Kidney Transplant

What is a Kidney Transplant?

Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the "graft") takes over the functions of your nonworking kidneys. You can live normally with only one kidney as long as it functions properly.

The transplantation itself is a surgical operation. The surgeon places the new kidney in your abdomen and attaches it to the artery that supplied blood to one of your kidneys and to the vein that carries blood away from the kidney. The kidney is also attached to the ureter, which carries urine from the kidney to the bladder. Your own kidneys are usually left in place unless they are causing you problems, such as infection.

Kidney transplantation is not a particularly difficult or complicated operation. It is the period after the surgery that is most critical

End stage kidney disease causes the kidneys to stop functioning and that is the stage of Kidney transplant. However, the causes of ESRD (End stage Renal Disease) are Chronic Hypertension and Diabetes Mellitus.

What will be done before a Kidney Transplant in India?

For Recipients

• A very detailed medical evaluation will be required spread over weeks to a month. The purpose of this thorough evaluation is to test whether you would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

• Your blood and tissue will be typed so that you can be matched to a donor kidney. This significantly lessens the chance of rejection

• You will have blood and urine tests to monitor your creatinine level, other organ Functions, and electrolytes levels.

• You will have x-rays, ultrasounds, CT/MRI scans, and other imaging tests as needed to make sure your other organs are healthy and functioning.

For Donors

• The donor should be of sound health. He will also be evaluated on the entire medical Parameters as the recipient.

Most, but not all patients waiting for a kidney transplant are on dialysis. While you are waiting for a kidney, follow these steps:

• Follow any diet your transplant team recommends.

• Do not drink alcohol.

• Do not smoke.

• Keep your weight in the range that has been recommended. Follow any recommended exercise program.

• Take all medicines as they have been prescribed for you. Report changes in your medications and any new or worsening medical problems to the transplant team.

• Follow up with your regular doctor and transplant team on any appointments that have been made.

• Make sure the transplant team has the correct phone numbers so they can contact you immediately if a kidney becomes available. Make sure, no matter where you are going, that you can be contacted quickly and easily.

Living-Donor: In a living donation, one of a donor's two healthy kidneys are removed. This kidney is transplanted into the kidney patient. A donor who is fit and well before the operation will be able to live a completely normal life with the remaining healthy kidney. The most successful transplants come from living donors. In India, only a living relative donates a kidney for transplant. A living related transplant is more likely to work than a cadaveric transplant.

A Cadaveric Transplant is a kidney removed from someone who has died. Cadaveric kidneys are only removed after a series of tests have established that the donor is brain dead. This means that the part of the brain called the brainstem, which controls breathing, has permanently stopped working. A brain-dead patient is only being kept alive by a life-support machine.

Once the patient is referred to the transplant centre, he will be thoroughly evaluated by a transplant team. Certain tests are advised before the kidney transplantation procedure:

• Tissue and blood typing

• Blood tests

• Skin tests

• Heart tests such as an EKG, echocardiogram, etc.

• People receiving a kidney transplant are given general anesthesia before surgery. The surgeon makes a cut in the lower abdomen area.

• Surgeon places the new kidney inside the lower abdomen. The artery and vein of the new kidney are connected to the artery and vein in the pelvis. Ureter is then attached to the bladder. Patient’s own kidneys are left in place, unless they cause, high blood pressure, infections, or are too large for the body. The wound is then closed.

• Kidney transplant surgery takes about 3 hours. People with diabetes may also have a pancreas transplant done at the same time which usually adds another 3 hours to the surgery.

A nephrectomy is the surgical term for the removal of a kidney. A healthy kidney intended for donation is normally removed by one of the two procedures.

Laparoscopic Nephrectomy - A laparoscopic nephrectomy is performed under a general anaesthetic. Three or four small abdominal incisions are made in the abdomen to provide access for surgical instruments that are used to detach the kidney and to ligate the blood vessels. The intact kidney is enclosed in a bag and removed through an incision or it may be placed in an impermeable sack, morcellated and removed through one of the port sites. Laparoscopic Nephrectomy provides patients with a safe and effective way to remove a diseased or cancerous kidney. Laparosopic nephrectomy is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery.

• Open Nephrectomy - In a traditional, open nephrectomy, the kidney donor is administered general anesthesia and a 6–10 in (15.2–25.4 cm) incision through several layers of muscle is made on the side or front of the abdomen. The blood vessels connecting the kidney to the donor are cut and clamped, and the ureter is also cut between the bladder and kidney and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The kidney is removed and the vessels and ureter are then tied off and the incision is sutured (sewn up). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.

Kidney transplant surgery takes about 3 hours. People with diabetes may also have a pancreas transplant done at the same time. This will usually add another 3 hours to the surgery. Kidney transplant surgery usually lasts three to five hours.

The damaged kidneys are generally left in place and the new kidney being placed in the lower abdomen. The artery and vein of the new kidney will be attached to an artery and vein in the lower part of the abdomen, just above one of the legs. The new kidney's ureter, the tube that links the kidney to the bladder, will be connected to the bladder. The transplanted kidney may function immediately. In some cases the kidney begins to work only after a week or so. Soreness or pain around the surgery site is common.. The recovery time in the hospital is usually about seven days.

How will a kidney transplant change my life? There are many advantages to transplantation, including freedom from dialysis as well as diet and fluid restriction. Most important, however, is the quality of life almost everyone enjoys after transplantation. Patients are able to perform most, if not all, of the activities they were able to perform before the onset of kidney disease: work, exercise, recreational activities, etc. Almost everyone feels that they have a better quality of life after the transplant. For those who receive a close match, up to 90% are still alive after 1 year, and more than 70% are alive after 5 years.

In order to avoid rejection, almost all kidney transplant recipients must take medicines that suppress their immune response for the rest of their life. This is called immunosuppressive therapy. Although the treatment helps prevent organ rejection, it also puts patients at a higher risk for infection and cancer. If you take this medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol and increase the risk for diabetes. A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed

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.

You may want to ask some questions before your treatment begins: