Disability Doc

6.02 Impairment of renal function, due to any chronic renal disease that has lasted or can be expected to last for a continuous period of at least 12 months. With:

B. Kidney transplantation. Consider under a disability for 12 months following surgery; thereafter, evaluate the residual impairment (see 6.00E2).

End stage renal disease may result in the need for kidney transplantation to provide a healthy kidney that will filter waste from the blood.

The date of surgery for kidney transplantation is the established onset date (EOD) for meeting Listing 6.02 B.

SSA considers an individual disabled for 12 months following the surgery because there is a greater likelihood of rejection of the transplanted kidney and infections due to immunosuppression during the first year.

Signs and symptoms after kidney transplantation are only pertinent if at least 12 months have passed since the surgery, otherwise the individual meets 6.02 B, which recognizes the need for a one year post-operative recovery period.

All individuals who have kidney transplants must take immunosuppressants (medications that suppress the body’s immune system) to prevent "graft versus host disease" (GVHD) and rejection of the transplanted kidney. GVHD is an immune system response that occurs when the transplanted organ is attacked by the individual’s immune system, as if it is foreign material.

After the first year posttransplantation, SSA decides whether an individual is still disabled based on:

• Any residual impairment(s)
• Occurrence of rejection episodes
• Side effects of immunosuppressant drugs, including corticosteroids
• Frequency of any renal infections
• Systemic complications such as other infections, neuropathy, or deterioration of other body systems

In deciding whether an individual is still disabled, SSA considers whether there has been medical improvement of their condition based on symptoms (how you feel), signs (physical findings), and laboratory findings (diagnostic testing including blood work).

Immunosuppressant medications used to prevent GVHD and transplant rejection can cause fluid retention, high blood pressure, diabetes, kidney problems, and infection. Other potential side effects of therapy include itching (pruritus), nausea, vomiting, diarrhea, fatigue, and weight loss.

Corticosteroids, such as prednisone, can cause thinning of bone (osteoporosis) and skin, cataracts, destruction of hip and/or shoulder joints due to avascular necrosis (AVN), infections, diabetes, muscle wasting, rounding of faces, and psychiatric disturbances.

Immunosuppressant drugs, such as corticosteroids increase the risk of infection, which may result in chronic or recurrent bacterial (e.g. Tuberculosis, Listeria, Nocardia), viral (e.g. Hepatitis B & C, Herpes, Cytomegalovirus), and/or fungal (e.g. Candida, Aspergillus, Cryptococcus) infections.

Major causes of death after kidney transplantation include infection, coronary artery disease, liver failure and cancer.