Kidney transplant, or not? Research to guide difficult decisions

Kidneys are vital to life. They filter waste and excess water out of the body and help maintain blood pressure.  

So it’s a problem when kidneys aren’t able to do their job properly.

New research from Dr Georgina Irish focuses on complex decision-making in nephrology, the area of medicine focused on kidney health.  

“Receiving a kidney transplant is often the best treatment for people with severe kidney disease – but not everyone will benefit,” says Dr Irish, a Transplant Nephrologist in the Central and Northern Adelaide Renal and Transplantation Service at the Royal Adelaide Hospital.  

“My research aims to help doctors and patients make decisions about kidney health, including whether an individual should stay on dialysis or seek a kidney transplant.”  

For submission in November 2024, her PhD research project is titled Decision Making in Kidney Transplantation.  

Dialysis versus transplant

Around 25,000 Australians have kidney disease severe enough to require dialysis or transplantation.

For patients with severe kidney disease, dialysis treatment can replace some of the functions kidneys normally perform. Alternatively, transplantation surgery replaces a diseased kidney with a healthy, donated organ.

Population-level data shows kidney transplantation improves survival. But although health gains are clear for most patients, this is not true for all patients with kidney disease.  

“When you have severe kidney disease, sometimes it can be really tricky to make a decision about having a kidney transplant or not – and in turn, whether to accept a specific kidney if one becomes available at short notice,” Dr Irish says.  

“My work aims to help patients (and their doctors) feel more confident about what the outcome of a particular decision will be for them as an individual.”  

The value of data

In her PhD, Dr Irish worked with de-identified data in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), a registry that collects and produces statistics on treatment outcomes of those with kidney failure.  

“My work applied de-identified data from thousands of patients to help us better understand risks of certain decisions in kidney disease,” Dr Irish says.  

“We also generated a model that can predict whether a specific patient is likely to live longer or experience better health after a transplant, as compared to sticking with dialysis,” Dr Irish says.

“The next steps are to further validate the models and ensure they’re suitable for use in hospitals.”  

Read the research

Dr Irish has published several journal articles based on her recent work:  

• Should You Accept What Others Reject?
• Cancer post kidney transplant: the question of risk
• The kidney failure risk equation predicts kidney failure: Validation in an Australian cohort  
• Temporal validation of the Australian estimated post-transplant survival score
• Do patient decision aids help people who are facing decisions about solid organ transplantation? A systematic review
• Association of Admission, Nadir, and Terminal Donor Creatinine With Kidney Transplantation Outcomes
• The living kidney donor profile index fails to discriminate allograft survival: implications for its use in kidney paired donation programs 
   

She also recently published an analysis of management of kidney care in Oceana and South East Asia.