TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
 

STEROIDS, STEM CELL TRANSPLANTS AND KIDNEY TRANSPLANTS

 

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Steroids


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Home > Treatments > Steroids, Stem Cell and Kidney Transplants

 


Overview


  • This page covers some less commonly used treatments.

  • Steroids are not a routine part of CKD treatment, but may be necessary in some cases.

  • Stem cell transplants have been used for many years to treat joint problems in horses and dogs and are now being researched and used for cats with CKD.

  • Kidney transplants are not widely available and are extremely expensive, but are covered briefly below.


Steroids                                                                                                           


 

There are two classes of steroids:

Steroids are not a routine or essential treatment for CKD, and corticosteroids should not normally be used in the renally impaired, but you may sometimes be advised to use corticosteroids for a specific purpose, for example if your cat also has IBD (inflammatory bowel disease).

 

In the UK, you may be offered anabolic steroids as a general "pick me up" or to stimulate appetite. In the USA, steroids are used much less often.

 

Steroids may be given orally or via injection, but if you give them via injection (which is usually done only once a week or even once a month), you will often notice that the effects are wearing off by the time the next injection is due.

 

If you do use steroids, opt for anabolic ones if possible, and your vet should monitor liver values, because these sometimes increase with steroid use, in which case the steroids should be discontinued.

 

Corticosteroids


In general medicine, corticosteroids tend to be used for their anti-inflammatory effects. They are not normally appropriate for CKD cats, though may be prescribed for cats with elevated calcium levels.

 

Veterinary Partner explains how corticosteroids work.

Newman Veterinary has helpful information about corticosteroids.

Pet Education has detailed information on corticosteroids.

 

Prednisone and Prednisolone


If your vet prescribes corticosteroids, it is quite probable that you will be offered prednisone or prednisolone, commonly referred to as pred. Pred is usually given in pill form.

 

Cats metabolise prednisolone better than prednisone (they have to convert prednisone into prednisolone in their bodies anyway before they can use it) so it is usually better to give prednisolone in the first place. Bioavailability and activity of prednisone and prednisolone in the feline patient (2004) Graham-Mize CA &  Rosser EJ Veterinary Dermatology 15(s1), pp 10 supports this view. Glucocorticoid use in cats (2010) Lowe A Veterinary Medicine says "In cats, the absorption and conversion of prednisone to prednisolone is less efficient, and after the oral administration of prednisone, only about 21% of the drug occurs in the bloodstream as the active form prednisolone. For this reason, prednisone and prednisolone should not be considered bioequivalent in cats, and the active form, prednisolone, should be used preferentially."

 

Mar Vista Vet explains more about prednisone and prednisolone.

 

Corticosteroids Risks and Side Effects


Corticosteroids commonly cause increased drinking and increased urination. They can have serious side effects with long-term use (including triggering diabetes, fluid retention, high blood pressure, and masking or increasing the risk of infections). They may also increase stomach acid and in the worst case may cause stomach ulcers and gastro-intestinal bleeding, not ideal for a CKD cat.

 

According to Plumb's Veterinary Drug Handbook, corticosteroids may cancel out the effects of calcitriol. This is because calcitriol increases calcium absorption, whereas corticosteroids inhibit calcium absorption.

 

NSAIDs should not be used at the same time as corticosteroids.

 

If your cat develops congestive heart failure (CHF) within a week of starting corticosteroids, the steroids may be the cause. One study, Corticosteroid-associated congestive heart failure in 12 cats (2004) Smith SA, Tobias AH, Fine DM, Jacob KA, Ployngam T The International Journal of Applied Research in Veterinary Medicine 2(3) pp159-170 found that some cats developed a unique form of CHF within seven days of starting steroids. Five of the cats died, but once taken off the steroids the seven that survived did much better than the typical CHF patient.

 

If for some reason you are using corticosteroids, these should never be suddenly discontinued: the dose must be tapered because using corticosteroids may suppress the adrenal glands' ability to produce cortisone naturally. Tapering the dose minimises the risk of adrenal insufficiency occurring as a result.

