A kidney transplantation is a surgical procedure to place a healthy kidney from a living or deceased donor into a patient whose kidneys are not functioning any more properly. The kidneys are two bean shaped organs located on each side of the spine just below the rib cage, with each one being the size of a fist. The main function of the kidney is to filter and remove waste, minerals and fluid from the body in the form of urine. When these functioning kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in the body, hence raising the blood pressure and finally resulting in kidney failure (end stage kidney disease). End stage renal disease occurs when the kidney has lost 90% of its ability of functioning normally.
There could be many reasons for a kidney failure:
- Chronic glomerulonephritis- an inflammation within your kidneys resulting in scarring of the tiny filters.
- Chronic high or low blood pressure.
- Inflammation/scarring of kidney filters.
- Polycystic kidney disease.
Now people with end stage renal disease need to have the waste removed from their bloodstream by the method of dialysis or kidney transplantation. Team of nephrologists in Bangalore will discuss the case of the patient and arrive at the best treatment for him/her. Quick tests would be done, appointments scheduled in coordination with your transplant care team to decide what is best for your body now.
If the donor is a blood relative:
Members of the family, spouse(living, related donors) and friends can (living, unrelated) can safely donate one kidney if the medical tests show that the donor would have one kidney functioning properly after donating the other kidney. Usually a perfect match is from a brother or a sister, but sometimes it is from the national registry, although the chances of the former are much higher than the latter. There is a match test done to find out whether the kidney that is donated matches the recipient. Take a consultation with the best nephrologist in Bangalore.
Kidney Transplantation Surgery
After matching the kidney of the donor, a kidney transplant is done by placing the kidney over the lower belly without removing the failed kidney of the patient. The artery and the vein of the new donor kidney would be joined to an artery and vein in the pelvis next to the bladder. The ureter (the tube that drains urine from the kidneys into the bladder) attached to the new kidney is joined to the bladder or to one of the ureters. The kidney transplantation of a living donor would allow the kidney to start working immediately, but in a deceased donor the kidney transplant can take some time to start functioning properly. It might take several weeks before the new kidney starts functioning. Therefore in such a case the patient needs to be on dialysis until then.
Risks associated with kidney transplantation include:
- Rejection of transplant
- Side-effects of medications given fro anti-rejection
- Blood clots.
- Heart stroke.
Advantages of a kidney transplantation over dialysis
- Kidney transplant is a one time major surgery, while dialysis needs to be done on a daily basis and takes a few hours.
- The kidney transplant surgery involves a surgery replacing the unhealthy non-functioning kidney with a healthy one.
- Lower risk of death.
- Fewer dietary restrictions.
- Lower treatment cost.
- Getting a kidney transplant provides a better quality of life and a longer life as well.
Once you have been diagnosed with a non-functioning kidney and you are suggested to have a kidney transplant, meet a well known nephrologist at Bangalore for a good consultation. Only one donated kidney is enough to replace two failed kidneys, hence making living -donor kidney transplantation an option. Nevertheless for some people with kidney failure, a kidney transplant could be more risky than dialysis. Let us find out what could be that category of people:
Conditions that may prevent you from being eligible for a kidney transplant :
- Advanced age
- Severe heart disease
- Active or recently treated cancer.
- Dementia or poorly controlled mental illness
- Alcohol or drug abuse
- Any other factor that could hinder the ability of a safe procedure of kidney transplant and medications needed post the surgery to prevent organ rejection.
Life expectancy after a kidney transplantation – A living donor kidney functions upto around 12 to 20 years, while a deceased donor kidney from 8 to 12 years. These patients who get the kidney transplant done before the dialysis live on an average of 10 to 15 years longer if they continue with dialysis.
Success rate for a kidney transplant – in the case of a living donor kidney has been reported as 97% in one particular year, while 86% after 5 years. But the success rate of a deceased donor kidney was 96% at 1 year and 79% at 5 years.
Normalcy of life after kidney transplant – Usually a successful kidney transplant surgery would allow a patient to live the kind of life he/she wishes to live. Studies have shown that people with kidney transplants live longer than those who remain only on dialysis.
The biggest problem of kidney transplant – is death from cardiovascular disease, infection, and malignancy which are common complications of immunosuppression. Viral infections and donor transmitted infections do emerge after the next few years.
Disadvantages of kidney transplantation – are bound to happen as it is a major surgical procedure, with risks both during and after the surgery. Some commonly noticed risks are infection, bleeding, and damage to the surrounding organs. Death can occur in rare cases.
