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The Benefits of Transplant versus Dialysis

When your kidneys fail, you need one of two treatments to stay alive: a kidney transplant or dialysis therapy (either peritoneal dialysis or hemodialysis).

Many patients come to the Transplant Institute with the myth that they can live forever on dialysis, but this is simply not the case. While dialysis is a lifesaving treatment, it performs only about 10 percent of the work a functioning kidney does. Also because of its impact on the body, dialysis can cause other serious health problems and complications including:

  • Anemia (a shortage of red blood cells, which diminishes oxygen and saps energy and strength)
  • Bone disease
  • High Blood Pressure
  • Heart Disease
  • Nerve Damage
  • Infection

As a result, the average life expectancy for a patient on dialysis is generally five years.

Longer Life with a Transplant

On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years, and a deceased donor kidney from 8 to 12 years.

Patients who get a kidney transplant before dialysis live an average of 10 to 15 years longer than if they stayed on dialysis. Younger adults benefit the most from a kidney transplant, but even adults as old as 75 gain an average of four more years after a transplant than if they had stayed on dialysis.

Research Favors Transplant

Some patients may need to spend time on dialysis as they wait for a good match from a deceased donor kidney or search for a living donor kidney. Spending a long time on dialysis does not ruin your chances of having a kidney transplant. But research shows that getting a transplant sooner rather than later is generally the best approach because of the health problems dialysis can cause over time.

Moreover, spending a long time on dialysis before transplantation may also compromise the life of the new kidney graft once transplant occurs. Published medical data has shown that the kidney will work much longer in patients transplanted before they start dialysis. Patients who wait for a transplant on dialysis for two years are three times more likely to lose their transplanted kidney than those patients who wait less than six months on dialysis. Even the benefits of a live donor kidney transplant may fade away if you wait too long (more than two years) on dialysis. So given the choice, patients who find a donor match and opt for transplantation tend to do better than those who elect to live on dialysis.

Preemptive Transplantation

Preemptive transplantation refers to kidney transplantation before a patient needs to start dialysis therapy. Patients who get a preemptive transplant receive their kidney when their health is generally good, which can improve new kidney function and enhance overall health and life expectancy.

Almost all transplants before dialysis are from live donors. This is because kidneys from deceased donors are distributed in this region (UNOS Region 1, which includes Massachusetts, Maine, New Hampshire, Rhode Island and parts of Connecticut and Vermont) by a number of considerations, but wait time on the transplant list is one of the most important. You cannot start gaining time on the transplant list in Region 1 until you actually start on dialysis. Click here for more information about kidney transplantation before starting dialysis.

So having a live donor is the most common and best way to get transplanted before starting dialysis. However, no matter how long someone has been on dialysis, a transplant from a live donor is preferable to a deceased donor for many reasons including improved kidney graft function.

Preemptive transplant is especially beneficial for patients with type 1 diabetes who need both a kidney transplant and a subsequent deceased donor pancreas transplant.

Better Quality of Life

Even though kidney transplant is major surgery with a phased recovery period, it can, in comparison to dialysis, offer you the opportunity for a longer, more satisfying life. Most patients who have been on dialysis and then had a transplant report having more energy, a less restricted diet, and fewer complications with a transplant than if they had stayed on dialysis. Transplant patients are also more likely to return to work after their transplant than dialysis patients.

Here to Help

Your transplant team is here to help you evaluate your health options early on, and make the treatment choice that is right for you. We can help you understand the risks and benefits of transplant surgery versus dialysis, and the advantages of having a live donor kidney compared to a deceased donor organ. We will carefully and clearly explain your options, offer advice and support, and help you and your loved ones make the best treatment choice.

Contact Information

Transplant Institute
Beth Israel Deaconess Medical Center
Lowry Medical Office Building, 7th Floor
110 Francis Street
Boston, MA 02215