 

Mar Vista Vet discusses the potential problems of ongoing corticosteroid use.

VCA Animal Hospitals discusses the short and long term effects of using corticosteroids.

Glucocorticoids use in cats (2010) Lowe A Veterinary Medicine pp56-62 discusses the pros and cons of using corticosteroids.

 

Anabolic Steroids


Anabolic steroids can help build up muscle, and thus have their place in the treatment of CKD cats with muscle wasting; they may also be beneficial as an appetite stimulant and are sometimes used for mild anaemia.

 

Your vet may prescribe anabolic steroids in the form of either tablets or injections. A commonly used anabolic steroid in Europe is Laurabolin. Stanozolol (Winstrol-V) was popular in the US but it is no longer routinely available, which apparently is related to an FDA regulation. It may still be obtainable from some compounding pharmacies. Pet Place has some information about Winstrol-V.

 

Thomas took anabolic steroids whilst he had CKD. He received a monthly shot at the vet's. We were able to reduce Thomas's steroid dose, but he still seemed to do better overall when he was taking his anabolic steroids. 

 

Pet Education has information about anabolic steroids.

The Merck Veterinary Manual also has some information.

 


Stem Cell Transplants                                                                                     


What are Stem Cells?


There are two types of stem cell:

  • embryonic, which are found in embroyos; and

  • adult (somatic) stem cells, which are found within the body, particularly in the bone marrow and within adipose tissue (fat).

There are ethical concerns regarding the use of embryonic stem cells, but the stem cell transplants discussed below use adult stem cells.

 

Pet Place has an overview of stem cell therapy in cats.

Medical Video Tube has a video about stem cell therapy in a CKD cat.

 

Autologous Versus Allogeneic Stem Cells


If the stem cells come from the cat's own body, they are known as autologous stem cells.

 

If they come from another source, they are known as allogeneic stem cells.

 

Stem cell therapy in emergency and critical care diseases (2015) Sharp CR Presentation to the Australian and New Zealand College of Veterinary Scientists Science Week 2015 mentions that "The use of allogenic MSCs is feasible since MSCs are nonimmunogenic and hence not expected to incite an immune response in the recipient."

 

Novel treatment strategies for feline chronic kidney disease: a critical look at the potential of mesenchymal stem cell therapy (2015) Quimby JM & Dow SW The Veterinary Journal 204(3) pp241-246 does mentions that one study found that allogeneic MSCs were less effective than autologous MSCs in rats with AKI, but points out the "advantages of using allogeneic MSCs include sparing the patient from undergoing the harvest procedure as well as the use of MSCs from young healthy donor animals. Recent studies in humans and rodents support the view that MSCs obtained from young healthy individuals have greater proliferation potential and have greater therapeutic potential than those collected from elderly diseased individuals."

 

The Quimby paper also makes the important point that "Another concern about autologous MSC administration in animals with kidney disease is the growing body of literature supporting the theory that MSCs are adversely affected by uremia. Recent studies have documented that MSCs obtained from uremic rats have reduced proliferation in culture, caused loss of regenerative potential, premature senescence, decreased capacity to induce angiogenesis, and an altered secretome."

 

Assessment of allogeneic mesenchymal stem cell therapy for feline kidney disease (2012) Quimby JM Presentation to the Advanced Renal Therapies Symposium, NYC, explains more about allogeneic stem cells (page 45).

 

Stem Cell Transplant Benefits


Adult stem cells can help the body to repair itself. One type, mesenchymal stem cells (MSCs), help to produce bone, cartilage and cells that assist with the creation of fibrous connective tissue, so they can be useful for treating joint problems. They have been used to treat arthritis in dogs and tendonitis in horses.

