feline family member
Transplantation can also extend the duration of life
Earlier transplantation leads to longer survival times
Acceptable candidates for transplantation
Your cat should be free of a variety of diseases other than kidney disease. These include:
Any of these diseases may complicate the potential outcome of the kidney transplantation. In addition, an ideal candidate for the surgery should not have lost more than about 20 to 25 % body weight. I have performed transplantation in spite of 40% loss of body weight with success. The recipient cat should also be type A blood, as it is very difficult to find a type B or AB donor. Blood testing, urine testing, ultrasound and x-rays will be performed on your pet to rule out these complicating diseases.
Acceptable kidney donor
Only living donors are used for kidney transplantation. These donors should be adult, healthy, large (preferably 10 pounds in weight), and no older than 5 years of age. A variety of testing is done on the donor cat to ensure its health and compatibility with the recipient cat. According to a research study, removal of one kidney from a donor cat does not increase the risk of developing kidney failure, nor does it shorten the life span of the cat. The donor must be adopted by you or a dependable family; the donor has given life so you must likewise give the donor a wonderful life.
Transplant patient preparation for surgery
It is common for cats in kidney failure to be anemic prior to the surgery. Administration of medication (erythropoietin) may be required for about 3 to 4 weeks prior to transplantation in order to reverse your pet’s anemia. If your cat is not eating well, we recommend that a stomach tube (PEG tube) be placed so that your pet will be in a positive nitrogen balance at the time of the surgery. About 2 days prior to the transplantation procedure, the recipient cat is given anti-rejection medication. Your pet will need this medication (cyclosporin) for the remainder of its life to prevent rejection of the transplanted kidney.
Both the recipient and donor cats are on operated at the same time. One kidney is removed from the donor and implanted into the abdomen of the recipient. The ureter (tube through which the urine is passed to the bladder) is implanted into the bladder. If your cat does not have a PEG tube, it will be placed at this time.
Expectations be after the surgery
Typically, the BUN and Creatinine (poisons that are excreted by the kidney) will return to the normal range in 2 to 7 days. By 7 to 10 days after the surgery, your cat should regain its appetite and resume relatively normal grooming behavior. Over the next couple of months, your cat will gain weight and the anemia should resolve.
Transplantation does improve the longevity and quality of life of the patient. This procedure, however, is not a cure, as rejection of the transplanted kidney will occur. Acute rejection in the cat is rare, however, chronic rejection is common. Chronic rejection takes months to years to take place. Our expectation is that your cat will be able to live for another 2 years. There are cats that have surpassed this (6 or more years). When rejection does occur, it is possible that retransplantation can be performed.
Cyclosporin will suppress your pet’s immune system and make him/her more susceptible to infection. The most common complication is a bladder infection. The infection may also develop in the transplanted kidney. This type of infection may not clear up and the kidney may need to be removed. Stricture of the ureter of the new kidney can occur and results in obstruction to urine flow from the kidney. If this has not occurred by the 21st day after surgery it is unlikely to occur. The vessels of the kidney can develop a blood clot and cause death of the kidney. By the third day after the surgery, the chance of this complication is minimal. In general we have a 95% success rate with microvascular surgery. Rejection of the kidney is also a potential complication, especially if the level of cyclosporin drops too low in the blood.
Your pet will need to be on anti-rejection medication for the rest of its life. Cyclosporin is not predictably absorbed from the intestinal tract and there is tremendous variation in the blood levels from cat to cat. It is, therefore, important to determine the amount of medication that your cat is absorbing via blood testing. The oral dose is then adjusted accordingly. For the first three months after the surgery, your pet should return weekly to us or your regular veterinarian for this testing. In addition, blood and urine tests will be done to evaluate the function of the transplanted kidney.
After the third month following transplantation, you will need to return for a recheck every month. It is imperative that you watch your cat closely for any signs of illness and seek immediate attention by your regular veterinarian or an MVS veterinarian who is familiar with kidney transplantation.
Transplantation requires a significant financial commitment not only for the surgery and peri-operative care, but also after your pet is at home.
Frequently Asked Questions After Surgery - General Information
When should my cat have the first bowel movement after surgery?
My cat had surgery and will not eat. What can be done?
My cat is vomiting now that he/she is at home. What can be done?
How do I know that my cat is in pain following surgery?
What can be done for pain at home for my cat?
Is it okay for my cat to lick or scratch the incision?
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