Kidneys remove excess fluid and waste from blood. When kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in body — a condition known as renal failure. To replace the failing kidney, renal replacement therapy in form of hemodialysis, peritoneal dialysis, and renal transplant is available. A kidney transplant is often the best treatment for kidney failure.
A kidney transplant is a surgical procedure to place a functioning kidney from a donor into a person whose kidneys no longer function properly. The kidney may come from a living donor or from a deceased organ donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. If kidney is harvested from a cadaver or brain dead patient it is called cadaveric donor.
Prospective renal transplant patient is evaluated by the transplant team. The transplant team includes a transplant surgeon, a transplant nephrologist, transplant coordinator, a social worker, and a psychiatrist.
A potential donor must have a compatible blood group and be in good health and preferably in age group 18-60 years. Both donor and recipient undergo various laboratory investigation. Commonly advised investigations are as follows:
Blood tests : CBC, KFT,LFT, HbsAg, Anti HCV, HIV, FBS, PPBS, Lipid profile, IgG and IgM for CMV.
Urine test : Urine R/E, Culture
Radiology tests : CXR, USG Abdomen, Echocardiography, ECG, DTPA scan and CT Angiography of renal vessels(donor)
Immunological test : HLA typing , Cross matching
Others : Urine R/E, Culture
Psychological and social evaluation
After a thorough evaluation of donor and recipient, papers are processed for transplant committee approval as per the THOA act. Patient is taken for transplant surgery after committee's approval. Patient is admitted two days and donor one day prior to surgery. One or more session of hemodialysis is required before surgery. Surgery is done under general anesthesia. The surgeon makes an incision and places the new kidney in the` lower abdomen. Unless the native kidneys are causing complications such as high blood pressure or infection, they are left in place.Kidney transplant surgery usually lasts about three to four hours. A kidney from a living donor may begin to make urine immediately, but urine production in a cadaver kidney may take longer. Patient is shifted to kidney transplant ICU after recovery from anesthesia. In the ICU special monitoring of vitals, IV fluid infusion and urine output is maintained. Immunosuppressive medications are given to prevent rejection of graft kidney.
The antirejection medications most commonly used in combination include:
Immunosuppression medications is closely monitored to make sure optimum dose and the best combination is prescribed. Kidney transplant recipient is discharged normally after 10 days and donor is discharged after 5 days in hospital.
Individuals who donate a kidney can live healthy lives with the remaining kidney.
After discharge from hospital, regular follow up is required with your nephrologist as per hospital protocol. The frequency of follow will decrease with passage of time. The stitches or surgical staples are removed during follow-up. DJ stent is removed after 4 weeks of transplant surgery. Medications are continued life long, the dose of which is adjusted during follow-up visits.
Few things to watch out for and consult nephrologist at earliest include :
Fever, which may be a sign of rejection or infection
Redness, swelling, or bleeding or other drainage from the incision site
Increase in pain around the incision site
Increase in creatinine
Kidney transplant survival rates
Graft survival and patient survival after 1 year of live related renal transplant is 95% and 98% respectively. After 5 years graft survival and patient survival is 80% and 90% respectively.