This article by Dr. Dunn was published in the March, 2002
Issue of Dog World Magazine
NOTE: Individuals, references, costs, protocols and other information
may
have changed since publication.
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.
The following are some of the tests required
that the referring veterinarian must perform on proposed Recipients and Donors.
|
RECIPIENT
|
DONOR
|
Complete blood count
Serum biochemistry profile
Urinalysis
Urine culture and sensitivity
Urine protein:creatinine ratio
Echocardiogram
Abdominal ultrasound
Thoracic radiographs
Heartworm antigen tests
Toxoplasmosis titer
Thyroid function test
Blood type
Blood cross-match to DONOR
|
Complete blood count
Serum biochemistry profile
Urinalysis
Heartworm Antigen Test
Toxoplasmosis titer
Blood type
Intravenous pyelogram
|
|
Tests
results or physical exam findings that exclude a dog from the transplant
program:
|
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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reprinted with kind permission from Dr Dunn
The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist you
in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.
