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.
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.
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.
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.
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%.
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.
Factors that may affect long-term outcomes of kidney transplantation include
Quality of the kidney
Living donor versus deceased donor
SCD versus ECD versus DCD donor
Age at the time of transplant
History of kidney disease
Human leukocyte antigen (HLA) matching
Time on dialysis
Graft function in the course of transplantation
Prevention of rejection and compliance
Specific side effects
Infections and cancer
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.
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
Antibodies against the donor’s kidney
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
If the transplanted kidney fails, patients have two options - either go for second renal transplantation or undergo dialysis.
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
HOD And Consultant - Urology
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