 

A number of studies have shown that stem cell transplants may improve kidney function, prevent scarring and improve proteinuria (excess protein in the urine) in rats (see Research). This may be because mesenchymal stem cells can travel to affected areas of the body and help other stem cells to grow, encouraging healing. Fresh and cryopreserved, uncultured adipose tissue-derived stem and regenerative cells ameliorate ischemia-reperfusion-induced acute kidney injury (2010) Feng Z, Ting J, Alfonso Z, Strem BM, Fraser JK, Rutenberg J, Kuo HC & Pinkernell K Nephrology Dialysis Transplantation 25(12) pp3874-84 found that they seemed to help rats with artificially induced acute kidney injury, with 100% surviving rather than only 57% of the rats who were not given stem cell transplants. Therefore, some US vet schools have been studying the use of stem cells to help cats with CKD (see below). 

 

Stem cells come back to fore (2012) Veterinary Times 16 is an article about stem cell transplants.

 

CKD Stem Cell Research


There have been a number of studies performed in the USA into the use of stem cell transplants in CKD cats. Many of these have taken place at the Veterinary Teaching Hospital at Colorado State University, in cats with stable chronic kidney disease (creatinine 2.0 to 5.0 mg/dl). Exclusion criteria include heart disease, kidney infection, stones in the ureter or other renal complications.

 

Evaluation of intrarenal mesenchymal stem cell injection for treatment of chronic renal disease in cats: a pilot study (2011) Quimby JM, Gibbons DS & Dow SW Journal of Feline Medicine & Surgery 13(6) pp418-26 reports on the pilot study. A member of Tanya's CKD Support Group enrolled the first cat in this study in February 2009, and she told me that the initial cost (for tests and visits) was in the region of US$600, although she was given a lot of free therapeutic kidney food. Her cat had stem cells injected into one kidney initially, and she said he was a little quiet immediately afterwards, which she thinks might have been caused by the mild anaesthesia he was given, but he seemed OK otherwise. After one month, it appeared his kidney function had improved by approximately 15% according to a scintigraphy scan which checks glomerular filtration rate (not every cat will undergo this, he did so because he was the first participant). His creatinine fell from 6 to 5.2 mg/dl and his BUN from 80 to 66 mg/dl. Sadly, her cat had kidney stones before he took part in the study, and he died in June 2009, probably because of the complications caused by the kidney stones. Cats with kidney stones are no longer eligible for the study.

 

In this study, the stem cells were autologous stem cells administered intrarenally. The study concludes "Despite the possible benefits of intrarenal MSC injections for CKD cats, the number of sedations and interventions required to implement this approach would likely preclude widespread clinical application. We concluded that MSC could be transferred safely by ultrasound-guided intrarenal injection in cats, but that alternative sources and routes of MSC therapy should be investigated."

 

Safety and efficacy of intravenous infusion of allogeneic cryopreserved mesenchymal stem cells for treatment of chronic kidney disease in cats: results of three sequential pilot studies (2013) Quimby JM, Webb TL, Habenicht LM & Dow SW Stem Cell Research & Therapy 4(2) reports on three further studies (numbers 1, 2 and 3) conducted at Colorado State University in which the stem cells were administered intravenously. CSU had found that it can be difficult to grow stem cells from older cats, which CKD cats often are, so they obtained and grew stem cells from the fat of young healthy cats (allogeneic) and these cells were given to CKD cats as an intravenous (IV) injection. The stem cell therapy was given once every two weeks for three treatments, and then monthly for three treatments if improvement was seen. At each visit, bloodwork was performed and an IV catheter placed to administer the stem cell treatment.

 

Cats in study 1 had no adverse side effects. Study 2 found that of the five cats in the study, side effects of vomiting (two cats) and increased respiration (four cats, one severe) were seen. This study used the same sort of cells but cells were taken directly from cryopreservation and higher doses were used than in the other two studies. Study 3 did not see any side effects, and the report states "Thus, we have concluded that the administration of a higher dose of aMSCs taken directly from cryopreservation, despite careful washing, was the source of the toxic reactions observed, and this form of administration is not recommended."

 

Unfortunately, although 40% of cats in studies 1 and 2 showed an improved GFR, the researchers felt that overall the improvement was modest. The paper concludes "Administration of cryopreserved aMSCs was associated with significant adverse effects and no discernible clinically relevant improvement in renal functional parameters. Administration of aMSCs cultured from cryopreserved adipose was not associated with adverse effects, but was also not associated with improvement in renal functional parameters."

