Kidney Transplant
Overview
Kidney Transplantation (Renel Transplantation), is a surgery that involves the implantation of a healthy donor kidney to a patient suffering from an end-stage renal disease (ESRD).
A Kidney Transplant is done when the patient is suffering from End-Stage renal Disease (kidneys lose about 90% of their functioning). The common causes that may lead to this condition are:
- Uncontrolled/high blood pressure
- Diabetes
- Polycystic Kidney disease
- Analgesic Abuse
- Glomerulonephritis
The patient usually has three options available:
Haemodialysis: The patient requires atleast 2-3 dialysis sessions per week in the hospital. To maintain such a patient on dialysis, a vascular access is required through which arterial blood is pumped in the dialysis machine. After cleaning, the blood is then returned to the body.Continuous Ambulatory Peritoneal Dialysis (CAPD): In this, a tube is inserted in the abdomen by doing a small operation. The patient fills the dialysis liquid in the abdomen and keeps it for 60-90 minutes. Around 2-3 exchanges are to be made daily to keep the body functions normal. The procedure is comparatively costly and can lead to infection if not done properly.
Kidney Transplant: A healthy kidney from another person is placed in the patients’ body to sustain normal renal functioning. The patient is kept on dialysis till the time renal transplant is done. The procedure ensures a normal functioning for the patient. At Max, we offer we offer all kinds of kidney transplants, including an advanced ABO Incompatible Kidney Transplant procedure (transplant without a blood type match), Second Transplant, Paediatric Transplant etc.
The appropriate candidates will be the one:
- In whom the transplant can be successfully performed
- Who are able to withstand the after effects of surgery
- Who adheres to the treatment plan suggested by the doctor and attends follow-up checkups.
| Patient Blood Group | Donor Blood Group |
| AB | A, B, AB, O |
| A | A, O |
| B | B, O |
| O | O |
Renal transplantation is the definitive treatment for patients with end stage renal disease (ESRD). ESRD can be defined as patients who are suffering with chronic kidney disease (CKD) and require regular dialysis or possibility of permanent dialysis requirement is imminent.
Renal transplantation is one of the best ways to treat the patient suffering from the end-stage renal disease. Below are some of the advantages of a renal transplant:
- Treats kidney failure
- Quality Life
- No More Dialysis
- Increased Life Expectancy
- Immunosuppressant medications are started 2 days before transplant for the Recipient.
- Additional Induction of immunosuppressant is given to recipient night before surgery depending upon the matching with donor to reduce the chances of rejection.
- Dialysis is done a day before the kidney transplant procedure.
- Blood is cross-matched and arranged for the surgery as kidney patients are usually anemic.
- The transplant team informs the patient about the procedure and clarifies any doubts related to the transplant.
- Documentation and consent form are to be filled and signed.
- The patient is not allowed to eat at least 8 hours before the transplant
Before the Procedure:
Before renal transplant surgery, donor and recipient have to undergo certain investigations related to fitness for surgery, matching of kidney and proof of relationship. Donor is evaluated whether he / she is fit for donation and not suffering with any disease which can impact his life after donation. Better one of his two kidneys, is left with donor. Certain legal formalities have to be done for approval of renal transplantation by committee.
The other hand, in cadaveric donation, two to three blood group matched ESRD patients are called as per waitlist, as and when cadaveric kidney is available for transplantation. They are prepared for transplantation and one who has best cross match with donor kidney receive the kidney graft.
During the Procedure:
During the renal transplant procedure, the surgeon makes an incision on one side of lower abdomen, and the donor kidney is placed in abdomen. The blood vessels of the donor kidney are connected to the arteries and veins of the patient. The ureter of the donor kidney is also connected with the bladder of the patient. A siliconized stent is placed inside donor kidney to patient urinary bladder which is usually removed two weeks after surgery by simple procedure of flexible cystoscopy. A urinary catheter and drainage tube are also placed which are removed before discharge from hospital. Abdominal incision is closed by fine suture or staples. Patient is usually kept for 7 days is hospital.
Donor kidney is removed by laparoscopy usually which involve 3-4 small holes and one small lower abdominal cut to remove kidney. Donor is usually discharged from hospital after 4 days of surgery.
After the Procedure:
The patient usually makes lot of urine in tune of half to one liter per hour which usually sets to 2-3 liter per day after 5-7 days of surgery. His creatinine improved to normal. Immunosuppressant drugs are given and monitored as per their level in blood.
Even after getting discharged, the patient needs to visit the hospital for regular checkups initially twice a week for a month and weekly for next month. He has to continue immunosuppressant medication for life.
Just like every transplant, renal transplant is also associated with some of the risks and complications that can occur after the kidney transplant procedure. Some of the complications a patient may experience after a renal transplant are rejection of the donor kidney, infection, bleeding, failure of the donor kidney and reaction to medications. Regular follow up and investigations are required for early diagnosis and treatment of any of these complications.
Types of Donors:
- Living Donor: Usually healthy individual has two kidneys and he can donate one kidney without any implication to his future life. If any healthy blood group matched relative of ESRD patient donate a kidney for him, it is called living kidney donation.
- Decease Donor: Organs taken from brain dead or sometime, cardiac death patients are used to give new life to patients suffering with end organ damage. Both kidneys of such brain death patients are used and two patients of ESRD are transplanted each kidney. Such transplantation is governed by NOTTO (National Organ & Tissue Transplant Organisation). Hospitals with transplant facilities maintain a waiting list of ESRD patients for this purpose.
On the other hand, the kidney taken from a deceased donor is called a deceased donor kidney, and patients must get their names listed on the waiting list to get the chance for the transplant.
Minimum Requirements of an ABO Incompatible Donor
- Donor should be of the same blood group or O +ve like in blood transfusion. Such a transplant is called as ABO compatible Kidney Transplant.
- Donor’s kidney must be in a good condition to sustain normal renal functioning.
- A HLA typing is also done to determine how many antigens are matching. Minimum mismatch means a long term graft survival.
How is the Donor Outcome?
At Max, we are doing laparoscopic donor nephrotecomy that allows the patient to move around freely from the next day. Generally discharging is done on the 3rd and 4th post-operative day. However, long term follow up shows that with proper modification of lifestyle, the patients can lead a normal life.
