What is Kidney Transplant?

Dr Madan Bahadur

Dr Madan Bahadur

Nephrologist, Jaslok Hospital, 30 years of experience

August 4, 2021 Lifestyle Diseases 300 Views

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What is a Kidney Transplant?

A kidney transplant is a surgical procedure in which a healthy kidney from a donor is placed into a person who suffers from kidney failure. The kidneys are two bean-shaped organs that are situated on either side of the spine just below the rib cage. Kidneys are essential organs that perform major functions such as-

  • Filtration of the blood to remove toxic waste products from the body
  • Regulation of blood pressure 
  • Stimulation of production of red blood cells (RBCs)

When the kidneys stop performing these functions, harmful levels of fluid and waste accumulate in the body which can raise the blood pressure and cause kidney failure i.e., end-stage kidney disease. Common causes of end-stage kidney disease include:

  1. Diabetes 
  2. Uncontrolled blood pressure
  3. Glomerulonephritis, a condition in which there is inflammation of the tiny filters in the kidneys (glomeruli)
  4. Polycystic kidney disease, a condition in which clusters of cysts develop inside the kidneys, resulting in their enlargement and loss of function over time.

Such patients with end-stage kidney disease or renal failure need to have waste removed from their blood through a machine which is known as dialysis or they must opt for a kidney transplant to live a longer and healthy life. A kidney transplant can free you from long-term dependence on a dialysis machine and help you live a more active life. However, a kidney transplant may not be suitable for every individual suffering from renal failure. 

 Let us tell you in detail about kidney transplants through today’s article.

  • What is the purpose of Kidney Transplants?
  • What are the advantages of the Kidney Transplant?
  • Who is not an ideal candidate for a Kidney Transplant?
  • Types of Kidney Transplant 
  • What are the tests done before a Kidney Transplant?
  • Kidney Transplant team
  • What is the preparation done before a Kidney Transplant?
  • What is the procedure for a Kidney Transplant?
  • What is the care to be taken after a Kidney Transplant?
  • What are the side effects of the Anti-rejection medication?
  • What are the complications and risks of kidney transplants?
  • What is the success rate of Kidney Transplants?
  • What is the cost of a Kidney Transplant in India?

What is the purpose of Kidney Transplants?

A kidney transplant can help treat chronic kidney disease or kidney failure and is usually the treatment of choice when the kidneys have lost about 90% of their normal function. 

Some symptoms that can help detect the need for kidney transplantation are-

  1. Swelling of the extremities and face 
  2. Headache and elevated blood pressure 
  3. The pale appearance of the skin
  4. Coffee colored urine ( Know more about- What is Blood in Urine? )
  5. Fatigue 

What are the advantages of the Kidney Transplant?

Patients with kidney failure can also choose to undergo dialysis, however, compared to dialysis, a kidney transplant has the following advantages-

  • After a kidney transplant, the quality of life is better. You no longer have to make frequent trips to a dialysis center to receive treatment and you are free from long-term dependence on a dialysis machine. 
  • There is a lower risk of death 
  • Reduced dietary restrictions 
  • A kidney transplant has a lower treatment cost

Who is not an ideal candidate for a Kidney Transplant?

For certain people, a kidney transplant may be riskier than dialysis and they may NOT be eligible for a kidney transplant in the following conditions – 

  • Severe heart condition
  • Severe active infections such as tuberculosis, hepatitis, etc. ( Know more about- What is Hepatitis B ? )
  • Ongoing cancer or have recently been treated for cancer 
  • Dementia or another poorly controlled mental illness. ( Know more about- What is Dementia? )
  • Drug or alcohol abuse 
  • Old age 

There are many experienced cardiac surgeons in different hospitals across the country where heart surgeries are done with success. Heart Bypass Surgery is also performed by these experienced cardiac surgeons in these hospitals in different cities in India. 