 

The most recent study, Assessment of intravenous adipose-derived allogeneic mesenchymal stem cells for the treatment of feline chronic kidney disease: A randomized, placebocontrolled clinical trial in eight cats (2015) Quimby JM,Webb TL, Randall E, Marolf A, Valdes-Martinez A & Dow SW Journal of Feline Medicine and Surgery March 17, concluded "No significant change in serum creatinine, BUN, potassium, phosphorus, GFR, UPC, or packed cell volume was observed in cats treated with MSCs. While administration of MSCs culture-expanded from cryopreserved adipose was not associated with adverse effects, significant improvement in renal function was not observed in the weeks following administration. Long-term follow up of cats participating in all clinical trials is still under way and will provide additional information about the effects of MSC therapy on disease progression."

 

CSU is continuing its research into stem cells but for cats with AKI rather than CKD.

 

The Animal Medical Center in New York is conducting research into stem cell therapy in CKD cats. They are examining intra-arterial administration because it is thought more of the stem cells reach the kidneys with this method. Intra-arterial delivery of mesenchymal stem cells in veterinary patients (2012) Berent A Presentation to the Advanced Renal Therapies Symposium, NYC, discusses their research (page 49). See the Research Participation Opportunities page for more information.

 

In a review of the use of stem cell therapy for feline CKD to date,  Novel treatment strategies for feline chronic kidney disease: a critical look at the potential of mesenchymal stem cell therapy (2015) Quimby JM & Dow SW The Veterinary Journal 204(3) pp241-246, the researchers write "A conservative interpretation of the available data from studies in cats with CKD is that the current approach of IV administration of allogeneic MSCs is not likely to exert marked clinical benefit, although more animals should be treated before this conclusion can be firmly established."

 

How Stem Cell Transplants are Performed


In vitro comparison of feline bone marrow-derived and adipose tissue-derived mesenchymal stem cells (2012) Webb TL, Quimby JM & Dow SW Journal of Feline Medicine and Surgery 14(2) pp 165-168 found that not only is it usually easier to obtain feline stem cells from adipose tissue (fat), but the stem cells obtained are usually more proliferative too, so obtaining stem cells from fat is the preferred choice for cats.

 

Whichever way the stem cells are obtained, unfortunately anaesthesia is usually necessary (VivaStem's stem cell fluid treatment does not require anaesthesia), which is not ideal for CKD cats, but for most cats it will be day surgery and they will be able to return home in the evening of the procedure.

 

The vet makes a small incision in the abdomen, groin or behind the shoulder blade and extracts some fat. The vet removes stem cells from the fat, then transplants them into the cat via an intravenous infusion (drip) (the process may be slightly different in vet schools, see below).

 

The extraction takes several hours, but if your vet is trained to perform this procedure in-house, the transplant can normally be completed within a day. Otherwise your cat will normally have to return two days later to have the stem cells injected via an intravenous infusion, for which the cat may be under sedation.

 

The stem cells then travel to areas of inflammation within the body where they help to repair damaged tissue. Spare stem cells can be stored until they are needed. One procedure can yield up to 18-20 doses, which could last up to two years.

 

Stem Cell Therapy in Emergency and Critical Care Diseases (2015) Sharp CR Presentation to the Australian and New Zealand College of Veterinary Scientists Science Week 2015 has more information on the types of stem cell and methods of administration.

Animal Medical Center explains more about how the stem cells are harvested.

 

Stem Cell Transplant Providers


There are four companies in the USA which offer stem cell treatments for vets to use on dogs with arthritis and they will also consider assisting with stem cell therapy for CKD cats. Vets are trained by these companies to take stem cells from the animal, but the process thereafter depends upon the company:

  • Vet-Stem require the fat tissue to be sent to their own laboratory for processing, and they then return the cells to the vet for injection into the dog.

  • MediVet Biologics sells kits to vets so they can provide same day treatment. Its partner in the UK is Tuta Vet.

  • ReGena-Vet Laboratories will treat local patients itself for inhouse trials, or can produce stem cells for remote use by other vets.

