Kidney Transplant - When is it needed?

What is a kidney transplant?

A kidney or renal transplant is a surgical procedure where a diseased (non-functioning) kidney is replaced with a healthy kidney from a donor.

Kidney transplant is associated with a lower risk of death, fewer dietary restrictions and a better quality of life.

What is the indication of getting a kidney transplant?

The indication of getting a kidney transplant is when a patient is at the end-stage renal disease (ESRD).  It is the last stage of chronic kidney disease, where the kidney fails to function completely. 

  • The common causes of end-stage renal disease are diabetes, high blood pressure, and autoimmune diseases. 

  • Genetic factors may also play a role in end-stage renal disease. 

  • Other causes include recurrent urinary infections, glomerulonephritis, polycystic kidney disease, hemolytic uremic syndrome, and obstructions. 

What is the statistic in India?

  • The prevalence of end-stage renal disease requiring a transplant is about between 151 and 232/million population. 

  • About 7500 renal transplantations are done at 250 kidney transplant centers in India. 

What types of operations are performed?

Renal transplantation is done usually by open surgery (open donor nephrectomy). 

The other option available is a laparoscopic approach (laparoscopic donor nephrectomy), which is less invasive.  

What is the of prognosis (outcome) of renal transplantation?

After receiving a kidney transplant, the prognosis is usually excellent. 

  • A 1-year transplant has a survival rate of 93% to 98%. 

  • A 5-year transplant has a survival rate of 83% to 92%. 

What are the types of donors?

There are three types of donors. The donated organ is either from a living related person, a living and not a related person or a deceased person. 

  • The donated organ from a living person is from a blood relative such as parents, siblings, and children over 18 years old. 

  • The donated organ from a living person is from someone who is not related such as friends or spouse.

  • A deceased donor transplant is from someone who has already died. This type of donor has various classifications of kidneys.

  • Standard criteria donor (SCD): The deceased donor is less than 60 years old

  • Extended criteria donor (ECD): The deceased donor is more than 60 years old or more than 50 years old with two or more risk factors

  • Deceased donors from cardiac death (DCD) are categorized as controlled and uncontrolled. 

    • The controlled donor is one who had a cardiac arrest due to withdrawal of support or after brain death. 

    • The uncontrolled donor is one who died on the way to the hospital or was unable to resuscitate. 

  • High social risk donors: Donor with a higher chance of spreading infectious disease.  

What are the possible factors that may affect the outcome of renal transplantation?

Factors that may affect long-term outcomes of kidney transplantation include

  1. Donor factors

    1. Quality of the kidney

    2. Living donor versus deceased donor

    3. SCD versus ECD versus DCD donor

  2. Recipient factors

    1. Age at the time of transplant

    2. History of kidney disease

    3. Human leukocyte antigen (HLA) matching

    4. Anti-HLA immunization

    5. Time on dialysis

    6. Cardiovascular comorbidities

    7. Graft function in the course of transplantation

    8. Prevention of rejection and compliance

    9. Specific side effects

    10. Infections and cancer

What are the risks or complications related to kidney transplant?

Some complications after kidney transplantation include infection, bleeding, leakage of urine or blockage of urine in the ureter, obstruction of the blood vessels to the new kidney, the new kidney does not function well in the beginning, side effects of medications, and possible rejection of the new kidney. 

What are the contraindications to receiving kidney transplants?

There are some contraindications to receiving renal transplantation such as:

  • Having cancer that has spread

  • A current or recurring infection that cannot be treated 

  • Heart problems or other medical problems that may not be safe for surgery

  • Serious medical conditions (besides kidney disease) that may not produce a good outcome after transplantation

  • Unable to follow the treatment

  • Psychological problems 

  • Having AIDS

  • Antibodies against the donor’s kidney

What are the precautions or care required after a kidney transplant?

After a kidney transplant, patients need to take immunosuppressive medications which play a role in decreasing the chance of getting the graft rejected. These medications are taken throughout life. 

Other medications that may be required after a kidney transplant include anti-hypertensive drugs, medications for treating infections, calcium, and anti-peptic ulcer drugs. 

Other measures that need be followed: 

  • Taking medications daily

  • Regular follow-up with your doctor

  • Checking blood pressure, blood sugar, urine volume, and weight

  • Proper meals and enough water intake

  • Physical activity but avoiding strenuous physical activity 

  • Avoid smoking and alcohol 

What are the other options if the transplanted kidney fails?

If the transplanted kidney fails, patients have two options - either go for second renal transplantation or undergo dialysis.

When to consult a doctor post a transplant?

  • High fever over 37.8 C or 100 F

  • Symptoms such as cough, shortness of breath, diarrhea, vomiting

  • Visible blood in urine or burning micturition 

  • A rapid increase in weight 

  • A decrease in urine output

  • Swelling/edema 

 

Dr. Sanjay Gangoi

HOD And Consultant - Urology

Manipal Hospitals, Dwarka, Delhi

 

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