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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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