Kidney Transplant

Lupus nephritis affects both kidneys equally. Between 10 and 30 percent of people with lupus develop end-stage renal failure due to lupus nephritis. When someone with lupus develops severe kidney (renal) disease, a kidney transplant may be a treatment option. A transplant may also be the person’s best chance for long-term survival.¹

One study found that among 9,659 people with end-stage kidney disease due to lupus nephritis, 59 percent received a transplant. Most (82 percent) were female, and 60 percent were non-white. The doctors found that receiving a kidney transplant reduced the risk of early death.²

Qualifying for a transplant

In order to receive a kidney transplant, you must be sick enough to need the organs yet still healthy enough to survive what will be a complicated surgery and long, difficult recovery. Your rheumatologist or nephrologist will bring up the possibility of a transplant. If you are interested, you are then referred to an organ transplant center for evaluation.³

In general, people cannot qualify for a kidney transplant if they smoke, are currently abusing drugs or alcohol, have HIV, or hepatitis. You may also be disqualified if you do not have adequate support at home or have a history of not following medical advice or refusing medications.³

Tests to evaluate kidney transplant candidates

Several tests will determine if you would be a good candidate for a kidney transplant, including function tests of the kidney, lungs, and heart. A psychological exam will assess your mental well-being and support network of family, friends, and professional help.

Any transplant recipient must commit to a lifestyle that keeps their new kidneys healthy. This includes:

• A commitment to taking immunosuppressants daily
• Eating properly
• Exercising
• Practicing stress management techniques
• Avoiding unhealthy behaviors that could damage the new organ

There are more than 200 transplant centers in the United States, and each has slightly different standards for who is eligible for a transplant through their center. You may be rejected at one center and accepted by another. Once you qualify for a transplant, you then register for the national waiting list. There are always more people on the waiting list than available organs.⁴

How long is the wait for a kidney donor organ?

Kidney transplants are the most common transplant in the United States by far, so competition for these organs is great.⁴

If you do not have a friend or family who is a willing and suitable donor, the wait for a kidney from the national list can take 3 to 5 years. How long you wait depends on several factors, including your blood type, antigens, and the organ size needed.^5,6

Does lupus nephritis return after transplant?

Because lupus has no cure, lupus sometimes attacks the new kidneys in the same way it did the original organs. One study found that between 2 and 30 percent of people with lupus who received a kidney transplant experienced a return of lupus nephritis. However, the study also found that this new nephritis tended to be mild and rarely lead to organ rejection. Consistent use of immunosuppressants can help control both lupus flares and lupus nephritis.^5,7

What are the possible side effects?

Many people feel much better after a kidney transplant and find their symptoms improve dramatically. However, immunosuppressants that prevent organ rejection also increase the risk of infections. Many times, these immunosuppressants are the same drugs you would take to suppress lupus flares, so taking steps to prevent infections may not require any new habits.⁵

Choosing to undergo a kidney transplant

A kidney transplant operation is a very personal and difficult choice. Transplants can be very expensive, even with insurance. Insurance likely will not cover most non-medical expenses associated with a transplant, such as:

• Relocating to live close to a transplant center
• Living expenses if you cannot work
• Transportation to and from the transplant center.

Plus, insurance may only pay part of the costs for tests, medicines, and post-surgery rehabilitation. Your healthcare team may be able to help you find support for these costs.