Outcome after Renal Transplantation in 26 Dogs Kate Hopper 1 , BVSc, PhD, Diplomate ACVECC, Margo L. Mehl 2 , DVM, Diplomate ACVS, Philip H. Kass 3 , DVM, PhD, Diplomate ACVPM, Andrew Kyles 4 , BVMS, PhD, Diplomate ACVS, and Clare R. Gregory 5 , DVM, Diplomate ACVS 1 Department of Surgical and Radiological Sciences School of Veterinary Medicine, University of California—Davis, Davis, CA, 2 San Francisco Veterinary Specialists San Francisco, CA, 3 Department of Population Health and Reproduction School of Veterinary Medicine, University of California—Davis, Davis, CA, 4 NYC Veterinary Specialists, New York, NY and 5 PetCare Veterinary Hospital Santa Rosa, CA [Correction added after online publication 8-Feb-2012: Author name has been corrected. Kate Hoppe should be spelled as Kate Hopper] Corresponding Author Kate Hopper, BVSc, PhD, Diplomate ACVECC, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California—Davis, Davis, CA 95616 E-mail: khopper@ucdavis.edu Submitted June 2011 Accepted October 2011 DOI:10.1111/j.1532-950X.2011.00924.x Objectives: To evaluate clinical outcome in dogs after renal transplantation and determine predictors of outcome. Study Design: Retrospective case series. Animals: Dogs (n = 26) that had renal allograft transplantation. Methods: Medical records (1994–2006) of 26 consecutive cases of dogs that had kidney transplantation were reviewed. History, signalment, pre- and postopera- tive clinicopathologic and monitoring variables, postoperative complications, im- munosuppressive therapy, and survival were recorded. Results: Median survival was 24 days (range, 0.5 to 4014 days) with a probability of survival to 15 days of 50% and the 100-day survival probability was 36%. Cause of death was attributed to thromboembolic disease in 8 dogs, infection in 6 dogs, and rejection in 1 dog. The only factor significantly associated with an increased likelihood of death was increasing age at time of surgery (P = .024). Conclusions: Canine renal transplantation in clinical patients is associated with a high morbidity and mortality and increasing recipient age has a negative associa- tion with outcome. Thromboembolic complications are a major cause of death in the immediate postoperative period and effective anticoagulation protocols may greatly improve survival in the future. Renal transplantation is a treatment for end-stage renal disease in human, feline, and canine patients. Kidney trans- plantation has been more successful in the management of human and feline patients when compared with canine patients, which have higher morbidity and mortality rates. The exact reasons that canine renal transplantation is less successful remain to be defined. Several studies suggest it is because of the intense host immune response of the dog, which makes it necessary to use potent immunosuppressive therapy to prevent rejection and increases the likelihood of adverse effects. 1–4 Given the financial and emotional burden associated with renal transplantation, it is important to understand why this procedure is less successful in dogs. We describe the largest population of clinical canine renal transplant re- cipients reported to date, all from a single institution. Our objectives were to document outcome after surgery, to iden- tify the cause of death, and to look for factors associated with postoperative death. Fifteen of the dogs included in this study were previously described in a prospective clini- cal trial of a triple drug immunosuppressive protocol. 4 Al- though the short-term outcome of these dogs was reported, Presented at the Annual American College of Veterinary Sur- geons Veterinary Symposium, Chicago, IL, October 17–20, 2007. factors associated with mortality and long-term outcome for the surviving dogs were not addressed. Evaluation of the outcome of these 15 dogs in context of all 26 clini- cal cases provides a unique opportunity to maximize our understanding of the challenges of canine renal transplan- tation. MATERIALS AND METHODS Criteria for Case Selection Medical records (March 1994–December 2006) for 26 con- secutive dogs that had renal allograft transplantation were reviewed. Included were 15 dogs previously described in a prospective clinical trial between 1999 and 2004. 4 Their medical records were reviewed retrospectively for the cur- rent report. Presurgical Evaluation Preoperative data collected from the medical record in- cluded age at surgery, sex, breed, body condition score, body weight, past and current medical therapies, and perti- nent medical history. All dogs were managed with a similar Veterinary Surgery 41 (2012) 319–327 C  Copyright 2012 by The American College of Veterinary Surgeons 319