So when “Despy” suddenly developed a congenital form of advanced kidney disease at age 2 and the veterinarian estimated his lifespan in months, Segal vowed to do everything he could to save the cat. “He took care of me when I was sick,” says Segal, a software developer who lives in San Jose. “It was my turn to take care of him. It’s simple.
Segal, who was living in the Boston area at the time, took her cat to the University of Pennsylvania School of Veterinary Medicine in Philadelphia, where Despy underwent a kidney transplant in 2018. Today, Despy is thriving. The same goes for Stevie, the kidney donor cat from a local shelter that Segal agreed to adopt as part of the kidney transplant. He loves them both. “They play together, they groom each other, they fight,” Segal says. “We became a comfortable and loving family.”
Chronic kidney failure is one of the most common conditions in aging cats and a leading cause of death. The disease can be hereditary, affecting young cats like Despy, and can result from exposure to toxins, such as eating lilies. (A cat that eats even a small amount of any part of a lily plant can suffer fatal kidney failure within a few days.)
Like humans, cats have two kidneys, which filter waste from the body, and can live with just one if that kidney is healthy.
Kidney transplants in cats began more than 25 years ago, although they are still rare and only three institutions perform them: Penn Vet, the University of Wisconsin School of Veterinary Medicine, and the College of Medicine veterinarian from the University of Georgia.
Penn Vet has performed 185 transplants since 1998, the Georgia school more than 40 since 2009 and Wisconsin 87 since 1996.
Not all cats are candidates for the procedure, and for those that are, surgeries to retrieve the donor kidney and transplant it into the recipient cat can be expensive, up to $25,000. Yet the surgeons who practice them say they find it personally rewarding to give people more time with their precious companions. Additionally, they add, surgical interventions and long-term follow-up in cats can provide knowledge potentially beneficial to human health.
Most cats gain an average of two to three years, with a few exceptions. Despy, for example, is six years post-transplant. “Our longest survivor was almost 13 years old,” says Chad Schmiedt, Alison Bradbury Chair in Feline Health at the Georgia Veterinary School. “Shilo was 3 years old when we did the transplant in June 2009 and lived until April 2022.”
About 40 percent “come out three years after the transplant,” says Robert J. Hardie, clinical professor of small animal soft tissue surgery at the Wisconsin Veterinary School, adding that survival often depends on whether post-surgical complications. “Some live longer. We’ve been out for 10 years. At Penn Vet, up to 70 percent are alive and doing well one year after transplant, and two recipients lived 13 years after surgery.
“This is a life-prolonging procedure with the potential for relatively good – sometimes spectacular – results in longevity, which is of great value to many pet parents” , explains Hardie. Additionally, scientists could learn more about immunosuppression in cats, which could apply to humans, he says.
Lillian Aronson, professor of surgery at Penn Vet — who performed Despy’s transplant — agrees. “Cats are a natural living model of kidney disease,” she says, and their shorter lifespans may make information available more quickly than that of humans.
Many pet health insurance companies cover part of the costs for the recipient, but usually not for the donor, because “the donor is not the insured animal,” according to the North American Pet Health Insurance Association. The cost of the donor surgery to remove the kidney is about 25 percent of the $25,000 total, Aronson says.
However, some pet owners are devoted to their cats and don’t hesitate. “We don’t question someone spending $40,000 on a car,” Aronson says. “One of my clients said to me, ‘I just spent $17,000 on my roof and I love my cat more than my roof.'”
Cats who receive new kidneys are typically between 8 and 12 years old, although younger cats without other potentially serious medical problems often do better and live longer, experts say. Schmiedt generally does not perform a transplant on a cat over 16 years old. Hardie says the oldest cat transplanted to Wisconsin was 18 years old. Aronson already did one on a nearly 18-year-old cat who had no other health problems and had youthful behavior and lived for two more years with the new kidney.
Cats with moderate kidney disease are better candidates than those with mild or advanced disease, due to the balance of risks and benefits of surgery, although age offers an advantage for young cats likely to have advanced kidney disease. Cats also cannot suffer from chronic infections or cancer because they must take the immunosuppressive drug cyclosporine for life, which can make both conditions worse. Severe heart disease also rules them out. “You want a recipient who has the best chance of success” through surgery and beyond, Schmiedt says.
Matching is easier for cats than for humans needing a transplant because there are only two blood types among all cats.
Donors come from breeding facilities or feline research shelters, where they might otherwise face a bleak future, and families whose cats undergo transplants must adopt the donors. “For the price of a kidney, (donor cats) can move into a cat-loving home and are universally loved by their new adoptive families,” Schmiedt says.
Andy and Eleni, financial consultants from Gainesville, Fla., who spoke on the condition that their last name not be used for privacy reasons, hugged their second cat, Pappy, after Teenie’s surgery there is six years in the Georgia establishment. Teenie was 8 when kidney failure meant he would need a new one to survive; he is now 14 years old. Pappy was 2 years old when he donated his kidney and is now 8 years old.
“The surgery not only gave us more time with a cat we love, but we were also blessed with a wonderful new cat who saved his life and brought so much joy and love into his life. ours,” says Andy.
During the operation, the team removes the new kidney from the donor and then sews it back into the recipient. They suture the donor’s blood vessels – the renal artery and vein – to the recipient’s aorta and vena cava and attach the donor’s ureter to the recipient’s bladder.
They usually leave the old kidneys in place as a backup, in case the new kidney does not work immediately. However, many cats urinate immediately, even during surgery. “It’s always exciting the first time they pee,” says Schmiedt.
Surgeries can last up to eight hours. The donor may return home after a few days, while the recipient usually stays longer, sometimes a week or more. Both cats are being monitored for life.
Transplants other than kidneys in pets are not viable because most require the death of the donor. Kidney transplants in dogs can be difficult because, unlike cats, they often suffer from immunosuppression problems, says Aronson, who has performed three. (The dogs survived but didn’t fare as well long-term as the cats, she says.)
Although post-transplant complications can occur, research suggests that cats with kidney failure can do well – if they are good candidates for the procedure. “I think transplantation is the only real way to cure kidney disease” in cats, Schmiedt says. “The goal is to give them back the quality of life they had before. »
This seems to be true for Despy. “He has all the energy he’s ever had,” Segal said. “He’s living his best life.”