by Vidya Bhandaram

Selena Gomez, the most followed person on Instagram (@selenagomez), recently announced on the social platform that she underwent a kidney transplant due to complications from lupus.

“There aren’t words to describe how I can possibly thank my beautiful friend Francia Raisa,” Gomez captioned the Instagam post of her and her best friend from their hospital beds. “She gave me the ultimate gift and sacrifice by donating her kidney to me. I am incredibly blessed. I love you so much sis.”

While, thankfully, the 25-year-old singer, actress and executive producer (see “13 Reasons Why”) is on the road to recovery, many are left to wonder what does all of this mean? What is lupus? How does it affect your kidneys? Why was a transplant needed?

If that’s you, we’ve got you covered.

Dr. Vidya Bhandaram, medical director of the kidney transplant center at HealthONE’s Presbyterian/St. Luke’s Medical Center in Denver, sat down to answer our most burning questions about the condition (lupus), treatment options, and the quality of life after a kidney transplant.

What is lupus?

Lupus is an autoimmune condition that is seen more frequently in young women than men. It is a disease where your body produces antibodies called ANA or antinuclear antibodies. Those antibodies attack various organ systems in the body including the kidney and sometimes the heart, joints, lungs or liver or brain.
These patients can develop joint pain, heart disease, lung disease or kidney failure from lupus, and often need strong immunosuppressants to keep it under control.

How exactly does lupus affect the kidney? Is it common?

About 10 to 30 percent of patients with lupus end up with end stage renal disease or kidney failure related to lupus.

How is lupus diagnosed?

Patients will exhibit typical symptoms such as joint pains, skin rashes, protein or blood in urine. Lab tests will reveal antibodies, elevated inflammation markers and in the case of kidney involvement, elevated levels of blood toxins. Additional testing in the case of kidney involvement will include a kidney biopsy where a small piece of kidney tissues Is obtained and special stains are performed.

Besides family history, what are other risk factors for lupus?

Lupus is commonly seen in females more than males, younger individuals opposed to older individuals and African Americans. Those are the big risk groups.

It’s been reported that Ms. Gomez had the kidney transplant due to complications from lupus. Why is the kidney important?

We all have two kidneys. Each kidney has about a million to a million and a half small tiny filters. So, we eat food, process it, and our body’s then produce toxic waste. It’s the kidneys job to filter the toxins and waste products that develop in our blood stream. The kidneys are also responsible for regulating toxins, blood pressure and fluid control.

What happens when someone has kidney failure?

Patients with kidney failure are unable to control toxin levels in their blood stream. They may develop high blood pressure or volume overload, meaning they will have trouble getting rid of extra fluids. This will lead to shortness of breath or swelling in their feet. They may also develop trouble concentrating, nausea, vomiting and fatigue.

Is there a cure for lupus?

Lupus, in general, is not fatal unless the patient develops severe complications such as encephalitis – inflammation of the brain tissue – heart disease from lupus or other severe complications. Nowadays, there are pretty strong treatments for lupus, as well as a great deal of research with newer medications being released to tackle lupus and lupus flares.

What’s the best treatment for kidney disease from lupus?

Transplant is the best treatment. It’s really the preferred treatment for patients that have kidney disease from lupus and end stage kidney disease. There are some recommendations that patients with lupus that have kidney disease may benefit from doing a short period of dialysis before getting a kidney transplant. However, that is only true for patients that have severe lupus manifestations that a period of dialysis may help to decrease their antibodies and flare before they get a kidney transplant. In patients that have slowly, progressive smoldering lupus symptoms that have developed very slowly over the years, we recommend getting evaluated for a kidney transplant, obtaining a living donor and going on to get a kidney transplant before dialysis. Every patient is a little different but the overarching theme is that the kidney transplant is the preferred choice of treatment with renal failure.

For someone with lupus of the kidney (nephritis), why is it important to consider a kidney transplant?

Patients who have lupus and develop kidney disease actually have a very good survival rate if they get a kidney transplant. The survival of the patient and the longevity of the kidney transplant is about the same in patients with lupus, compared to patients who don’t have lupus and receive a kidney transplant. We encourage patients who have lupus and kidney disease to get a kidney transplant evaluation so they can be listed for a future kidney transplant because this does prolong their life.

Ms. Gomez’ best friend donated her kidney. What’s the difference between a living and deceased donor?

The big difference between these two is the longevity of the kidneys. Kidney transplants don’t last forever. They have a lifespan. After that lifespan, they tend to burnout and then patients either turn to dialysis or go on to a second kidney transplant.

Lifespan: Deceased donor kidney transplants last, on average, for about 8 to 12 years. A living donor kidney transplant could last 20 to 30 years. We have some patients that have received a living donor kidney transplant and are now 30 years out.

Wait time for deceased donor kidney transplant: The other major advantage of receiving a living donor kidney transplant is that you don’t have to wait on the wait list. The national wait list for a deceased donor kidney transplant is up to 99,000 patients. Roughly, 19,000 transplants are performed every year. So, there is a huge discrepancy between how many patients are waiting for those deceased donor kidney transplants and how many kidney transplants are being performed every year. And each year new patients are added to the wait list. The wait time for a deceased donor kidney transplant, at least, in the state of Colorado, is anywhere between three to five years, depending on their blood type. That means that a patient has to stay on dialysis for that duration of time as they wait their turn.

Wait time for a living donor kidney transplant: If you have a living donor available, there is no wait time. Once your evaluation is done and you’re listed as an appropriate recipient, and the donor gets tested, evaluated and approved for appropriate donation, the transplant center will set up a date and time for surgery.

Recovery time: The third advantage is that the recovery time is much shorter with a living donor kidney transplant. The transplant “kicks in” much sooner than a deceased donor kidney transplant, which might require one or two sessions of dialysis before the kidney starts functioning properly. Patients are out of the hospital sooner and their risk of complications are much lower with a living donor kidney transplant – mostly because the surgeries are well planned ahead of time. They are elective surgeries, as opposed to the middle of the night surgeries, so to speak, with the deceased donor kidney transplants.

How do you go about finding a match for a kidney transplant?

The match for a kidney donor is two-fold.
We look for blood type compatibility.
Another way of looking for a match is to look at antibodies in the bloodstream. We want to make sure the recipient has no pre-existing or pre-formed antibodies in the blood stream that could react against the donor kidney when it is placed. (We use a blood test called a cross match, which mixes the recipient blood with the donor cells before transplant. If the reaction is clean then we can proceed with surgery.) There are situations where an “incompatible” kidney transplant can be performed in a monitored well planned setting. Those patients will need some type of pre transplant treatment to bring their antibody levels down before transplant can proceed.

Are medications required after a kidney transplant?

The immune system is very strong. It’s going to recognize the transplant kidney as foreign. It’s going to do everything it can to attack that transplant kidney. Our immune system does what it’s trained to do: attack anything that doesn’t belong to itself. And it will do that with a kidney transplant too. In order to prevent that process, or what we call rejection, we give patients anti-rejection medications that they have to take life-long. Patients usually take 2-3 anti-rejection medications.

It sounds like one’s quality of life after a kidney transplant due to lupus is normal. Is that correct?

That’s correct. Lupus patients do really well after a transplant. The survival of these patients are pretty much the same, compared to the patients who receive a kidney transplant that did not have lupus as a cause of renal failure.
Lupus can come back in a kidney transplant. The risk of that happening is anywhere between 2 to 10 percent. However, there are medications to treat that if it reoccurs. A very small portion of patients (less than 5 percent) actually lose a kidney transplant from recurring lupus. Really, a kidney transplant is the way to go to prolong life and to provide a much better quality of life.