There have been numerous time periods in kidney transplantation where one could argue that not much has changed. Thankfully, we are currently in an era where there are new developments either already happening or on the near horizon. Major changes are on the way!
Organ Procurement/Allocation
If you are on a kidney transplant waitlist or seeking to be added to one, you should be aware of the significant recent changes in this area. Many have felt that the existing system was inefficient and in need of reform. To address these concerns, in 2024 Congress initiated a modernization project focused on organ procurement and allocation. This initiative aims to enhance quality measures, streamline operations, increase data transparency, and leverage technology. From the patient’s perspective, there is hope for greater transparency from the organ transplant community and ultimately an increase in the availability of organs.
Another significant initiative expected to benefit patients and their families is the Improving Organ Transplant Access (IOTA) project, which will be launched by the Centers for Medicare and Medicaid Services (CMS) this summer. This mandatory pilot project will involve 50 percent of U.S. transplant centers, aiming to increase the volume of transplants while ensuring good patient outcomes through an incentive, and penalties to transplant centers if they do not perform to quality standards.
Xenotransplantation
You may not be familiar with the term “xenotransplantation,” but you have likely come across it in your reading. Xenotransplantation refers to the transplantation of tissues or organs from one species to another, typically from animals to humans. When I first learned about this concept over 20 years ago, I believed it might never become a reality or that it was far off in the future. However, that future has arrived, as you may have seen on the internet or television. There have been recent transplants being performed of a genetically engineered pig kidney. Although we are still in the early stages of this therapy with clinical trials yet to be completed, there is no doubt that we will see more developments in this exciting field. It holds the potential to help alleviate our significant organ shortage, especially as wait times continue to increase.
I am also frequently asked about alternatives to transplantation, including artificial kidneys, stem cells, and other treatments. These technologies are progressing as well, and I remain hopeful that there will come a time when patients with advanced kidney disease have access to a range of effective options.
Diagnostic Testing
For people who have a working transplant, the constant fear of organ rejection is a reality. The most common method for detecting this serious complication is a kidney biopsy. Fortunately, there are several less invasive tests available which can assist your clinical team in assessing the risk of rejection. If we can detect rejection early, we can get ahead of it and help prevent it. While these tests are not foolproof, they can help determine whether a biopsy is necessary, or equally important, whether it can be avoided or postponed. Most of these assessments are blood-based, although urine tests are also in development.
Immunosuppression
As many of you may know, after receiving a transplant, it is essential to take medications routinely to prevent rejection throughout the life of the transplant. Unfortunately, while these medications are effective in preventing rejection, they also come with numerous side effects which can adversely impact the transplant or cause other health issues. This might partially explain why the incidence of early rejection episodes has decreased, but the longevity of transplants has not improved at the same rate.
Immunosuppressive therapy is an area of transplantation which has experienced fewer recent advancements compared to other fields, with the last significant development occurring nearly 15 years ago. Nonetheless, there have been many advances in treating chronic rejection and preventing initial rejection, which we hope will ultimately lead to longer-lasting transplants.
What You Can Do Now
To maintain your transplanted kidney health, always take your immunosuppressant medications, ensure you have an adequate supply, and keep up with doctor appointments and lab tests. Regularly monitor your blood pressure, temperature, and weight, and report any health changes to your doctor, such as pain or fever. Prioritize a healthy diet, exercise, and hydration. Use your healthcare portal to check lab results and medications and stay in touch with your healthcare team whenever you experience nonemergency issues. And most importantly, stay informed and ask questions!
If you are waiting for a kidney transplant, ensure that all your tests are up to date and that your transplant team has your current contact information. If you are unsure if they have your current information, send a message though your portal. It is important to always answer your phone, as the call for a kidney transplant may come from a number you do not recognize.
Transplantation is an increasingly sought-after treatment for kidney failure, which is why the waiting list continues to grow each year. Living donation provides additional options for people who may not be a match for their known donor. Swaps, paired donations, and vouchers can enhance opportunities for those in need. Some of these options have taken place a few times at my center. If someone you know in your community passes away and they are eligible to be an organ donor, their kidney could be directed to you. You need to be active on the waiting list, allowing you to potentially skip the waiting list if it is a match. The deceased donor family will need your name and the name of transplant facility. They must inform the local Organ Procurement Agency of their wishes.
It is important to consult your healthcare team if you have questions or do not understand something, join a support group, and do your own research to learn more about these options.
Rafael Villicana, MD, is a transplant nephrologist and the medical director of the kidney transplant program at Loma Linda University (LLU) Transplantation Institute. His interests include kidney and pancreas transplantation, living kidney donation, and ABO /HLA incompatible kidney transplantation.
Web ID: 45000
