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Kidney Transplant

Kidneys are bean shaped organs that play a pivotal role in eliminating the toxic material from the body through urine. A pair of kidneys is present in the body just below the rib cage on the either side of the spinal cord. A kidney transplant is a surgical process in which a donor donates one of the kidneys to a patient suffering from an end-stage renal disease. End-stage renal disease is the critical stage of kidney’s failure where the kidneys fail to function.

A donor is a person who donates one of his kidneys to a person with chronic kidney disease, such as kidney failure or end-stage renal disease. A live donor is a person who is fit and healthy, belongs to the same family or another; same ethnic origin, and same blood group of the patient. A deceased donor is a person, who is almost dead, but his kidneys are functioning properly and are in a healthy state.

Causes

 The common causes of kidney failure are:

  • Diabetes
  • Chronic uncontrolled high blood pressure
  • Glomerulonephritis
  • Liver disease or liver failure
  • Heart disease or heart attack
  • Major surgeries
  • Inherited kidney diseases
  • Vascular diseases
  • Amyloidosis
  • Rheumatoid arthritis
  • Gout
  • HIV/AIDS
  • Sickle cell anemia
  • Past kidney transplant
  • Polycystic kidney disease

Procedure

Kidney transplant is a surgical procedure performed under the influence of general anesthesia where the patient is put to sleep. Catheters are placed on the body near the groin, chest, neck, and wrist to monitor vital responses such as heart beat, and blood pressure. A tube is inserted into the lungs through the mouth; this tube is attached to a ventilator to provide breathing during the procedure.

A long incision is made deep into the lower abdomen on one side. The doctor examines the donor’s kidney and places it into the abdomen. The left donor kidney is implanted on the patient’s right side and right donor kidney on the left side. This allows proper access to the ureter and connection to the urinary bladder.  The renal artery and vein of the donor’s kidney are sewed to the external iliac artery and vein of the patient. The blood flow through these blood vessels is checked for any bleeding at the suture lines. The donor’s ureter is connected to the patient’s urinary bladder. The incision is closed with stitches and surgical staples. 

Complications

The risks associated with kidney transplantation are:

  • Kidney rejection: The immune system of the body recognizes the donor’s kidney as foreign and tries to kill it. Immunosuppressant medications are given to suppress the immune system.
  • Side effects of medications: Immunosuppressant medications that are given to suppress the immune system cause many side effects.
  • Infections: As the immune system is suppressed due to immunosuppressant medications, the body cannot fight any infections, and causes various other problems.
  • Surgery: A kidney surgery has complications like bleeding, infections, blockage of the blood vessels, leakage or blockage of urine in the ureter etc. >
  • Cancer: Increased risk of cancer in patients due to the use of immunosuppressant drugs.
  • Failure of the donor’s kidney: In major cases, there is the risk of failure of functioning of the donor kidneys that leads to dialysis again.
  • Severe health complications: There are other serious health issues that arise due to kidney transplant such as liver cirrhosis, heart disease, cataracts, blood pressure and diabetes.

The success rates of a kidney transplant depend on the following conditions:

  • Kidney donor life status (living donor or deceased donor)
  • Kidney matching in terms of blood group, and tissue type
  • Age and overall health of the recipient (patient)

Follow-up after kidney transplantation 

Kidney transplant needs a lifetime commitment from the patient. Regular follow-up is required for monitoring the signs of organ rejection in the patient. The physician orders for certain laboratory tests that include:

  • Blood analysis and urine analysis for detecting any signs of organ failure.
  • An imaging test such as ultrasound test is performed on the grafted kidney to detect any structural abnormalities due to rejection.
  • An arteriogram test is performed to confirm the flow of blood into the transplanted kidney.

Post procedure Care

The following modalities help in keeping the transplanted kidney safe and effective.

  • Maintaining a proper and balanced diet, and drinking adequate amounts of water, helps in keeping the transplanted kidney healthy, hydrated and effective.
  • Avoiding smoking and triggering factors such as dust, pollution, pollens, and dander helps in preventing infections like flu, cold, etc.
  • Avoiding vaccinations such as rubella, BCG, mumps, measles etc helps in preventing contact with persons receiving these vaccinations.
  • Maintaining a proper body weight, avoiding high-calorie foods helps in maintaining the transplanted kidney.
  • Exercising regularly helps in keeping the body weight under control, burns the calories, prevents high levels of cholesterol, strengthens the heart, and keeps the bones healthy which aid in maintenance of the kidney.
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