Veterinary Medicine - February 2008 - (Page 101) ing any signs of illness; less frequent rechecks (every three to four months) are indicated in future years. Aside from the complications discussed in the immediate postoperative period, several long-term adverse effects have been documented. Transplant recipients have an increased susceptibility to infection, presumptively because of immunosuppressive therapy.32 Viral, bacterial, parasitic, coccidial, protozoal, and fungal infections can develop and require unusually intensive treatment and supportive care. Urinary tract infections are most common; antimicrobial therapy should be considered with special concern for any potentially nephrotoxic drugs or drugs that may alter the half-life of cyclosporine. Because of their increased susceptibility to infection, transplant recipients should be housed exclusively indoors. Use standard parasite control and vaccination schedules in these cats. However, killed or inactivated and recombinant or subunit vaccines should be administered when possible rather than attenuated or modi ed-live products. Toxoplasmosis has been reported as a rare sequela to transplantation and may be due to transplanting a kidney from a healthy but latently infected donor into an uninfected recipient or through reactivation of a latent infection in a recipient because of immunosuppression.31 Transplant recipients are also at an increased risk for developing neoplasia, particularly lymphoproliferative neoplasms.48,49 In one retrospective study, nine of 95 cats (9.5%) developed malignant neoplasia after renal transplantation and immunosuppression, a frequency higher than that expected in cats that do not undergo this procedure.48 Diabetes mellitus is also more common in transplant recipients, which further increases the risk of infection.50 TABLE 4 Institutions Performing Feline Renal Transplantation* • Michigan Veterinary Specialists, Southfield, Mich. • North Carolina State University, College of Veterinary Medicine, Raleigh, N.C. • University of Florida, College of Veterinary Medicine, Gainesville, Fla. • University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pa. • University of Wisconsin, School of Veterinary Medicine, Madison, Wis. *This may not be an all-inclusive list. Donor cats. The long-term risks associated with kidney donation in cats appear to be minimal. Donors presumptively have normal renal function at the time of nephrectomy, and loss of 50% of functional nephrons should not result in azotemia or decreased urine concentrating ability. No regular recheck examination schedule is usually recommended, but measuring a serum creatinine concentration and urine speci c gravity one to two months after surgery to establish a baseline, followed by yearly rechecks, is likely reasonable. SUMMARY Despite being a costly and medically intensive option, kidney transplantation has proved to be an effective method for treating some cats with chronic kidney disease. The highest chance of success is achieved through careful patient selection and a close working relationship among the client, primary care veterinarian, and surgical and internal medicine specialists. Standardized preoperative screening and postoperative management protocols exist, with some variation, among institutions that offer kidney transplantation (Table 4). The critical rst steps to a successful transplantation are contacting an appropriate transplant center and optimizing the candidate’s overall health status. VETERINARY MEDICINE February 2008 101 http://www.meridiananimalhealth.com
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.