What to Consider When Referring a Patient for Kidney Transplant

More than 37 million Americans have kidney disease. This translates to 15% of the adult population and more than 1 in 7 adults. For many, a transplant is a viable option for a better life. However, determining the right time to refer a patient for a kidney transplant evaluation can be a challenge. 

Early referral is critical to determining the feasibility of a transplant and optimizing co-morbidities to improve the likelihood of a successful outcome. At the UPMC Kidney Transplant Program, our main goal is to improve the lives of people who have kidney disease, problems from diabetes, or both. We view living-donor kidney transplant as a frontline treatment option and offer it to all patients who qualify.

All patients with advanced chronic kidney disease (CKD) should be considered for transplant evaluation. Medical literature demonstrates that kidney transplant is a superior form of kidney replacement therapy compared to dialysis. As such, referral to transplant should be the default care plan for CKD patients. There are no strict criteria for referral, but most patients with stage 4-5 CKD are appropriate for referral.

In select cases, referral at higher levels of kidney function may be appropriate, particularly for patients requiring partial or total nephrectomy or those with rapidly progressive CKD. Early referral provides time for identification and evaluation of potential living kidney donors as well as improved patient education regarding transplant options.

Glomerular filtration rate (GFR) is the measure of kidney function and ranges from 0 to 140 mL/minute with measures ≥ 90 mL/minute considered normal. As GFR may vary from person to person, physician judgment is necessary to appropriately determine the rate of end-stage renal disease (ESRD) progression. To avoid comorbidities associated with dialysis, physicians are encouraged to refer patients for transplant once they reach a GFR of 20 mL/minute or less, or with significant symptoms of ESRD.

Our team is dedicated to caring for patients with kidney disease, which is why we encourage physicians to refer patients early — before their disease progresses, their overall health declines, and their chances of being a suitable candidate for kidney transplantation decreases. The more time patients spend in dialysis before a kidney transplant, the shorter their survival.

As one of the nation's most active and experienced transplant programs, we have vast experience in kidney transplants. From thorough evaluation to world-class treatment, we provide a patient-centered approach to care throughout the entire transplant process.

Our transplant team will guide and support your patients each step of the way. They will identify any potential issues and avoid possible complications, determine the patient’s best course of treatment, educate the patient and the patient’s family about the benefits of receiving a living-kidney donor transplant, and share resources on how to help them find a living donor. Currently, more than 92,000 people are listed for a kidney transplant in the United States. Living donor transplant helps overcome the shortage of organs and saves more lives.

There are several preparations required before a kidney transplant can be performed including a variety of tests and discussions about topics such as insurance, medications, support systems, and travel arrangements. In most cases, an evaluation can be scheduled within 72 hours of insurance approval. The kidney transplant evaluation will last three to five days. A care partner or support person will need to be with the patient at each appointment.

As an integral member of the patient care team, the referring physician will be continually updated about the patient’s progress by a member of the transplant team. Continuous interaction with the transplant team can range from in-person and telephone interactions to email communications or teleconference sessions for physicians located remotely.

People with kidney disease or kidney failure have hope at UPMC. We have a robust team of transplant experts across the state of Pennsylvania, including Pittsburgh, Erie, and Harrisburg. This allows us to provide patients with live-saving transplant care, closer to their home.

The UPMC Kidney Program is one of the leading transplant centers in the country and home to some of the world’s most experienced transplant experts. Founded in 1988, our skilled team of kidney transplant surgeons take on some of the most complex cases and have performed more than 4,700 deceased-kidney transplants and 1,900 living-donor kidney transplants. Our experts are available to discuss your patients to determine if they are appropriate for a kidney transplant evaluation. We accept many high-risk patients that other centers may decline. 

To refer a patient or request a consultation, call 412-692-4081 or email UPMCKidneyTxReferral@UPMC.edu. For urgent referrals, please contact UPMC’s 24-hour physician referral service by calling 1-844-896-3997.