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Feline renal transplantation
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Kidney transplantation has been pioneered in the USA as an option for treating feline renal disease and is still very much a specialist procedure, but Lillian Aronson reviews the technique, the ethics and the possible pitfalls in a paper that will be of benefit to all first-line small animal clinicians.
Lillian R. Aronson
VMD, Dip. ACVS - School of Veterinary Medicine, University of Pennsylvania, USA
After completing veterinary school and an internship at the University of Pennsylvania, Dr. Aronson undertook a small animal surgical residency at the University of California, Davis (UCD). From 1994-1996 she was the coordinator of the renal transplantation program for animals at UCD. Following her residency, she joined the faculty at the University of Pennsylvania – where she is currently Professor of Surgery – and started their renal transplantation program. Her clinical interests include all areas of soft tissue surgery, but in particular microvascular surgery and complex urinary tract surgery (including renal transplantation), and treatment of urolithiasis. As well as frequently lecturing in her specialist fields, she is the author of a textbook on small animal surgical emergencies.
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Key Points
- Kidney transplantation may be a viable option for some cats suffering from acute and chronic renal failure.
- Stringent case selection is a critical part of patient evaluation to prevent serious, life threatening complications.
- Lifelong immunosuppression post-surgery consists of a combination of the calcineurin inhibitor, cyclosporine, and the glucocorticoid, prednisolone.
- For ethical reasons, the owner of the transplanted cat commits to adopt the donor.
Introduction
Renal transplantation for cats continues to gain acceptance as a treatment option for patients presenting with early, decompensated chronic renal failure as well as those with acute irreversible renal failure. Since its introduction to veterinary medicine in 1987, it is estimated that between 600-700 cases of feline renal transplantation have been performed at various centers in the USA. The ability to successfully perform the technique in cats has been attributed to a number of factors, including the use of the drug cyclosporine for immunosuppressive therapy, the development and refinement of specific microsurgical techniques for the procedure, and the use of an allograft from an unrelated or related donor (1). Successful transplantation can result in the disappearance of clinical signs previously associated with the patient’s kidney disease, weight gain, an overall improvement in the quality of life and prolonged survival time compared to medical management of the condition (2). [...]
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