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Kidney Transplantation

With an increase in End stage renal or kidney disease cases in the recent years, Kidney Transplantation is a blessing for patients with chronic renal disease giving them a ray of hope towards a normal life.

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kidney transplantation
Fig1. – Kidney Transplantation

The kidneys are two bean-shaped organs, each about the size of a fist. They are located at the back of the abdominal cavity on either side of the spine. The main function of the kidneys is to filter the blood before sending it back to the heart and remove wastes and extra fluid from the blood. They help the body pass the wastes as urine.

Kidney Failure:

When the kidneys lose their ability to filter the blood; the body becomes overloaded with wastes and toxins. This raises the blood pressure and gradually leads to kidney failure, also known as end-stage renal disease or end-stage kidney disease.

Some of the factors that can interfere with the kidney health and their functioning include:

  • Being exposed to toxic substances such as environmental pollutants or certain medications
  • Severe dehydration
  • Kidney trauma
  • Certain acute and chronic diseases such as diabetes, hypertension, polycystic kidney disease etc.

Causes of Kidney Failure:

The most common causes of kidney failure include:

Diabetes mellitus:

Diabetes injures small blood vessels and nerves in the body. When the blood vessels in the kidneys are damaged, kidneys lose their ability to filter and eliminate the toxins. This leads to the accumulation of waste products in the blood. Also, damaged nerves can cause difficulty in emptying the bladder which increases the pressure and injures kidneys.

Glomerulonephritis:

A condition in which the tiny filters present inside the kidneys get damaged. This affects the kidney functioning and gradually leads to kidney failure.

High blood pressure:

The high blood pressure leads to damage the tiny blood vessels around the kidneys and affects the filtering process. When kidney functioning begins to deteriorate, it leads to kidney failure.

Polycystic kidney disease:

A condition in which clusters of cysts begins to develop within the kidneys. These cysts cause the kidneys to enlarge and lose their function gradually. Polycystic kidney disease can lead to serious complications such as high blood pressure and kidney failure.

Severe defects of the urinary tract:

Defects in the urinary tract can cause difficulty in the elimination of urine. This leads toxins to build up and overload the kidneys. Defects of the urinary tract include blockages in the urine passageways, kidney stones, enlarged prostate, blood clots in the urinary tract, and damaged nerves that control the urinary bladder.

Treatments of Kidney Failure:

S. NoTreatmentDescriptio
1DialysisDialysis is a treatment which replicates the functioning of healthy kidneys when they stop working or fail. In cases of kidney failure and chronic or acute kidney disease, a person needs to undergo dialysis.
2Kidney Transplantation

A kidney transplantation is a surgical procedure that places a healthy kidney in a person’s body, whose kidneys no longer function properly. The healthy kidney which will be transplanted will be taken either from a live or deceased donor.

The transplanted kidney takes over the function of the two kidneys that failed so that the person no longer needs dialysis. Kidney transplantation is a more cost-effective alternative to dialysis.

Types of Kidney Transplantation:

Based on the source of kidneys for transplantation and the time there are two types of kidney transplantation:

  1. Deceased – donor kidney transplant
  2. Living – donor kidney transplant

Deceased – donor kidney transplant:

In deceased – donor kidney transplant surgery, the kidney is obtained either from a person who recently passed away or suffered brain death. The obtained kidney will be then transplanted into the patient whose kidneys no longer work properly or suffering from kidney failure.

The kidney is obtained with due consent from the deceased person’s family and the procedure is carried out within few hours of the donor’s death. The donated kidney is stored in a cold storage or connected to a machine to keep the oxygen and nutrients supply intact until the procedure is carried out.

Living – donor kidney transplant:

In living – donor kidney transplant, the kidney is taken from a living donor and is placed into a recipient whose kidneys functioning is deteriorated. Only one donated kidney can take over the functioning of two failed kidneys. It is an alternative to deceased – donor kidney transplant.

This can be a scheduled process which can avoid the initiation of dialysis process when compared to the waiting time and emergency surgery in case of a deceased donor. Living donor kidneys are said to start their functions quicker than the kidneys obtained from a deceased person.

In most cases, a living – donor kidney transplant usually involves the donation of a kidney from someone the recipient knows, such as a family member, friend or co -worker. Genetically related family members are most likely to be compatible living donors for the kidney transplant. Sometimes, a living donor may also be a person who is not known or genetically related, a non directed living kidney donor.

Steps of Kidney Transplantation:

Kidney transplantation is a very complex surgery. The procedure involves several crucial steps right from finding the donor till transplanting the kidney. Here is a step-by-step procedure of kidney transplantation for those who are unaware and waiting patiently for a kidney transplant.

  1. Finding the Donor
  2. Evaluating the Compatibility
  3. Admittance
  4. Preparation for Surgery
  5. Transplantation Surgery
  6. After The Surgery

Finding the Donor:

Though there has been an increase in organ donation awareness in the recent years, obtaining a donor can be a tedious process in case of emergency.