  • VivaStem uses stem cell fluid rather than stem cells. It is not clear how they collect the fluid (they say it is a "proprietary technique"), though one member of Tanya's CKD Support Group says she was told they actually come from horses. I have asked the company for clarification but have not yet had a response.

Stem cell transplants are not currently approved for CKD cats but a number of vets do now offer them in the USA and the UK. MediVet provide their product to vets in both countries. Vet-Stem is evaluating the use of its product for CKD in cats, and may agree to this treatment being given to a CKD cat if a vet requests it, on the basis of what it calls "compassionate use." The conditions for doing this can be found on page 42 of Feline chronic kidney disease: cell therapy perspectives (2012) Harman R Presentation to the Advanced Renal Therapies Symposium, NYC.

 

Apparently there are a couple of vets in Australia who offer stem cell therapy, and they seem to charge a lot less. I am told the injections are given every week for three weeks, by which time one would expect to see a difference in the cat in terms of improved appetite and reduced vomiting. I only know of one person to date whose CKD cat has had this treatment in Australia, she didn't think it helped.

 

Studies into the use of stem cell therapy for CKD cats have taken place and are continuing at Colorado State University and the Animal Medical Center in NYC ((see below).

 

Stem Cell Effectiveness


In Feline chronic kidney disease: cell therapy perspectives (2012) Harman R Presentation to the Advanced Renal Therapies Symposium, NYC, Dr Harman states that 25 feline CKD cats had been treated by Vet-Stem as at February 2012, for an average period of 776 days, with the longest case to date being 1460 days. 84% of those treated thus far were still alive. For 14 of the cats, there was no outcome yet, but of the 11 with an outcome, one cat did not respond to the treatment, and another had only a mild response. 54% (seven people) felt their cat had a significant improvement in quality of life, and a further 15% (two people) felt there had been a mild improvement. 23% (three people) saw no change, and 8% (one person) felt their cat was worse.

 

Not everyone is so positive. Stem Cell Therapy in Emergency and Critical Care Diseases (2015) Sharp CR Presentation to the Australian and New Zealand College of Veterinary Scientists Science Week 2015 says ""Unfortunately, multiple companies saw the potential for commercial gain in this field and started marketing veterinary “stem cell” therapies without safety or efficacy data. Subsequent to products already being on the market, a few studies have been done in dogs with chronic orthopedic disease, however reading the methodology of these papers suggests that these cell therapies should not be considered stem cells. These commercially available “stem cell” products will not be discussed further. Fortunately, there are multiple groups of credible investigators evaluating the therapeutic potential of true MSCs that have published their work in the translational and veterinary literature. Although none of these therapies are commercially available at this time, there is most definitely potential for a therapeutic role of such therapies in veterinary medicine in the future."

 

Novel treatment strategies for feline chronic kidney disease: a critical look at the potential of mesenchymal stem cell therapy (2015) Quimby JM & Dow SW The Veterinary Journal 204(3) pp241-246 reviewed the current situation regarding the use of stem cells to treat CKD in cats (the authors have conducted much of the research into the use of stem cells for feline CKD). It states "Although it holds much promise, at this time MSC therapy for CKD in cats should still be considered an experimental and unproven therapy. Notably, none of the studies conducted in cats with CKD by our group has been able to replicate the efficacy of MSC treatment reported in numerous rodent models of experimentallyinduced CKD."

 

Stem Cell Experiences


I have heard from a number of people who have tried stem cell transplants on their cats. Many of them felt it had made no difference, and several felt it made their cats sick (vomiting, lethargy etc) but there have been a few apparent successes. One six year old cat on my support group had creatinine of 900 µmol/L (8.9 mg/dl) upon diagnosis, together with severe anaemia. Her condition improved after each stem cell treatment and eventually her creatinine stabilised at 135 µmol/L (1.5 mg/dl). The anaemia also resolved.

