Kidney Transplantation

What is Kidney Transplant?

Kidney transplant is a surgical procedure of placing a healthy kidney from a donor (alive or deceased) in the body of an individual whose kidneys fail to perform normal functions.

The person who receives the kidney is called a ‘recipient’ and the person who donates the kidney is called a ‘donor’.

One of the most common transplant surgeries done around the world is kidney transplant. Around 10000 kidney transplants are carried out in India each year, most of these being from live donors. Success rate of kidney transplants in India is estimated to be around 90 per cent.

What are the types of kidney transplant?

There are two types of kidney transplant:

  • Deceased-donor kidney transplant
  • Living-donor kidney transplant

What is deceased-donor kidney transplant?

In this form of transplant surgery, the donor’s kidney is removed from a person who is brain dead and placed in recipient whose kidneys are not functioning properly or have failed. This is done either with the consent of the family or when the deceased person has signed a donor card. The kidney donation is contraindicated if the deceased donor had serious infections (such as HIV, Hepatitis B & C, tuberculosis) a history of cancer (other than non-invasive tumours) been in a high risk group for HIV infections (such as intravenous drug user or engaged in unsafe sexual activities)

What is living-donor kidney transplant?

In this process, a good functioning kidney is removed from a live donor and placed into the recipient whose kidneys are not functioning properly or have failed. Only one donor kidney is sufficient to replace the non- functioning kidneys in the recipient. The live donor kidney can be availed from any family member or any other person who wishes to donate his/her kidney to the recipient.

The living donor should have:

Two kidneys with normal renal function No diseases related to blood vessels, cancer or infectious diseases including Hepatitis B and C and HIV (Human Immunodeficiency virus) infection. Blood group and tissue type compatible (well-matched) with that that of the recipient. No problems related to blood supply and the urinary collecting system. No significant mental dysfunction.

Who might need a kidney transplant?

All patients with permanent kidney failure should be considered for kidney transplantation unless they have absolute contraindications.

It is recommended in patients with kidney failure caused by:

Diabetes (Diabetic Nephropathy) High blood pressure (Hypertensive Nephropathy) Glomerulonephritis (inflammation of the filtering system of kidneys. Congenital kidney problem such as Polycystic kidney disease (a genetic disorder in which fluid filled cysts grow and replace the normal kidney tissue resulting in a decrease in kidney function and ultimately kidney failure)

Tumors of the kidney (such as Wilm’s tumor) Some Autoimmune diseases

Who may not be suitable for kidney transplant?

The overall general health of a person is an important criterion for determining eligibility.

Some of the factors that render a person unsuitable  for the kidney transplant procedure include:

Alcohol or drugs dependence, comorbid conditions like cancer, untreatable cardiac conditions, inability to adhere to the treatment regime, life expectancy below five years . Contraindications to transplant may also be case specific, hence it is  highly recommended to discuss the eligibility with the doctor when considering a transplant.

Do people who have undergone kidney transplant live longer than those on dialysis?

Yes. Kidney transplant is the most definitive treatment for ens stage renal disease and individuals with a transplant generally show improved outcomes and better quality of life as compared to those on dialysis.  An important reason for this is the ability of the natural kidney to function continuously to remove toxins from the blood, dialysis, on the other hand, is done 3-4 times a week, thereby allowing the waste to accumulate within the body for a little longer time.

Why is kidney transplant preferred over dialysis? 

Kidney transplant is the best option for people with end stage renal failure because dialysis can replace only up to 10-15% of the work of a functioning kidney.  Because of prolonged accumulation of toxic waste in the body, a person undergoing dialysis usually faces the risk of other health problems. A kidney transplant, on the other hand, offers more longevity and a much better quality of life.

How can a person in need of transplant get a donors kidney?

A living donor kidney transplant is considered to be better as compared to deceased donor transplant. A living donor can be anyone from a person’s family or friend who is willing to donate and provided the removal of the kidney will not be detrimental to the donor’s health. If you have a donor that willingly wants to donate the kidney, you can seek consultation from your nephrologist for further course of action that would include a thorough medical evaluation and blood work to rule the tissue compatibility and the chances of organ rejection.

Compared to deceased donor transplant how is living donor transplant better?

Living donor transplants are considered to be long lasting when compared with deceased donor transplants. This is so because the living donor kidneys are healthier as the period for which the donor’s kidney remains outside the living environment is shortened.

Cold preservation of the deceased donor kidney reduces the function of the kidney. Living donor transplants are believed to last as long as 15-20 years or more than that and deceased donor transplants are expected to last for 10-15 years on an average.

What are the options for patients if there is no kidney donor?

When living donors are not-availability, individuals needing a kidney transplant can consider a deceased donor kidney. People who need a kidney transplant but lack availability of living donor can register themselves for inclusion in the waiting list if they are taking treatment from a registered transplant hospital.

What is waiting period for kidney transplant ?

If the kidney is obtained from a living donor, the recipient and the medical team usually will be able to schedule the time of transplant surgery. In such cases pre- transplant waiting period is only a few weeks.

However, if the kidney is awaited from a deceased (cadaver) donor then the recipients name is placed on a waiting list. The recipients consent is to be taken before putting him on the waiting list.