Once the doctor suggests a transplant procedure, they usually recommend a known transplant center which can sometimes be in-house departments in specialty hospitals or an external center, where you need to register your requirement. Then they evaluate the patient in order to declare the eligibility of the patient to undergo a transplant surgery. If you do not find a compatible living donor, you might be put on waiting till a deceased person’s kidney is obtained.

Evaluating the compatibility:

Once a kidney is obtained, several tests like blood type and tissue matching are done to check the compatibility. These evaluations may include blood tests, imaging scans, and other investigations. The recipient will be screened for other serious conditions such as chronic infections, cancer, and cardiovascular disease. Once satisfactory results are seen the transplant surgery is arranged immediately. In case of incompatibility, the paired donation might be arranged where the same kidney is donated to another needy recipient with whom it is compatible and obtain a compatible kidney from their donor.

Admittance:

Once the transplantation surgery is planned, the patient and the donor (in case of living donor kidney transplantation) are admitted to the hospital. Both the donor and the recipient will receive a physical exam, blood work, a chest x-ray, EKG and perhaps even some other investigations. This process determines whether the patient is healthy and ready for the transplantation or not.

Unfortunately in some cases, the surgery will be postponed and the patient will be sent home. These include:

  • If the patient has been diagnosed with any infections or a fever. In this case, the surgery will be postponed and then if the donor is live, the person will be reserved for later or the donated kidney can be used for another recipient who is waiting for a kidney transplant.
  • If the donated kidney has any problems or considered as not suitable for any reason, the recipient will be notified and sent home to wait until the right kidney is found.

Preparing for surgery:

To ensure the patient is ready for the surgery, several things are carried out. These include:

  • Both the patients, the recipient and the donor, if donor is live; will have chest and abdomen shaved.
  • A laxative or enema will be administered to clean out the intestines and prevent bowel blockage after the surgery.
  • An IV line (Intravenous) will be inserted to supply medicine and prevent dehydration.
  • A sedative will be given to reduce the stress and help the patient relax before surgery.

During surgery, the patient might need the blood transfusion. Though the donated blood is screened very carefully in order to minimize the chances of contracting a disease from the transfusion; at the time of waiting for a kidney, the patient should discuss with the doctors regarding the concerns about transfusions, if any.

Transplantation Surgery:

  • At first, the patient will be given a general anesthetic and will remain asleep during the surgery.
  • A small incision is made over the lower abdomen through which the donated kidney will be placed.
  • The recipient’s own kidney is left in its position unless there is an indication of infection or cancer.
  • After the kidney is placed in the right position, the blood vessels from the lower abdomen are connected to the donated kidney much like an original kidney. This ensures the blood supply to the donated kidney.
  • Finally, the ureters that carry urine from the kidneys to the urinary bladder are attached to the donated kidney.
  • After the procedure, the skin is sewed either with sutures or staples.
  • A small drain may be inserted into the abdomen to drain any excess fluid that may have accumulated during the operation.

After the surgery:

After the surgery, the patient will be taken to ICU or Acute Care Unit and monitored until the anesthesia wears off. During recovery, the patient may expect following things:

  • Pain and discomfort which can be relieved with medications.
  • The patient may be asked to cough to ensure proper lung function.
  • Fluids and medications will be administered intravenously for few days after the surgery.
  • A catheter will be inserted to drain urine from the bladder, temporarily. This may cause discomfort and create the feeling for the need for constant urination.
  • In some cases, it takes much time for the transplanted kidney to fully recover than expected. So, dialysis may still be used in order to remove excess fluid and toxins.
  • The patient will be prescribed anti-rejection medication to prevent the body rejecting the newly transplanted kidney for the rest of their life and monitored regularly to make sure the new kidney is functioning well.

Why is kidney transplantation done?

When compared to a lifetime on dialysis, a kidney transplantation is often the treatment of choice for kidney failure. A kidney transplant can treat the chronic kidney disease and end-stage renal disease to help the patient feel better and live longer. It can offer a better quality of life, fewer dietary restrictions and also lowers the risk of death when compared to dialysis.

In some cases of kidney failure, a kidney transplantation is performed before needing to go on dialysis. This procedure is known as “Preemptive kidney transplant”.

It should be noted that one healthy kidney can carry out the required functions in the human body. Hence, only one donated kidney is adequate to replace the functioning of two failed kidneys, making a living-donor kidney transplantation an option.

When is a kidney transplant preferable?

An individual who has been suffering from kidney failure will be considered suitable for a kidney transplant if he/she is healthy enough to undergo a major surgery and follow a strict, lifelong medication regimen after the surgery. The recipient must also be willing and be able to follow all the post-operative instructions properly to ensure the healthy functioning of the transplanted kidney.