Dialysis is not necessary after a kidney transplantation – since your new kidney will filter your blood. So to prevent your body from rejecting your donor kidney, you would need medications to suppress your immune system.
Complications involved in Kidney Transplantation –
- Blood clots and bleeding
- Leakage or blockage of the ureter that links the kidney to the bladder.
- Failure or rejection of the donated kidney
- Infection or cancer that can be transmitted with the donated kidney.
- Death, heart attack or stroke.
Side effects of kidney transplantation include:
- Increased risk of cancer, specially skin cancer and lymphoma
- Puffiness (edema)
- Weight gain
How to choose the right Kidney transplant centre:
- Find out the number of transplants the center performs each year
- Ask about the number of survival rates after the kidney transplants
- Compare the statistics of the transplant center through the database maintained by the Scientific Registry of Transplant Recipients.
- Check if the center offers any donation programs that might increase your chances of receiving a living-donor kidney.
- Costs that would be incurred before and after the kidney transplant procedure. The costs should include tests, organ procurement, surgery, hospitalization and follow-up appointments.
- Other services provided by the center, such as support groups, travel arrangements, local housing for recovery period and referrals to other resources.
- The center’s involvement in the latest transplant technology and techniques that would indicate the growth of the program.
Transplant team assessment include:
- Are you healthy enough to undergo the surgery and tolerate life-long post-transplant medications?
- Do you have any medical conditions that could interfere with a successful kidney transplant?
- Are you willing and able to take medications as directed and also follow the suggestions of the transplant team.
- A thorough physical examination.
- Imaging studies, x-ray, MRI and CT scans.
- Blood tests
- Psychological evaluation
- Any other necessary testing suggested by the nephrologist.
- Blood typing for donor-kidney match
- Tissue typing for donor-kidney match
- Crossmatch, a matching test for donor-kidney match.
Staying Healthy: Ensure that you stay healthy and active while you are waiting for a donated kidney/transplant surgery so that you can go through the procedure easily, recovery is faster post surgery. Let us look at certain conditions you would need to follow during this period:
- Medicines should be taken as prescribed.
- Regular diet and exercise need to be followed.
- Quit smoking, talk to your doctor if need be.
- Keep all appointments with your nephrologist in Bangalore.
- You should be relaxed by spending quality time with your family and friends.
Be sure to intimate your transplant team about any unusual changes in your health during this period. Always be connected to your healthcare team in case you are waiting for a donated kidney. Your hospital baggage should be ready along with the transportation you would be taking to reach the transplant centre in advance.
Steps of the Transplant Surgery:
Kidney transplantation surgery is performed on general anaesthesia, as the surgical team manages your heart rate, blood pressure and blood oxygen during the procedure. The steps of the surgery are as follows:
- An incision is made on the lower part of one side of your abdomen to place the ney kidney. The new kidneys are left there if they are not causing complications such as high blood pressure, kidney stones, pain or infection.
- The blood vessels of the new kidney are attached to the blood vessels in the lower part of the abdomen, just above one of your legs.
- The ureters of the new kidney are connected to your bladder.
Post kidney transplant surgery:
- One week at the Hospital: You should be under proper supervision in the hospital’s transplant recovery area to watch for any complications after surgery. Your new kidney will be efficient enough to make urine on its own, either immediately or after several days, during which time you may need to undergo dialysis until proper functioning.
- The healing process comes with some pain and soreness in and around the incision area. You can return to normal activities within eight weeks after the transplant.
- Do not lift any objects more than 10 pounds or exercise, as only walking is advised until you heal fully, which would be around six weeks after surgery.
Healing process needs frequent checkups:
- Once you are out of the hospital post surgery, you need to keep a close monitoring with your doctors’ team to check the proper functioning of the new kidney.
- Blood tests would be needed several times a week so that the medications given are at the right dose after transplant.
Medications to be taken for your lifetime:
- Number of medications would be prescribed after the kidney transplant which need to be taken meticulously on time.
- Drugs known as immunosuppressants(anti-rejection medications) would help keep your immune system from attacking and rejecting the new kidney.
- Other drugs would be prescribed that help reduce the risk of post surgery complications, such as infection after the transplant.
In case of any side effects post surgery, inform your transplant team immediately to prevent any further complications. Also, ensure that you make self-checks or checkups with a dermatologist to screen for skin cancer if any. Nephrologist in Bangalore to be consulted if you have any kidney disease with some complications.