renal transplantation

Last edited 10/2018 and last reviewed 07/2022

Renal transplantation is the gold standard of renal replacement therapy. It enables complete rehabilitation, free from dietary and fluid restriction, restoring all the important excretory and metabolic functions of the kidney.

Success rates for carefully selected patients are high. Patients with grafts that fail can be successfully switched to dialysis.

• renal replacement therapy (RRT) is a treatment option in people with CKD whose condition progresses to kidney failure
  • RRT essentially comprises either transplantation or dialysis (artificially removing waste products and excess water from the blood)
  • transplantation can be from living or deceased donors, and for some people it may involve the transplantation of more than one organ simultaneously (for example, combined pancreas and kidney transplantation for people with type I diabetes mellitus). In some cases, transplantation may be pre-emptive, occurring before dialysis would be needed

According to the 19th annual report by the UK Renal Registry (2016), on 31 December 2015 there were 61,256 adults in the UK receiving RRT

• of these, 53.1% had received a transplant, 41.0% were receiving haemodialysis (21.2% in satellite units, 17.8% in hospitals, 2.0% at home), 2.5% were receiving continuous ambulatory peritoneal dialysis and 3.4% were receiving automated peritoneal dialysis
• in addition, 769 children and young people under the age of 16 years were receiving RRT
  • most had received a transplant (41% live, 34% deceased), with 13% on haemodialysis and 12% on peritoneal dialysis

Reference:

• NICE (October 2018). Renal replacement therapy and conservative management