RISK FACTORS FOR SELECTED RENAL TRANSPLANT CANDIDATES
We are frequently presented with patients that have various health problems in addition to chronic renal failure. Often these problems will disqualify the candidate for a transplant. However, diseases which are treatable and for which survival with such treatment can be expected to be several years or more are still acceptable candidates for transplant. In these cases we will place the candidate on therapy and assess the response before committing to a transplant procedure. Some commonly presented problems are listed below.
- Heart disease. Mild heart disease or cardiomyopathy will not rule out a candidate. However, we will place these patients on therapy and assess their response prior to moving ahead. A heart murmur alone will not rule out a candidate. Often these murmurs are related to anemia of chronic renal disease and wont affect the outcomes. However, all cats with murmurs are evaluated by echocardiography to assess heart muscle and valve function. Advanced heart disease will disqualify a cat from transplant.
- Hypertension. Hypertension will predispose the patient to a number of serious complications during and after surgery. Hypertension will not rule out a patient for transplant if it is controllable with medical mangement.
- Oxaluria. Oxalate stones and tubular oxalate deposits are a common cause of renal failure. It is known that oxalosis presents an increased risk of premature loss of the transplanted kidney. In extreme cases, this may shorten the graft life to only several months. However, the average overall effect of oxalosis on feline kidney transplant patients is not known. Thus, oxalosis does not rule out a transplant at the UW-VMTH at this time. However, the owner of such a cat must recognize that their cat is at increased risk for graft loss and that the level of risk (ie. % of patients) for early graft loss is not known. All cats transplanted with oxalosis will need to be on dietary and medical management to reduce the chances of a problem with oxalate deposits as much as possible.