 

Another cat was diagnosed in spring 2013 at the age of five (following suspected lily toxicity) with a very high creatinine level (1500 µmol/L or 17 mg/dl). His creatinine remained high (850 µmol/L or 9 mg/dl) a year later, but following three stem cell injections (on days 1, 14 and 28) his creatinine reduced to 340 µmol/L (3.85 mg/dl) and he lived until Christmas 2014. His caregiver stated that she did not know if the stem cell therapy definitely helped but it didn't seem to do any harm.

 

Many cats seem to feel below par for a few days after the injections and may vomit and not want to eat.

 

Vet-Stem has a checklist to use when considering stem cell transplants, and provides a list of conditions that exclude a cat as a suitable candidate.

 

Stem Cell Cost


The cost depends to a large extent on your vet. Most people who have the treatment performed on dogs with arthritis seem to pay around US$2000-4000. One member of Tanya's CKD Support Group was quoted US$3000 by her vet to treat her cat. She went ahead and her cat is recovering well, though he did not have it done because of CKD but because of severe immune-mediated anaemia. A British member was charged Ł2000 for a year's treatment.

 

Stem cell treatment is still available for free at the Animal Health Center in NYC for qualifying cats. See the Research Participation Opportunities page for more information.

 


Kidney Transplants


 

Some people are surprised to find kidney transplants listed as a treatment, but that is exactly what they are - a form of treatment, not a cure.

 

Transplant Availability


Kidney transplants are available at a limited number of facilities in the USA and at one location in Brisbane, Australia. At present (2015), kidney transplants are only available in the USA at:

Interestingly, the University of Georgia has performed two successful transplants which also utilised stem cells.

 

The Royal College of Veterinary Surgeons issued guidelines for kidney transplants in 2003 in order to ensure the highest welfare standards for both the recipient and the donor, but the guidelines were suspended in 2013 pending a review. Transplants are not currently (November 2015) available in the UK.

 

Survival Times and Potential Problems


Kidney transplants entail removing a kidney from a healthy donor cat and transplanting it into the CKD cat. As with human kidney transplants, the donor cat can manage with one kidney.

 

One centre has stated that the average survival time for a cat receiving a kidney at its facility is only 18 months; whilst The Animal Medical Center in New York stated that 25% of cats who underwent transplants there did not even survive the initial operation of receiving the kidney, and only 60% survived one year. Even at one of the most longstanding centres, The University of California at Davis, 20-25% of cats died in the year following the transplant. The Animal Medical Center in New York and The University of California at Davis are not currently performing kidney transplants.

 

Another vet school with extensive experience, University of Pennsylvania College of Veterinary Medicine, states that approximately 60-70% of recipients are still alive after one year (so 30-40% do not survive for a year). A kidney for kitty (2014) is an article in The Philadelphia Inquirer about kidney transplants at the University of Pennsylvania School of Veterinary Medicine. It states that 92% of patients leave hospital, 70% survive for one year and the median survival is 1000 days.

 

Renal transplantation surgery, anesthesia and survival times (2015) Snell W, Aronson L, Phillips H, Beale L & Larenza Menzies MP Journal of the American Veterinary Medical Association 247(3) pp267-277 examined the records of 94 cats who underwent kidney transplant and found that "median survival time for the cats in this study was 653 days. The proportion of cats that survived 30 days was 84%, 6 months (76%) and 3 years (30%)...Cats that were 12 years of age and older that underwent RTS had a decreased overall survival time compared to younger cats."

 

Problems arise for a number of reasons. Firstly, this is major surgery, and by definition it is being performed on seriously sick cats. The Snell study above found that the length of time the cat was under anaesthesia appeared to be a factor in length of survival post-surgery. It states "All the cats receiving m-opioid receptor antagonists reached the 30-day survival point and the significance of this factor was considered due to the prevention of opioid-induced cardiorespiratory depression post-anesthesia. Maintaining an adequate hematocrit post-surgery also improves the odds of cats surviving for at least 30 days."

 

Secondly, immunosuppressive drugs (usually cyclosporine), which stop the body rejecting the new kidney as a foreign body, are required. These must be given religiously at set times (usually every twelve hours), but even so, they may not work for every cat, and then the new kidney is rejected by the cat's body and ceases to work. Since these drugs suppress the immune system, transplant recipients are also vulnerable to infections, which may damage the new kidney.

