What is a kidney transplant?
A kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. The kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. People who donate a kidney can live healthy lives with one healthy kidney.
As kidneys become diseased, they lose their ability to function, a condition called end-stage renal disease (ESRD) or kidney failure. Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant.
None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully
Normal Kidney Function
The primary function of the kidney is to make urine and purify the blood. Each kidney removes waste materials, and other chemicals which are not required by the body. Most important functions of the kidney are described below.
The kidneys are organs whose function is essential to maintain life. Most people are born with two kidneys, located on either side of the spine, behind the abdominal organs and below the rib cage. The kidneys perform several major functions to keep the body healthy.
- Filtration of the blood to remove waste products from normal body functions, passing the waste from the body as urine, and returning water and chemicals back to the body as necessary.
- Regulation of the blood pressure by releasing several hormones.
- Stimulation of production of red blood cells by releasing the hormone erythropoietin.
- The normal anatomy of the kidneys involves two kidney bean shaped organs that produce urine. Urine is then carried to the bladder by way of the ureters. The bladder serves as a storehouse for the urine. When the body senses that the bladder is full, the urine is excreted from the bladder through the urethra.
WHY IS RENAL TRANSPLANTATION DONE?
Renal transplantation is the definitive treatment for patients with end stage renal disease (ESRD). ESRD can be defined as patients who are suffering with chronic kidney disease (CKD) and require regular dialysis or possibility of permanent dialysis requirement is imminent
When the kidneys stop working, renal failure occurs. If this renal failure continues (chronically), end-stage renal disease results, with accumulation of toxic waste products in the body. In this case, either dialysis or transplantation is required.
Common Causes of End-Stage Renal Disease
- Diabetes mellitus
- High blood pressure
- Polycystic Kidney Disease
- Severe anatomical problems of the urinary tract
Treatments for End-stage Renal Disease
The treatments for end-stage renal disease are hemodialysis, a mechanical process of cleaning the blood of waste products; peritoneal dialysis, in which waste products are removed by passing chemical solutions through the abdominal cavity; and kidney transplantation.
However, while none of these treatments cure end-stage renal disease, a transplant offers the closest thing to a normal life because the transplanted kidney can replace the failed kidneys. However, it also involves a life-long dependence on drugs to keep the new kidney healthy. Some of these drugs can have severe side effects.
Some kidney patients consider a transplant after beginning dialysis; others consider it before starting dialysis. In some circumstances, dialysis patients who also have severe medical problems such as cancer or active infections may not be suitable candidates for a kidney transplant.
Who can donates the kidney?
Kidneys for transplantation come from two different sources: a living donor or a deceased donor.
The Living Donor
Sometimes family members, including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. That person is called a “living donor.” The donor must be in excellent health, well informed about transplantation, and able to give informed consent. Any healthy person can donate a kidney safely.
A deceased donor kidney comes from a person who has suffered brain death. The Uniform Anatomical Gift Act allows everyone to consent to organ donation for transplantation at the time of death and allows families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected.
BEFORE THE TRANSPLANT?
Before transplant surgery, donor and recipient have to undergo certain investigations related to fitness for surgery, matching of kidney and proof of relationship. Donor is evaluated whether he / she is fit for donation and not suffering with any disease which can impact his life after donation. Better one of his two kidneys, is left with donor. Certain legal formalities have to be done for approval of transplantation by committee.
The other hand, in cadaveric donation, two to three blood group matched ESRD patients are called as per waitlist, as and when cadaveric kidney is available for transplantation. They are prepared for transplantation and one who has best cross match with donor kidney receive the kidney graft.
The Donor matching process
Blood Type Testing
The first test establishes the blood type. There are four blood types: A, B, AB, and O. Everyone fits into one of these inherited groups. The recipient and donor should have either the same blood type or compatible ones, unless they are participating in a special program that allow donation across blood types. The list below shows compatible types:
- If the recipient blood type is A Donor blood type must be A or O
- If the recipient blood type is B Donor blood type must be B or O
- If the recipient blood type is O Donor blood type must be O
- If the recipient blood type is AB Donor blood type can be A, B, AB, or O
The AB blood type is the easiest to match because that individual accepts all other blood types.
Blood type O is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type O donors. For example, if a patient with blood type O received a kidney from a donor with blood type A, the body would recognize the donor kidney as foreign and destroy it.
Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Individuals may make antibodies each time there is an infection, with pregnancy, have a blood transfusion, or undergo a kidney transplant. If there are antibodies to the donor kidney, the body may destroy the kidney. For this reason, when a donor kidney is available, a test called a crossmatch is done to ensure the recipient does not have pre-formed antibodies to the donor .
The crossmatch is done by mixing the recipient’s blood with cells from the donor. If the crossmatch is positive, it means that there are antibodies against the donor. The recipient should not receive this particular kidney unless a special treatment is done before transplantation to reduce the antibody levels. If the crossmatch is negative, it means the recipient does not have antibodies to the donor and that they are eligible to receive this kidney.
Crossmatches are performed several times during preparation for a living donor transplant, and a final crossmatch is performed within 48 hours before this type of transplant.
Testing is also done for viruses, such as HIV (human immunodeficiency virus), hepatitis, and CMV (cytomegalovirus) to select the proper preventive medications after transplant. These viruses are checked in any potential donor to help prevent spreading disease to the recipient.
What are the risks of a kidney transplant?
A kidney transplant is a major surgery. Therefore, it carries the risk of:
- an allergic reaction to general anesthesia
- blood clots
- a leakage from the ureter
- a blockage of the ureter
- an infection
- rejection of the donated kidney
- failure of the donated kidney
- a heart attack
- a stroke
The most serious risk of a transplant is that your body rejects the kidney. However, it’s rare that your body will reject your donor kidney.
The Mayo Clinic estimates that 90 percent of transplant recipients who get their kidney from a living donor live for at least five years after surgery. About 82 percent of those who received a kidney from a deceased donor live for five years afterward.
If you notice unusual soreness at the incision site or a change in the amount of your urine, let your transplant team know right away. If your body does reject the new kidney, you can resume dialysis and go back on the waiting list for another kidney after being evaluated again.
The immunosuppressant drugs you must take after surgery can lead to some unpleasant side effects as well. These may include:
- weight gain
- bone thinning
- increased hair growth
- a higher risk of developing certain skin cancers and non-Hodgkin’s lymphoma
What Follow Up Care to be taken Post Kidney Transplantation?
A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed. The period immediately following your transplant may be very stressful. Following are some of the important safety measures after your kidney transplantation surgery:
- Before leaving the hospital, patient will be given instructions about anti-rejection medication and its doses
- Patient will be taught about measuring blood pressure, temperature, and urine output at home.
- In the first few weeks after leaving the hospital, the transplant team will review the patient, perform blood tests, and adjust medication doses.
- You must keep follow-up appointments with your transplant team to monitor for signs of rejection.
- In the follow up appointments, the transplant team will conduct regular blood and urine tests to detect any signs of organ failure. One or more ultrasounds of the graft kidney may be done to see if there are structural abnormalities suggesting rejection.
- An arteriogram or nuclear medicine scan may be needed to confirm that blood is flowing to the transplanted kidney.
AFTER THE TRANSPLANT
The patient usually makes lot of urine in tune of half to one liter per hour which usually sets to 2-3 liter per day after 5-7 days of surgery. His creatinine improved to normal. Immunosuppressant drugs are given and monitored as per their level in blood.
Even after getting discharged, the patient needs to visit the hospital for regular checkups initially twice a week for a month and weekly for next month. He has to continue immunosuppressant medication for life.