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Kidney Transplant

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Kidney Transplant Treatment

Kidney Transplant

In
Dr PB Singh_0
Director - Institute of Renal Sciences

Kidney Transplant - an effective solution for patients suffering from end stage renal disease. The incidences of Kidney failure are increasing alarmingly with factors like hypertension and diabetes contributing to it. Once the kidney starts deteriorating, it becomes Chronic Kidney Disease (CKD).

With time, functioning of kidney progressively deteriorates till it is not able to sustain body functions; this is End Stage Renal Disease (ESRD). At this stage, dialysis becomes mandatory for proper functioning of the body. What are the options available for a patient with End Stage Renal Disease? Haemodialysis: As part of Haemodialysis, a patient undergoes minimum of 2-3 dialysis per week in the hospital.

To maintain such a patient on dialysis, a vascular access is required through which arterial blood is pumped into the dialysis machine. After the cleaning process, blood is returned back into the body.

Continuous Ambulatory Peritoneal Dialysis (CAPD): This is a form of peritoneal dialysis which can be done by the patient himself at home. A tube is inserted into the abdomen surgically, through which dialysing fluid is filled. The patient has to make 2-3 such exchanges daily for normal functioning of the body. This is comparatively costly and may introduce infection if not done carefully. Kidney Transplantation: This is the best method that is also cost effective, where the patient can soon get back to a normal life. A healthy kidney from donor is transplanted into patient to sustain normal renal function. Patient is maintained on dialysis till Kidney transplantation is done. Legally, relatives who can donate the kidney are the patient's mother, father, brother, sister, grandparents and spouse. Unrelated transplantation is possible only in exceptional cases where there is no suitable family donor.

What are the minimum requirements for a Kidney Donor? Donor should be from same blood group or O+ve (universal donor) as in blood transfusion. Such transplantation is called ABO compatible transplantation. Now ABO incompatible renal transplant is also possible with good results. Donor's kidneys must be functioning well so that his/her renal function can be sustained normally with a single kidney after donation. Donor also undergoes HLA typing which determines how many antigens are matching. Minimum mismatch means good and long term graft survival. What is the process for Kidney Transplant? After all formalities are completed, the donor and patient are presented to an independent authorisation committee that has been approved by the govt. for an approval.

The donor kidney is first retrieved through an open surgery or laparoscopic surgery. In the recipient his/her native kidneys are left as such and the new kidney is transplanted in the lower abdomen. During the surgery, the artery and vein of the donor kidney (renal artery) are joined to the artery and vein of the patient, respectively. This restores blood circulation in the transplanted kidney, thus restoring functioning of the kidney. The Ureter of the donor kidney is joined to the urinary bladder, thus completing surgery.

Post-surgery, what should the patient be careful of? In spite of being a relative's kidney, the body's immune mechanism doesn't accept any foreign organ and tries to reject it, making the kidney non-functional. To avoid this, the immune mechanism is suppressed by immuno-suppressive drugs, which need to be taken for life. Post-surgery, patients can resume normal life after kidney transplantation. If antigen match is good, the kidney can function for more than 30 years.