Types of Kidney Transplant 

There are three types of a kidney transplant-

  1. Cadaveric- donor kidney transplant wherein a kidney from a person who has recently died is removed with the consent of the family and placed into the abdomen of the recipient whose kidneys have failed. The donated kidney is either stored on ice or is kept attached to a machine that provides oxygen and nutrients until the kidney has been transplanted. 
  2. Living- donor kidney transplant wherein a kidney from a living person is removed and placed into a recipient whose kidneys have failed. Living donors can be family members such as brothers, sisters, parents, children above 18 years of age, relatives, a spouse, a close friend, or even an unknown person who may wish to donate a kidney. Genetically related family members have higher compatibility and thus it is better to have a family member donate a kidney. The donor should be in good health and well informed about the transplantation procedure. Only a single donated kidney is sufficient to replace two failed kidneys. Hence a living-donor transplant is a good alternative to a deceased-donor transplant and includes advantages such as- 
  • Spending less time on a transplant waiting list. This could prevent possible complications and deterioration of the health of the recipient
  • Dialysis can be avoided 
  • Better survival rates
  • With a living donor, the transplantation surgery can be scheduled in advance. However, with a deceased donor, the transplantation is an unscheduled, emergency procedure. 

In case your donor is incompatible with you, your transplant team might suggest that you and your donor opt for a paired donation program. In this program, your donor gives a kidney to someone compatible with him/her, and then you receive a compatible kidney from that recipient’s donor. 

  • Preemptive kidney transplant wherein a kidney transplant takes place before your kidneys aren’t able to function properly to the point of needing dialysis to restore the normal function. Several factors such as less number of donor’s kidneys, lack of access to transplant centers, low rates of physician referrals among patients of lower socioeconomic status, and lack of physician awareness of current guidelines have been linked to the lower than expected rate of a preemptive kidney transplant. 

end-stage

The advantages of preemptive kidney transplant include-

  • Better quality of life 
  • Higher survival rates 
  • Lower risk of kidney rejection
  • Lower treatment costs

The advantages of pre-emptive kidney transplant are particularly higher in children and adolescents

What are the tests done before a Kidney Transplant?

After you have decided on a transplant center, the transplant team will evaluate you to see if you meet the eligibility criteria for a kidney transplant. 

The team will evaluate whether you-

  • Are healthy enough to undertake a major surgical procedure
  • Have any chronic medical conditions or infections that can interfere with the success of the kidney transplant
  • If you are willing and able to take lifelong post-transplantation medications and follow the instructions of the transplant team

The above evaluation will be based on various investigations or tests which include-

  • A detailed history taking and physical examination by the doctor
  • Imaging tests such as X-rays, CT, and MRI scans of the kidney
  • Blood tests to check the function of your heart, kidneys, liver, thyroid, and immune system and check your blood sugar levels. You will also be screened for HIV, herpes, hepatitis, and other diseases. 
  • Psychological evaluation to assess if you are emotionally prepared for the surgery, post-transplant care, and for living with a new kidney.
  • An echocardiogram to check your heart’s chambers, valves, and pumping function, and an electrocardiogram to check the heart rhythm. Know more about- What is Echocardiography? )
  • Cancer screening. You must be cancer-free before a kidney transplant. The cancer screening tests can include colonoscopy, mammography (women), prostate examination (men), etc. 

( Know more about- What is Colonoscopy? )

After you are evaluated by your doctors, your transplant team will discuss the results with you and let you know if you have been selected as a kidney transplant candidate. Every transplant center has its eligibility criteria and if you aren’t accepted at one transplant center, you can apply to other centers.

Kidney Transplant team

For a transplant, not just one doctor but an entire transplant team is required which includes-

  1. Transplant surgeon
  2. Transplant Nephrologists- a doctor specializing in treating the kidneys
  3. Transplant coordinators- they are the patient’s link to the transplant hospital and they facilitate all aspects of the transplantation process. They educate the patients and their families about various treatment options and answer any questions they may have, evaluate living donors, and coordinate post-transplant follow-ups. 
  4. Social workers to provide emotional support and practical suggestions to help you cope with the psychological and financial stresses
  5. Financial advisors to evaluate your insurances and help with billing and any other financial questions you might have
  6. Dieticians to help plan healthy meals 
  7. Transplant psychiatrists to help deal with depression and anxiety that may be present as you are undergoing a major surgical procedure
  8. Transplant pharmacists to dispense your post- transplantation medications and answer questions on how to take them
  9. Transplant nurses 

What is the preparation done before a kidney transplant?