What can a person expect before kidney transplants?

After an individual is deemed as an appropriate candidate for a kidney transplant, the following will be done:

1) The transplant team will find a matching donor kidney for the recipient. The donor kidney can be available through a live or deceased donor.

2) Once a donor’s kidney is found, the doctors will run some tests to determine whether the donor’s kidney is a match for the recipient that include blood typing, tissue typing (HLA typing) and cross-matching.

Other tests are also performed on the donor that includes checking for any serious medical illnesses, transmissible diseases or infections and any other tests that are deemed necessary by the doctor.

What are the tests to undergo before undergoing kidney transplant?

If the doctor certifies or confirms an individual fit as a kidney transplant candidate, that person has to undergo further tests and evaluation for the transplant process. These include:

  • A detailed medical history and physical examination by the doctor.
  • Blood tests for basic and advanced parameters to detect underlying infections or conditions that can hamper the transplant process.
  • Diagnostic imaging studies like X-rays, MRI or CT scans.
  • Psychological evaluation.

Any other additional tests are necessarily required by the doctor or  transplant surgeon.  After these tests are done and results evaluated by the doctors, they will inform the individual whether he or she has been accepted as a kidney transplant candidate. This individual is then put on a kidney transplant wait list. Once an individual is added to the waiting list, he/she may receive the kidney quickly or may have to wait for a few years.

What can a person expect during kidney transplant? 

Typically, kidney transplant surgery is performed by a transplant team in a multi-speciality hospital. The team consists of the transplant surgeon/s, anaesthetist, physicians and the medical support staff (including nursing staff, physiotherapists and nutritionists).  The transplant surgery is done while the individual is under general anaesthesia. The surgery lasts from two to four hours.

What can a person expect after kidney transplant?

As soon as the transplant surgery happens, the individual is shifted to the ICU for monitoring. Meanwhile, the recipient is monitored for signs of infection, basic health parameters and urine output (as new kidney will begin to produce urine).  Once the recipient  is recovered, he/she is discharged typically after around a week of hospital stay.  After discharge, the recipient has to come for frequent check-ups with the doctors to see the state of recovery as well as to understand the way the graft is functioning. This might require additional tests as well.

The recipient will have to be on lifelong medications for the rest of his/her life. Customarily, anti-rejection medications and immunity-suppressing medications are administered to prevent rejection of the kidney.

For how long does a transplanted kidney last?

Meticulously selected cases of kidney transplants with particular adherence to the post-surgery treatment plan are likely to succeed in 95% cases or more. A transplanted kidney from a living donor is expected to last for 15-20 years or more and that from a deceased donor may last for as long as 10-15 years on an average.

What is graft or transplant rejection?

Rejection is the response of the body to foreign agents like objects, tissues or microbes. In case of a kidney transplant, the body treats the donor kidney as a foreign body and the immune system attacks it with antibodies perceiving it as a threat. Because of this reason, an individual who undergoes a transplant is advised immunity-suppressing medications and prevent the body from attacking the new kidney.

What are the symptoms of rejection?

Sometimes the only initial sign of rejection may be an elevated level of blood creatinine determined from a laboratory test.

Some other symptoms of rejection are:

  • Decreased urine output
  • Fever
  • High blood pressure
  • Malaise, body aches or a flu-like feeling
  • Sudden unexplained weight gain
  • Tenderness or pain in the region of the kidney

Should a person with a transplant experience such symptoms, it is  recommended to call the transplant coordinator.  How is rejection prevented? 

The recipient will have to be on lifelong medications for the rest of his/her life. Anti-rejection medications and immunity-suppressing medications are given to prevent rejection of the kidney.

What are the side effects of immunosuppression?

Yes. There are also complications after use of anti-rejection or immunity- suppressing medications like:

  • Thinning or damage to the bones or osteoporosis
  • Conditions like hair loss, acne, weight gain, puffiness over the body
  • High blood pressure and increased cholesterol
  • Increased susceptibility to infections

Increased risk of certain forms of cancer like skin cancer or lymphomas  Is a special diet required after kidney transplant?  Transplant patients are often placed on medications that reduce their immunity making them more susceptible to infections from germs in foods.  Patients with a transplanted graft are required to avoid raw or under cooked meat, poultry, fish, eggs etc in any form.  Food items may even intervene the action and absorption of medications. Therefore it is recommended to consult a dietitian for a customized diet plan which varies patient to patient.

Can a person exercise after transplant?

Even though strenuous exercise may not be advised immediately after surgery, a person who has undergone kidney transplant can resume activities once he/she gains sufficient energy and strength after the surgery.  Lighter forms of  exercises like walking 5 to 10 minutes a day following surgery should be good to start with, followed by a slow increase in the time of walk each week. Do consult your treating doctor about what should be the best exercise regime depending on your case.

Are there any restrictions to be followed after a transplant?

A very important factor to consider before and after the surgery is to restrict the usage any form of a habit-forming agent like tobacco or alcohol, to prevent any damage to the transplanted kidney. Consult your transplant nephrologist to figure out a suitable time to resume driving, work, travel, school etc.