Who cannot undergo a kidney transplant?

Though kidney transplantation is one of the treatment options for End-Stage Kidney Disease or Kidney failure, people with serious underlying medical conditions are not recommended to undergo transplantation. These serious conditions include:

  • Cancer
  • Serious infections such as hepatitis, tuberculosis or bone infections
  • Cardiovascular disease
  • Liver disease

Complications and Risks of a Kidney Transplant:

Almost all major surgeries carry risks and complications and so does a kidney transplant. The most dreaded complication is the rejection of transplanted kidney by the body. The other possible complications and risks of a kidney transplant include:

  • Minor infections such as urinary tract infections, cold, and flu.
  • In rare cases, blood clots can form in the blood vessels that have been connected to the donated kidney.
  • Arterial stenosis, narrowing of the artery connected to the donated kidney. This can develop after months or even years after the transplantation and can cause a rise in blood pressure. A stent might be placed inside the affected artery to prevent further narrowing.
  • The ureter, the tube that carries urine from the kidney to the urinary bladder might be blocked after a kidney transplant. A catheter is used or surgery may be required in order to unblock the ureter.
  • Urine leakage may occur from the ureter can occur during the first month after the surgery. This may result in fluid accumulation in the abdomen or leak through the surgical incision.
  • Acute rejection is the most common complication during the first year after a transplant in spite of anti-rejection medication. It means the immune system suddenly starts to attack the transplanted kidney.
  • The long-term use of immunosuppressants to lower the body’s ability to reject the transplanted kidney can increase the risk of developing certain types of cancers.

Diet After Kidney Transplant:

After the kidney transplant, the person is instructed to follow a well-balanced diet to ensure the health of the new kidney. A diet chart is prescribed to offer a nutritious diet with the right balance of carbohydrates, protein, and fats. The diet plan is designed in such a way that it focuses on the underlying medical conditions which can contribute to kidney failures such as diabetes, high blood pressure, or cardiovascular disease to reduce the risk of damage to the new kidney.

A healthy diet is essential to keep the transplanted kidney healthy and minimize the chances of infection and organ rejection.

Exercise After Kidney Transplant:

Exercise and physical activity must be a regular part of one’s life after a kidney transplant. A moderate exercise routine post-transplant surgery helps maintain the physical and mental health. It also boosts the energy levels and increases strength. Exercise helps to maintain healthy weight, reduces stress and prevents common complications such as high blood pressure and cholesterol levels. Walking or any kind of lighter exercises like swimming, cycling etc can help the patient develop a healthy lifestyle after kidney transplant which paves the way to a longer life.

Frequently Asked Questions About Kidney Transplant:

How does the quality of life of a person change after getting a kidney transplant?

People who undergo a kidney transplant observe an improvement in their quality of life. They feel much better with increased energy levels and more time, as they need not spend hours for dialysis each week.

How long does a transplanted kidney last?

Nowadays kidney transplants are very successful with a success rate of more than 95 percent. Living donor transplants last for an average of 15 to 20 years, as a living donor kidney is transplanted as soon as it is taken from the healthy donor. While the deceased donor transplants last for 10 to 15 years.

Can a person live longer with a kidney transplant compared to staying on dialysis?

Yes, patients who undergo a kidney transplant usually live longer when compared to those who stay on dialysis. This is because the transplanted kidney works continuously for 24 hours a day and removes around 50 to 85% of the total wastes generated by the body. While dialysis only removes 15% of total waste and only when the patient is on the dialysis machine.

What happens to a person if a kidney transplant didn’t work?

There are only a few cases in which the transplants fail. If the transplant fails, the patient should

  • start or resume dialysis
  • pursue another transplant

How long does the transplantation surgery last?

A kidney transplant is a major operation and it requires a general anesthetic. As all the blood vessels from the lower abdomen are connected to the transplanted kidney much like an original kidney to ensures the blood supply, the surgery lasts about two to three hours.

Who can be a donor for the kidney transplant?

In most cases, a living – donor kidney transplant usually involves the donation of a kidney from someone the recipient knows, such as a family member, friend or co-worker. Genetically related family members are most likely to be compatible living donors for the kidney transplant. Sometimes, a living donor may also be a person who is not known or genetically related. A good living donor candidate is someone who is healthy and has no evidence of high blood pressure, diabetes, kidney disease, cancer, heart disease or hepatitis. The donor must be over 18 and usually less than 70 years of age.

Does living kidney donation pose any risks to the donor?

Usually, the donor’s risk of mortality is low. But the possible long-term risks to the donor after donating a kidney include:

  1. High blood pressure
  2. Loss of protein in the urine
  3. A hernia
  4. Bloating in the abdominal area or bowels
  5. Nausea
  6. Impairment of remaining kidney or possible organ failure that leads to the need for dialysis

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