  • Finding a match – Before the kidney transplant, special blood tests are carried out which help to match a donor kidney to the recipient. The tests include-
  • Blood typing-There are four blood types: A, B, AB, and O, and every individual fits into one of these inherited groups. To reduce the risk of organ rejection and other complications, the blood type of the donor’s kidney should match that of the recipient. Blood incompatible transplants can also take place; however, such transplants require additional tests before and after the transplant to reduce the risk of kidney rejection. 
  • Tissue typing- The second test called tissue typing is a blood test to determine the tissue human leukocyte antigen (HLA) type of the patient and the potential donor see how well they match. The better the human leukocyte antigen (HLA) match, the more successful the transplant will be over a longer time. As genetic material is passed down in a family, a parent and child would have at least a 50% chance of matching, siblings could have a zero to 100% match, and unrelated donors would in all probability not match at all. 
  • Cross-matching- this is the last matching test which involves mixing a small sample of the recipient’s blood with the donor’s blood in the laboratory. This cross-matching determines whether antibodies in the recipient’s blood will react against specific antigens in the donor’s blood. A negative crossmatch indicates that they are compatible and the chance of kidney rejection is less. A positive cross-match transplant is also possible. However, this type of transplant will require additional medications before and after the transplant to reduce the risk of the donor’s antibodies reacting with that of the recipient. 

Additional factors such as matching age, kidney size, and infection exposure may be considered by the transplant team while finding a donor’s kidney. 

  • Staying healthy– It is important to stay healthy while waiting for a donor’s kidney.  This can be done by-
  1. Taking all medications as prescribed by the doctor
  2. Following a healthy diet 
  3. Exercising regularly. Being active for 30 minutes every day can help you remain healthy 
  4. Quit smoking and reduce alcohol consumption 
  5. Indulge in relaxing activities and spend more time with family and friends 

Keep in touch with your transplant team and contact them in case there are any significant changes in your health. Make sure your transplant team knows how to reach you at all times in case a donor is available and you immediately have to undergo surgery. Keep your hospital bag ready and make arrangements for transportation to the transplant center in advance. 

What is the procedure for a Kidney Transplant?

  •  A kidney transplant is carried out under general anesthesia so that you are asleep during the surgery and feel no pain. The anesthetic is injected into the body through an intravenous line (IV) in your arm or hand.
  • The operation takes about 2-4 hours. Throughout the surgery, the surgical team will monitor your vitals such as your heart rate, blood pressure, and blood oxygen levels.
  • Once you’re asleep, the doctor will make an incision on one side of your abdomen and place your new kidney. A kidney transplant surgery is a heterotrophic type of surgery in which the kidneys are placed in a different location than the existing kidneys. The new kidney is placed in the front or anterior part of the lower abdomen, in the pelvis. 
  • The original kidneys are not removed from the body unless they are causing severe problems such as uncontrollable high blood pressure, frequent kidney infections, kidney stones, pain, etc. 
  • The blood vessels of the new kidneys are surgically attached to blood vessels in the lower part of the abdomen and the ureter (the tube that connects the kidney to the bladder) is connected to the bladder. 

What is the care to be taken after a Kidney Transplant?

