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When to Refer a Patient for Kidney Transplant

December 11, 2023

At the UPMC Kidney and Pancreas Transplant Program, our mission is to improve the lives of those living with kidney disease. We view living-donor kidney transplant as a frontline treatment option and offer it to all patients who qualify.

Kidney transplantation is the optimal treatment for patients with end-stage kidney disease. The one-year survival rate following a kidney transplant is 96.12%, and the three-year survival rate is 94.65%. With nearly 100,000 individuals waiting for a kidney transplant in the United States, approximately 12 patients a day will succumb to their disease before making it to transplant due to organ scarcity. 

Medical literature shows that kidney transplant is a superior form of kidney replacement therapy when compared to dialysis. Referral to transplant should be the preferred care plan for chronic kidney disease patients, and most patients with stage four to five chronic kidney disease are appropriate for referral. In some cases, referral at higher levels of kidney function may be appropriate, especially those with rapid disease progression.

General indications for when to refer include continued progress of the patient’s disease despite maximized medical therapies, development of a life-threatening complication, or an increasingly unsatisfactory quality of life. 

Indications for a Kidney Transplant 

At UPMC, we evaluate every patient referred to us to determine the best treatment option for them. We accept traditional and complex, high-risk cases. Our team evaluates patients with the following conditions or risk factors:

Kidney Transplant

  • Chronic kidney disease (currently on dialysis)
  • Chronic kidney disease (not yet on dialysis)

Kidney-Pancreas Transplant

  • Diabetic nephropathy
  • Diabetic neuropathy
  • Diabetic retinopathy
  • Diabetic autonomic neuropathy or gastroparesis
  • Accelerated atherosclerosis

Glomerular Filtration Rate (GFR)

GFR can vary from person to person, so physician judgment is necessary to appropriately determine the rate of disease progression. To avoid comorbidities associated with dialysis, physicians are encouraged to refer patients for transplant once they reach a GFR of 20 mL/minute or less, or with significant symptoms of end-stage renal disease.

Benefits of Early Referral

Referral for a kidney transplant should be initiated early before the patient is too sick to be considered an appropriate candidate. Early referral allows our team to address and resolve any pretransplant complications while the patient’s kidney disease is relatively controlled. Early referral also allows time to identify and evaluate potential living-kidney donors and provide patient education regarding transplant options.

To best implement this model of care, we need to start working with you and your patients early in their disease progression. Delaying the evaluation process can:

  • Allow more time for your patient’s disease to progress
  • Cause further decline in their overall health
  • Decrease their chances of being a suitable candidate for kidney and/or pancreas transplantation

Referring a patient early means that we have more time to work with you to discuss the patient’s needs and medical history to determine the best treatment plan.

Partnering With Referring Physicians

Our expertise in kidney transplantation has allowed us to gain invaluable insight and experience in working with referring physicians. Throughout the transplant process, the referring physician remains an integral part of the patient’s care by:

  • Identifying patients with end-stage kidney disease who will benefit from transplantation.
  • Timely referral of those patients.
  • Assisting in the coordination of specialists in pretransplant evaluation.
  • Continuing to medically manage the patient’s care while he or she awaits transplantation.
  • Collaborating with the transplant team in the long-term care and posttransplant care of the patient.

As an integral member of the patient care team, the referring physician will be continually updated about the patient’s progress by members of the transplant team. Continuous interaction with the transplant team can range from in-person and telephone interactions to email communications or teleconference sessions.

About UPMC’s Kidney Transplant Program 

UPMC has performed more than 6,200 adult kidney transplants and more than 1,700 adult living-donor kidney transplants. We believe that kidney transplantation should be an option for any patient with end-stage kidney disease who no longer experiences results with medical therapy. 

With vast experience in kidney, pancreas, and combined kidney-pancreas transplants, our experts take on some of the most complex cases using a patient-centered approach, and they provide guidance each step of the way.

For more information about our program and how to begin the referral process, call 412-692-4081 or email