Page 24 - Boca Club News - September '23
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Page 24, Boca Club News

                Nature & Pets



      You and Your Pet:



      Kidney Transplants for Cats and Dogs



      By Margaret Johnson DVM, Calusa Veterinary Center,                                                   usually given every other day long term. Medication costs
      6900 Congress Avenue, Boca Raton, FL 33487, (561)                                                    for dogs can vary from $150 per month to $2000 per month
      999-3000. www.CVCBoca.com.                                                                           depending on the dog’s size.
         Kidney transplants are something everyone has heard                                                  What are potential complications to the recipient?
      of for people, but may be confined to specialized facilities                                         There are basically three main complications:
      with experienced surgeons, Successful kidney transplants                                                • Infection from the immune-suppressive therapy is the
      in cats have been going on since the mid-1980s. Canine                                               second most common cause of transplant-associated death
      programs have been less successful, but are also available                                           (rejection being the first). In cats, Toxoplasma infection is
      in limited facilities.                                                                               of particular concern and, while preoperative testing may
         To the uninitiated, the impression may be that once                                               have already been negative, some cats turn positive after
      someone receives a new kidney, life is renewed and all                                               the immune suppression begins. Also in cats, old viral
      the kidney problems are solved. In fact, this is hardly the                                          upper respiratory infections can be expected to recur and
      case. There are immune-suppressive medications needed to                                             they can be severe. In dogs, life-threatening infections can
      prevent the new organ from being rejected, not to mention                                            emerge in any organ system.
      potential for infection, on-going screening tests and other   Ollie and Mr. Moto now live together after one cat’s kidney      • Stricture (narrow scarring) of the ureter, which is
      issues. A kidney transplant is a very big deal regardless   was transplanted into the other. Photo courtesy of Dr. Lillian   the tiny tube that carries urine from the new kidney to the
      of the species, and not every patient is even a candidate,   Aronson.                                urinary bladder. If this occurs, another surgery is needed to
      so let’s walk through the main considerations.                                                       trim the scarred area and re-attach the ureter to the urinary
         Where do the donors come from and what happens   the new kidney occurs when levels dip below 200 ng/ml.)  bladder. The original kidneys are generally not removed
      to them afterwards? This question is important ethically      Cyclosporine has some disadvantages that include:  unless there is a reason to do so. The new kidney is simply
      for everyone involved in the transplantation program.      •  Expense. Cyclosporine is expensive. Concurrent   an extra one. There is an approximately 21% incidence of
      No one wishes to harm the donor animal who cannot   administration of ketoconazole, a medication normally   this complication in the first 62 days post-operatively in
      voluntarily become an organ donor in the way a human can,   used to treat fungal infection, has an added benefit   cats. Mostly males are affected.
      nor is there a mechanism to harvest organs from comatose   of “potentiating”  cyclosporine.  This means  that  less      • The risk for developing diabetes mellitus increases
      brain-damaged patients as might be done for humans.  cyclosporine is needed to achieve the desired effect. If   by approximately five times after a kidney transplant.
         Feline  kidney  donors  usually  come  from  research   ketoconazole  is  well  tolerated,  a  substantial  financial      What kind of survival time can you expect? In a
      facilities. These cats are classified as “specific pathogen   savings can be realized. Additionally, if ketoconazole is   recent study of feline kidney transplants, 59% of renal
      free,” which means they are free from infectious diseases.   used, it may become possible to dose the patient only once   transplant patients were still alive six months after
      They are matched by blood typing, and potentially by   a day rather than twice. Approximately 30% of transplant   surgery and 41% were still alive three years afterwards.
      tissue-typing depending on the transplant program. A   patients will not be able to utilize this protocol due to the   Apparently the first six months are a somewhat crucial
      research  cat  is  selected  and  a  kidney  removed  for  the   development of excessive cyclosporine levels or liver   time in determining long-term survival.
      recipient. After the procedure, the owner of the recipient   enzyme elevations from the ketoconazole.     The University of Wisconsin Renal Transplant Center
      cat must adopt the donor.                            •  Expenses for Monitoring. Periodic blood level   reports 70% survival at six months for cats and 50%
         Some transplantation programs allow the owner of the   monitoring is needed to check that the right dosage is being   survival at three years. Of the cats that survived to be
      recipient cat to provide the donor. Donors must be young   used. For most drugs, “what you swallow is what your   discharged from the hospital (i.e., they did not succumb
      adults, generally at least 10 pounds in size, be free of   body gets.” For other drugs, there are individual variations   to problems directly related to the surgery), 96% survived
      infectious diseases such as feline immunodeficiency virus,   in how the medication is absorbed, and cyclosporine is one.   to six months.
      feline leukemia virus and toxoplasmosis, and must have   When two patients take the same amount of cyclosporine,      In dogs, the picture is not nearly as bright.  The
      excellent kidney function. Basic blood testing and urine   they may not achieve the same serum levels; some   University of California at Davis program was seeing
      cultures must be normal.                          individual fine-tuning is needed.                  about a 40% success rate.
         You enter the program with one cat and leave with      • Long-term use of cyclosporine increases the risk for      Kidney transplantation is an expensive undertaking. The
      two cats. For dogs, the owner of the recipient is generally   the development of cancer, specifically lymphoma. At the   University of California at Davis program, for example,
      responsible for finding the donor. The University of California   University of Wisconsin Renal Transplant Center, a 14%   required a deposit of $11,000 for cats and $13,000 for
      transplant program has been on hold since 2007, but as an   incidence of malignant tumor development is reported for   dogs. Transplantation involves the adoption of a donor and
      example their former donor guidelines were that the donor   cats with post-transplant time (and thus cyclosporine use   long-term medication and blood testing for the recipient.
      must be less than six years of age, of similar size as the   time) of greater than one year.         If this is something you are seriously considering, be sure
      recipient (and preferably of the same breed), and if the donor      In dogs, the chemotherapy agent azathioprine is also   to discuss the procedure with the transplant center closest
      is not related to the recipient tissue matching is needed.  regularly used for its immuno-suppressive properties. It’s   to you, as well as with your regular veterinarian.
         What kind of home care will the recipient require?
      The recipient is going to require suppression of his immune
      system for the rest of his life. This not only requires a
      substantial financial commitment for the medication but
      also the ability to give the cat oral medication at least
      twice a day for the rest of his life. The heart of this therapy
      is a medication called cyclosporine, a medication that
      has revolutionized organ transplantation for humans.
      Prednisone, a commonly used cortisone derivative, is
      typically used as well, at least to start.
         Cyclosporine is typically given twice a day with the
      lowest blood level of the day being approximately 500 ng/
      ml around the time of surgery and lowering to 250 ng/ml
      after a month or so of recovery after surgery. (Rejection of
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