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Renal transplantation is the preferred treatment for end stage renal disease, as quality of life is better with a well-functioning transplant compared with dialysis.

In the past renal transplantation was usually postponed until after the initiation of dialysis. Preemptive transplantation, however, is now strongly advocated for children and patients with diabetic nephropathy, in particular, because of the high morbidity associated with dialysis in these patient populations. The availability of a living donor greatly facilitates this strategy and avoids the ethical issues raised by the limited number of cadavaric kidneys.

The success of kidney transplantation has also greatly lengthened the list of patients waiting to be transplanted.

Survival is improving steadily because of a number of factors including the availability of potent drugs that suppress the immune response. These medications are required life-long and, while expensive, are still a more cost-effective option than either haemo- or peritoneal dialysis.

Expected clinical outcomes for renal transplantation is substantially better than before the Ciclosporin era, and globally patient care and donor management have improved. Typical one year patient survival rates are 97% and 93% for living-related and cadavaric donor transplants, respectively. One-year graft survivals are 91% for living-related donor transplants and 81% for cadavaric donor recipients.

There are guidelines set out by the Department of National Health regarding Renal Replacement Therapy in South Africa with the basic principal that all patients should be eligible for a renal transplantation before being accepted to a renal replacement therapy program.

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