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Getting a kidney transplant

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When should I start the process to get a kidney transplant?
If your kidneys are failing, a kidney transplant may be a treatment option for you. The balance of risks and benefits varies, though, depending on your age and other health problems. If you want a kidney transplant, you must contact a transplant center and ask for a transplant evaluation. It is not automatic. Only a transplant team can tell you that you are definitely eligible (or not eligible) for a transplant.

You can contact one or more transplant centers and start to be evaluated when it seems likely that you will need dialysis within two to three years. Most kidney transplants are successful-more than 90% of transplants are still working one year later. Recent studies have found that the odds of good results are somewhat better with a "preemptive" transplant done before dialysis is needed. Preemptive transplant requires a willing living kidney donor-probably a relative, spouse, or friend. In 2001, 42% of kidney transplants came from living donors.

If you do not have a living donor, you can ask to be placed on a national waiting list to receive a cadaver kidney from someone who has recently died-usually in an accident. After your evaluation is complete and you are placed on the list, credit for waiting time begins when your glomerular filtration rate (GFR) drops to 20 mL/min or lower. Long waiting times-often years-are common for kidney transplants from cadaver donors.

Can I get on the kidney transplant waiting list before I start dialysis?
Yes, you may want to be evaluated for a transplant before you start dialysis. After your evaluation is done and you get on the waiting list, credit for waiting time starts when your kidney function drops to less than about 20%. This is measured by a glomerular filtration rate (GFR) of 20 mL/min or less. Long waiting times-often years-are very common for kidney transplants from cadaver donors.

How will my doctor treat transplant rejection?
If you have acute or chronic transplant rejection, your doctor may change your medication or even hospitalize you. For example, if your cyclosporine dose is harming your transplanted kidney, your doctor might lower your dosage and change your other medications. All medication changes must be made by your transplant team.