Kidney transplantation or renal transplantation is the transplant of a healthy kidney in a patient with end-stage renal disease. The transplanted kidney takes over the work of the two kidneys that have failed, so one does not need dialysis. Kidney transplantation is typically classified into two types, one where a deceased-donor kidney is used and another is with Living-donor transplantation where kidney comes from a living family member.
The end-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally. A few common causes of end-stage kidney disease include Diabetes, Chronic, uncontrolled high blood pressure, chronic glomerulonephritis, an inflammation and eventual scarring of the tiny filters within your kidneys, glomeruli etc. People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.
Causes for Kidney Failure
- Kidney failure is usually caused by other health problems that have done permanent damage to the kidneys little by little, over time.
- When kidneys are damaged, they may not work as well as they should. If the damage to kidneys continues to get worse and kidneys are able to work efficiently, one gets chronic kidney disease. Kidney failure is the most severe and last stage of chronic kidney disease. This is reason why kidney failure is also called as end-stage renal disease or ESRD.
Diabetes is the most common cause of ESRD and High blood pressure is the second most common cause of ESRD. Risk factors that can cause kidney failure include:
- Autoimmune diseases
- Genetic diseases such as polycystic kidney disease
- Nephrotic syndrome
- Urinary tract problem
- Cancers including renal cell carcinoma, lymphoma etc
- Heart disease
- Liver Disease or Liver failure
- Vascular disease like Renal artery thrombosis ,progressive systemic thrombosis etc
Candidate for Kidney Transplantation
The kidneys remove excess fluid and waste from your blood. When kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in our body – a condition known as kidney failure or end-stage kidney disease.
If one is diagnosed with End Stage Renal Disease or if Glomerular filtration rate is less than 15ml/min/1.73 sqm or if there is no other way of restoring the kidney functions, and if one is healthy enough to undergo surgery, he/she can be a good candidate for the kidney transplant surgery.
Step 1 – Review of Reports and case analysis by Kidney Transplant Team on the basis of available medical reports.
Step 2 – Recipient (Patient) and Donor undergo pre-transplant work up like blood tests (A, B, AB or O) and HLA (human leukocyte antigen) typing.
Step 3 – Donor compatibility is assessed by the transplant team based on HLA testing. If the HLA type of the patient matches with the donor, then it is more probable that the patient’s body will not reject the kidney.
The No-Objection Certificate issued to the patient by the High Commission of the native country in India is submitted at the hospital
Step 4 – Case forwarded to the transplant committee for approval. Patient submits all necessary documents to the transplant committee for approval of transplant
Step 5 – Committee approval (May take 2-4 weeks after submission of all the necessary documents)
Step 6 – Patient undergoes transplant after Transplant Committee’s approval
The kidney transplant surgery is a very complex procedure which is performed under general anaesthesia.
Once the anaesthesia starts taking effect, the surgeon makes an incision in the abdomen and the diseased kidney is reached. The surgeon then places the donor’s kidney in the abdomen by connecting the blood vessels of the kidney to the patient’s arteries and veins. This starts the blood flow through new replaced kidney. After that the surgeon connects the ureters to the urinary bladder to let the patient micturate normally. Depending on the kidney disease, the surgeon decides to leave the diseased kidney inside the body. If he suspects that diseased kidney can cause any problems like high blood pressure etc, then removing it is the best option.
Once the kidney is transplanted, the incision is sutured back and both the patient and donor are transferred to the ICU.
After a successful kidney transplant, new kidney will filter blood, and patient will no longer need dialysis.
The results of kidney transplantation procedure are satisfying and good. The life expectancy of more than 90% patient who underwent live donor kidney transplant increases by 5 years and of 80% patient increases by more than 10 years.
The patient is taken to the ICU immediately after the surgery, where the patient is monitored; following which patient is shifted to the transplant care unit for another 1 week.
To prevent body from rejecting the donor kidney, one needs to take medications throughout the life to suppress immune system. Since these anti-rejection medications make body more vulnerable to infections, doctor may also prescribe antibacterial, antiviral and antifungal medications.