Beckoning a New Life
Kidney transplant is not just an alternative, but a superior choice for long-term survival, quality of life, and economic cost.
In Stage 5 chronic kidney disease (CKD), also known as kidney failure, the treatment landscape narrows to two scientifically-validated options: dialysis and kidney transplant. It is crucial to understand that all other so-called “treatments” circulating on social media are unscientific and invalidated therapies promoted by quacks. There is no third option that ensures survival.
While dialysis is a life-saving procedure, there is no doubt that a kidney transplant offers a superior outcome, both in terms of long-term patient survival and overall cost. Today, kidneys for transplant can come from a living donor—typically a family member—or from a deceased (cadaveric) donor via a national waitlist.
The field of transplantation has seen tremendous advances, broadening access significantly. When a blood group-matched donor isn’t available within the family, we can facilitate a kidney exchange between two families. We can also perform ABO (primary blood group system) incompatible transplants by using medication like Rituximab to prevent new antibody formation and employing plasmapheresis or special immunoadsorption columns to remove existing antibodies from the patient’s blood.
Furthermore, previous limitations are continually being overcome. With proper viral load control using Highly Active Antiretroviral Therapy (HAART), kidney transplants are now a reality for HIV-positive patients. Age, too, is less of a barrier; transplants can be performed in children weighing over 10 kg and, on the other end of the spectrum, in carefully selected elderly patients up to 80 years of age.
Survival Rates Tell the Definitive Story
The statistical difference in outcomes between dialysis and transplant is stark and compelling.
On dialysis, the one-year patient survival rate is approximately 75 per cent, and the five-year survival rate drops to about 20 per cent. These patients face an indefinite future tied to dialysis machines, often requiring frequent hospital admissions due to related complications like infections or cardiac issues.
In contrast, the success rates for kidney transplant are dramatically higher. One-year patient survival exceeds 99 per cent, with a 95 per cent rate for successful kidney function (graft survival). At the five-year mark, about 80 per cent of transplanted kidneys are still functioning well, and patient survival remains as high as 95 per cent. This translates to a survival rate more than four times better than dialysis, achieved at a much lower long-term cost.
The Gift of a Normal Life
Beyond the numbers, the most profound benefit of a transplant is the restoration of quality of life. Dialysis is a demanding, time-consuming treatment that severely limits daily activities. A successful kidney transplant is the only treatment that allows a person to return to a near-normal lifestyle. A transplant recipient can complete their education, work full-time, support their family, and enjoy a fulfilling social and family life. They regain independence and can become productive, contributing members of society, rather than remaining dependent on family for care and support.
Therefore, every patient diagnosed with Stage 5 CKD should actively plan for a kidney transplant. Ideally, they should aim for a pre-emptive transplant—receiving a new kidney before ever needing dialysis. This strategy not only yields the best medical outcomes but is also the most cost-effective path forward.
(The author is Chairman of Nephrology and Kidney Transplant at Fortis Hospital, Vasant Kunj, New Delhi, and Immediate Past President of the Indian Society of Nephrology.)