Live donor kidney donation

Patients with chronic kidney disease (CKD) need to make two important decisions, with each requiring careful consideration. The first is whether to proceed with transplantation or dialysis as primary therapy. Ideally, this decision should be made early in the course of CKD. Patients need to understand the risks and benefits of each treatment modality. The second is whether to proceed with living donation or to go on the waiting list for a deceased donor transplant. When compared with maintenance dialysis, a successful transplant is associated with significantly longer life and significantly better quality of life. However, a transplant is associated with the risks of surgery and of immunosuppression-related complications. Whereas in practice, patients transition from dialysis to transplant (e.g., after being on the waiting list) or from transplant to dialysis (e.g., after graft failure), a decision early in the course of CKD that transplantation is to be the primary therapy may facilitate early transplantation. Transplant results are significantly better for recipients who undergo transplant before initiating dialysis (preemptive transplant) or after a short course of dialysis versus recipients who undergo transplant after a more prolonged dialysis course. This was clearly shown in a study of “paired-kidney” deceased donor transplants, in which one kidney from the donor was transplanted to a recipient who had been on dialysis less than 6 months and the other kidney (from the same donor) was transplanted to a recipient who had been on dialysis more than 24 months (Figure 29.1).