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| INDEX OF ARTICLES | WAITING ROOM | EXAM ROOM | SURGERY ROOM | X-RAY ROOM | GENERAL TOPICS | IMPORTANT TOPICS | LAB and PHARMACY | PET PHOTOS | PET SUPPLIES | PET PHARMACY |
Looking up at Dr. Erwin Small,
my clinical medicine professor at the University of Illinois, College of
Veterinary Medicine, I inquired somewhat naively “Why can’t we just do a
kidney transplant, Dr. Small? All
he’d need is one good kidney and he would have years of life yet.”
As a veterinary medical student I worked in the school’s small
animal
clinic on holidays and summer “vacation”, and grew to trust Dr. Small’s
vast experience and insight into canine medicine.
He answered that the surgery would be no problem.
The great barrier to organ transplantation was rejection of the organ by
the dog’s immune systems. It
simply was not in 
the patient’s best interest to do a transplant.
I remained long after regular clinic hours with that courageous,
beautiful Doberman Pinscher; I held his head in my lap and talked softly to him.
Holding a finger on his ever weakening and irregular pulse, I waited
quietly with him as his life faded away… another victim of uremic poisoning
due to kidney failure. He knew he was dying, too… and no one could do anything
to help.
The vivid memory of that defeated and sickened Dobe thirty years ago still reminds me daily of just how dangerous kidney failure is for our canine friends. Today, though, there finally seems to be some good news on the horizon for dogs with failing kidneys. It is finally being done and with some very encouraging results!
The Small Animal Surgery Service at the University of California, Davis, College of Veterinary Medicine is making some pioneering strides to create a workable protocol for kidney transplantation in the dog. The doctors at UC-DAVIS veterinary school average one kidney transplantation procedure a week in cats; canine transplantation protocols, however, are more restrictive and challenging than in cats. Although the entire program might be classified as experimental because long-term data has yet to be tabulated, the science behind the tissue transplantation is sound. As of late 2001 the program has helped 3 dogs return to a reasonably normal and healthy life. Under the direction of Drs. Clare R. Gregory, DVM, DACVS and Lynda Bernsteen, DVM, DACVS, Board Certified Veterinary Surgery Specialists, the program has set up some very specific requirements for a patient to be admitted to the kidney transplant program.
I asked Dr. Bernsteen why it has taken so long for kidney transplantation to start becoming a potential resolution to renal failure in dogs when the ability to do the surgery has been with us for years. Her answer echoed Dr. Small’s of thirty years ago…
“Our primary problem has always been rejection”, says Dr. Bernsteen. “Now, with the advent of new and improved immunosuppressive drugs, we feel we can achieve a good outcome even for unrelated dogs.”
To help understand the mechanics of rejection, recall that the body (yours and the dog’s) has very sophisticated, innate biochemical and hemodynamic responses to anything that enters the body and is discovered to be “foreign”. These absolutely vital survival responses from our immune systems occur as a result of successful genetic programming that has taken eons to perfect. The dog’s inner army responds to a call to arms whenever anything is discovered to be non-self. Very efficient protection by the dog’s immune system will attempt to neutralize, eliminate or wall off the non-self invader… even if it happens to be a donated kidney.
As Dr. Bernsteen said, the key to elevating kidney transplantation in the dog to a state where it can be predicted to return the dog to a reasonable quality of life is the management of rejection. “We need to balance the suppression of the dog’s immune functions so that rejection doesn’t occur and yet retain some degree of protection against the ever-present threats of common environmental invaders. It is a fine line and every patient seems to be unique,” says Dr. Bernsteen. “With every patient we learn something new… and add to the foundation of knowledge that will benefit recipients of donated kidneys in the future”.
Even with the encouraging work
being done by the transplant team at UC-Davis, it may be a few years before
widespread access to kidney transplantation is realized. 
Rejection will always be a major determining factor and finding a
suitable donor through genetic screening and blood testing won’t be easy. For example, very special medical and financial circumstances
need to be present before even considering taking an organ from a donor dog.
Also, some people feel that there are strong ethical considerations to
examine before removing an organ from a healthy animal.
How does one obtain permission to surgically remove an organ from the
donor when the donor cannot speak for itself?
At this time, too, there are a number of strict criteria that have to be met before the UC, Davis transplant team will consider transplanting a kidney into a sick dog. See the table below for the DONOR and RECIPIENT CRITERIA tests that need to be evaluated before any dog will be considered for acceptance into the transplant program.
The financial burden can be
prohibitive at this time, as well. Just
the medications alone can cost from $500 to over $2,000 per month for a
sixty-pound dog depending on the combination of medications selected!
Transplantation requires extremely committed and financially capable dog
owners who are willing to pay for the dog’s treatment.
The surgical procedure itself costs between $5,500 and $7,000. With all these hurdles to
overcome, is kidney transplantation ever going to be available to dog owners on
a more local and “routine” basis? Dr.
Bernsteen responds “With the continued development of better immunosuppressive
agents, ongoing research into the prevention of rejection, decreasing drug
costs, and
pet insurance we may see a day when organ transplantation for our
pets is more commonplace.”
Victor and Corrine W. of Shepherd, Michigan, elected to have their dog go through the kidney transplant program several months ago. Are they happy with their decision, and is their dog’s quality of life what they had hoped for? According to the Williamson’s “There is no way to express the emotional commitment this requires and no way to put into words the happiness the outcome has brought us. It is a huge undertaking in all areas but I consider it to be the most rewarding experience we have ever undertaken. We love her so much and to see her eating, drinking, playing and returning to a normal life is priceless.”
I’d love to turn the clock back thirty years and have the UC-Davis transplant team offer a second chance at life for that big, beautiful, five-year-old Dobe I watched die from renal dysfunction back in school. What joy there would be for both of us if I could throw a stick for his retrieval and watch him move gracefully across a field just out of my reach as we he tried to keep me from grabbing his prize. Now with the help of Dr. Gregory, Dr. Bernsteen, and other veterinarians like them maybe some other dog and his human friends will get the chance…a second chance… to run and play fetch, just out of reach of kidney failure.
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The following are some of the tests required that the referring veterinarian must perform on proposed Recipients and Donors. |
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RECIPIENT |
DONOR |
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Complete blood count |
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Tests results or physical exam findings that exclude a dog from the transplant program: |
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| Heart disease that
produces hemodynamic changes Severe urinary tract infection A fractious temperament that prevents nursing care |
Heartworm disease Neoplasia Familial amyloidosis |
Diabetes or Cushings
Disease Poor body condition Inflammatory bowel disease |
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Veterinary Schools Doing Kidney Transplantation |
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Canine Kidney Transplantation Program |
Feline Kidney Transplantation Program |
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