Healthcare

Dialysis has long been the conventional solution for patients with advanced kidney disease, but medical professionals at Mayo Clinic are championing a game-changing alternative: preemptive kidney transplantation using organs from living donors. According to Dr. Mikel Prieto, a renowned transplant surgeon at Mayo Clinic in Minnesota, this approach allows patients to receive transplants before their condition worsens to the point of needing dialysis.

Chronic kidney disease affects approximately 10% of the global population and causes millions of deaths annually. As kidneys gradually lose their ability to filter waste and control blood pressure, many patients are placed on dialysis—often for years—while waiting for a deceased donor organ. However, dialysis can drastically affect quality of life, often requiring several hours of treatment multiple times a week and imposing strict dietary and lifestyle restrictions.

“People on dialysis may feel kind of lousy for the most part,” said Dr. Prieto. “Even though dialysis keeps you alive, it does not clean out all the waste effectively. Over time, the body deteriorates, and arterial health declines.”

Dr. Prieto advocates for living kidney donation, a process that significantly shortens waiting periods. These donations can come from relatives, friends, or even strangers. In cases where the donor isn’t a direct match, the kidney may be used in a paired donation chain, allowing both the donor’s intended recipient and others in the chain to receive compatible transplants.

“Typically, unless you are really hard to match, we’ll find a kidney for you within weeks or a couple of months,” Dr. Prieto said. “We also guide patients in identifying potential living donors.”

Mayo Clinic facilities in Minnesota, Florida, and Arizona have pioneered the use of donor chains. At Mayo’s Minnesota campus, about half of kidney transplant patients receive kidneys from living donors—often before dialysis becomes necessary. This proactive approach is part of what Dr. Prieto calls “preemptive transplantation,” ideally performed when kidney function falls between 20% and 10%.

“If you wait until function drops below 10%, it's often too late to avoid dialysis,” he explained. “Planning ahead allows us to perform the transplant in time.”

Dr. Prieto has also developed innovative techniques for patients with autosomal dominant polycystic kidney disease (ADPKD), a genetic disorder that causes kidneys to become enlarged with cysts. His minimally invasive procedure removes the diseased kidneys and transplants a new one—often from a living donor—in a single surgery. This approach not only reduces recovery time but also spares patients from multiple surgeries.

“These patients often struggle with daily activities due to the size and discomfort of their kidneys,” Dr. Prieto noted. “One surgery can restore both comfort and kidney function.”

Looking to the future, Dr. Prieto and his team are exploring techniques to perfectly match donor kidneys with recipients to minimize the need for strong immunosuppressive drugs. Through collaboration with the National Kidney Registry, of which Mayo Clinic is a key member, they are advancing the field of transplantation and setting new standards in kidney care.

As kidney disease continues to impact millions, Mayo Clinic’s leadership in living donation and transplant innovation offers new hope for patients seeking to avoid the burdens of dialysis and improve long-term health outcomes.

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