 

Unfortunately these anti-rejection medications also increase the chances of the cat developing cancer, with a 14% incidence rate reported in cats at one facility who survived more than one year after the transplant. 10% of cats also develop diabetes.

 

Because of the foregoing, as The University of California at Davis has stated, "Due to all the inherent risks with transplantation, it is not considered a prophylactic procedure, and those cats that are doing well with medical management are not considered candidates for transplantation."

 

Having said that, one cat who received a kidney transplant at the University of Pennsylvania College of Veterinary Medicine has managed thirteen years and counting, whilst the University of Wisconsin School of Veterinary Medicine reports on its oldest transplant recipient, who reached the age of 22 in 2014, having received a kidney five years earlier at the age of seventeen. Their longest survivor lived for over nine years following the transplant.

 

Athens Banner Herald reports on two cats who were given stem cell therapy prior to kidney transplants in 2013 and 2014. The second cat, Arthur, was given stem cell therapy because he did not properly absorb cyclosporine, which normally is used to reduce the risk of rejection following a kidney transplant, and it was hoped the stem cell therapy would reduce the risks of rejection. The procedures were successful, and the first cat was still alive a year after the transplant. Arthur was still alive eighteen months after his transplant according to an update in the Daily Mail dated November 2015.

 

Hobbes' story tells of one cat's experience of a kidney transplant where the surgery went well but the cat's body rejected the kidney a few months later.

 

Transplant Cost


Transplants are extremely expensive. The Animal Medical Centre in NYC estimates the cost at US$8000 for the initial surgery and hospitalisation, follow-up care at US$4000 in the first year, and medications and check-ups at US$3000 for each further year.

 

University of Pennsylvania School of Veterinary Medicine gives the cost of the initial transplant as US$12000 - 16000, but gives much lower figures than AMC for ongoing maintenance costs. A kidney for kitty (2014) is an article in The Philadelphia Inquirer about kidney transplants at the University of Pennsylvania School of Veterinary Medicine. It states that a transplant costs US$18-24000.

 

University of Georgia College of Veterinary Medicine states that a transplant costs in the region of US$12000-15000.

 

University of Madison School of Veterinary Medicine does not give prices online, but in 2014 one member of Tanya's CKD Support Group was quoted US$1500 for pre-transplant testing, US$5000-8000 for the transplant, and US$3000 per year for post-transplant medications.

 

Ethical Considerations


The transplanted kidney is taken from a healthy cat, who usually then goes to live with the family of the recipient. The major UK charities, Cats Protection, the RSPCA and International Cat Care, are opposed to kidney transplants because of the ethical issue of removing a kidney from a healthy donor cat with no benefit to that cat.

 

In the USA it is often argued that using a shelter cat "saves a life"; but in the UK, very few cats are euthanised compared to the millions in the USA. In any event, all the US transplants I heard about in the late nineties and early noughties used a cat purpose-bred by the transplant facility as a donor, so no shelter cats were saved. Recent transplants at the University of Pennsylvania School of Veterinary Medicine have used shelter cats, but the websites of the two other vet schools which perform transplants are very vague about where and how they "source" the donor cats.

 

I have often wondered what would happen should the donor cat develop CKD him/herself later in life; presumably such a cat, with only one functioning kidney, would develop end stage renal failure more quickly than a cat with two kidneys. Indeed, Challenges of  feline renal transplant (2010) Gunew M Presentation to the Australian College of Veterinary Scientists College Week states "The effects of unilateral nephrectomy seem to be a slightly reduced life expectancy."

 

Both Cats Protection and the RSPCA have stated that they will not supply cats as donors, and Cats Protection have gone so far as to state that they would "support rigorous punishment measures for any individual who acquires a cat, through whatever means, to use as a donor for feline kidney transplantation".

 


ACE Inhibitors and Angiotensin II Receptor Antagonists                       


These are now covered on the Proteinuria and Hypertension pages.

 

 

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This page last updated: 04 November 2015

Links on this page last checked: 04 November 2015

   

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TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

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