  • You will have to spend several days to a week in the hospital. The doctor and nurses will monitor your vitals and check for any signs of complications. Your new kidneys will start producing urine like your kidneys did when they were healthy. This often starts immediately after the transplant. However, in some conditions, the new kidneys do not produce urine immediately and you will be put on dialysis temporarily until the new kidneys start functioning.
  •  You might experience some pain and soreness around the incision site while healing. In most cases, after the kidney transplant, you will be able to return to work and resume your routine activities within 8 weeks after the blood type of the donor’s kidney should match the blood type of the donor’s kidney should match the transplant. Avoid lifting any heavy weights or doing any vigorous exercises until the wound has healed.
  • After being discharged from the hospital you will have frequent checkups with your doctor to check how well your kidneys are functioning and to make sure your body is not rejecting the donor’s kidneys. Your doctor will also ask you to get blood tests done several times a week and have your medications adjusted post- transplant. 
  • After the kidney transplant, you will have to take certain medications for the rest of your life to prevent your body from rejecting the new kidney. These medications called immunosuppressants or anti-rejection medications suppress your immune system so that your body cannot attack the donor’s kidney. About 30% of those who undergo a kidney transplant experience some degree of rejection. In most cases, the rejection occurs within 6 months of the transplant but the rejection can occur at any time, even years later. Prompt treatment can help reverse the rejection in most cases. Additional medicines might also be prescribed to prevent any risk of other complications 

What are the side effects of the Anti-rejection medication after a Kidney Transplant?

After a kidney transplant, you will be prescribed medications that will prevent the rejection of the donated kidney. These medications are known as anti-rejection medications and they have some side effects which include-

  • Bone thinning i.e., osteoporosis 
  • Bone damage i.e., osteonecrosis
  • Excessive growth of hair or excessive loss of hair 
  • High blood pressure 
  • High cholesterol (Know more about-  What are Cholesterol and the causes of high cholesterol? )
  • Increased blood glucose 
  • Infections as these medicines weaken the immune system
  • Weight gain and acne 
  • Increased risk of cancer especially skin cancer
  • Edema (puffiness)
  • Easily bruising and bleeding 
  • Mood swings 

What are the complications and risks of a Kidney Transplants?

A kidney transplant is a major surgical procedure and it has the following complications-

  • Bleeding
  • Blood clots can occur in blood vessels that have been connected to the donated kidneys. This usually occurs in around 1 in 100 kidney transplants. It can be possible to dissolve the blood clots using medication in some cases, but it’s often necessary to remove the donated kidney if the blood supply is blocked.
  • Narrowing of the artery that is connected to the donated kidney (arterial stenosis).
  • Infections such as urinary tract infection (UTI), pneumonia, flu, etc.
  • Rejection or failure of the donated kidney: The blood type of the donor’s kidney should match the blood type of the recipient’s kidney. 
  • Death, heart attack, or stroke ( Know more about- What is Heart Attack? )

What is the success rate of Kidney Transplants?

According to the Organ Procurement and Transplantation Network (OPTN) in the United States, (U.S.), the success rate after a kidney transplant with a living donor was reported as 97% at 1 year and 86% at 5 years. The success rate with a deceased donor kidney was 96% at 1 year and 79% at 5 years. 

However, multiple factors can influence the success rate of a kidney transplant such as the choice of hospital, the expertise of the surgeon and transplant team, post-operative care, the tissue matching and compatibility of the donor, whether the donor is blood-related, the overall health of the recipient, age of the recipient, etc. India has the highest success rate of kidney transplants in the world. 

What is the cost of a Kidney Transplant in India?

The total cost of a kidney transplant in India can range from around INR 8,00,000 to INR 9,00,000. However, the cost of kidney transplants may vary across different hospitals. 

If you are coming from abroad, in addition to the cost of a kidney transplant, there will be an additional cost of accommodation and food, the cost of local travel, etc. After the surgery, the patient has to stay in the hospital for a few days and in the hotel for around 10 days, after getting discharged from the hospital, for complete recovery. This might add to additional charges. So, the total cost of kidney transplant surgery will be around INR 9,50,000.

We hope that we could answer all your questions regarding Kidney Transplants through this article.

If you have any further queries regarding Kidney Transplants contact a Nephrologist.

We only aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a qualified doctor can give you good advice and the correct treatment plan.

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