“All you need to know about Kidney Transplant”
— Get Well in India
Kidney Transplant or Renal Transplant is a surgical procedure to place a healthy kidney from a donor into the recipient’s body. A donor is a person who has both the kidneys working in good condition. After the surgery both, donor and recipient can lead a normal life.
The kidneys are two bean-shaped organs that produce urine which is carried to the bladder and when the bladder is full, urine is excreted from the bladder through the urethra.
Most people are born with two kidneys. Kidney reside against the back muscles in the upper abdominal cavity. They perform following important functions in our body:
- Filter blood to remove waste products and extra fluid. This waste is then passed as urine. This is the main role of the kidneys. If the kidneys lose this ability, waste products can build up, which is potentially life-threatening.
- Control blood pressure by releasing several hormones.
- Make red blood cell production by releasing the hormone erythropoietin.
- Keeps bones healthy.
- Balance salts, electrolytes such as potassium and sodium and other substances in the blood.
- Control fluid and acid-base balance in the body to keep it neutral.
As kidneys become diseased, they lose their ability to function properly and lead to a condition called end-stage renal disease or kidney failure.
Treatments for kidney failure would include hemodialysis which is a mechanical process of purifying blood. The other possible treatment is peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen and last but not the least kidney transplant. None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.
The most common causes of kidney failure include:
- Diabetes mellitus
- High blood pressure
- Polycystic kidney disease
- Severe defects of the urinary tract
Suitable kidney donors can be:
- A living donor who is a relative to the person receiving the transplant, such as a parent, sibling, or child
- A living unrelated donor such as a friend or spouse or colleague
- A deceased donor, a person who died recently and was willing to donate his/her healthy kidney.
The healthy kidney of a donor is transferred in cool saline water. This is done to preserve the organ for up to 48 hours till the tests are perform to ensure that the donors and recipient’s blood and tissue matches before the operation.
Dr. Pankaj Maheshwari
Kidney Transplant Surgeon
Dr. Vijay Kher
Kidney Transplant Surgeon
Candidate for Transplant
The recipient and donor, may not qualify for a kidney transplant, if they have:
- Infections such as TB, hepatitis or osteomyelitis
- Heart, lung, or liver disease
- High blood pressure
- Drug or alcohol addict
- Hereditary kidney problems
- Kidney illness
- Active autoimmune disease
- Urinary reflux or bladder problems
- Mental illness
In-case either the recipient or donor has any other medical issue, then they must be treated for the same first before going for the kidney transplant.
People who are 60 years of age and older are considered for transplant on an individual basis after medical and cardiovascular evaluation. People with anatomically abnormal urinary tracts may not qualify until appropriate reconstructive surgery is completed.
Pre Transplant Evaluation
The tests and evaluation is done to know if the donor is healthy and will remain healthy even after donation. It provides a clear picture of donors as well as recipients health and help identify issues which may cause complications. Here is the list of tests conducted;
- Physical exam to get an overview of the patient’s health
- Chest x-ray of lungs and lower respiratory tract
- Electrocardiogram (EKG or ECG) to check the heart’s health and past undetected heart damage
- Ultrasound with Doppler examination
- Blood tests which include blood count, blood and tissue type, blood chemistries, immune system function and blood tests for certain infectious diseases will also be performed
- Blood typing to determine if you are blood type A, B, AB or O
- Pulmonary function to check Lung function and the blood’s capacity to carry oxygen
- Upper gastrointestinal (GI) series to check for Esophagus and stomach checks for disease
- Lower GI series to check for Intestinal problems
- Renal function studies with the serum creatinine test which is a blood test
- Tissue typing in which white blood cells which determine tissue type. This is used to find an appropriate kidney match
- Panel Reactive Antibody (PRA) to check the Immune system activity. Higher the PRA means more antibodies are being made; the less activity here, the better chance the body will not reject the transplanted kidney
- Viral testing for exposure to diseases such as hepatitis, cytomegalovirus, Epstein-Barr, and acquired immune deficiency syndrome
- Mammogram to check presence of breast cancer
- Pap smear to check presence of cervical cancer
- Echocardiogram to check Heart abnormalities
- Dental Evaluations to check for healthy teeth and gums. Regular dental check ups are necessary while waiting for a transplant.
During your evaluation for a transplant, you’ll have blood tests to determine your blood type (A, B, AB, or O) and your human leukocyte antigen (HLA). HLA is a group of antigens located on the surface of your white blood cells. Antigens are responsible for your body’s immune response. If your HLA type matches the donor’s HLA type, it’s more likely that your body will not reject the kidney. Each person has six antigens, three from each biological parent. The more antigens you have that match those of the donor, the greater the chance of a successful transplant.
Once a potential donor has been identified, you’ll need another test to make sure that your antibodies won’t attack the donor’s organ. This is done by mixing a small amount of your blood with the donor’s blood.
The transplant can’t be done if your blood forms antibodies in response to the donor’s blood. You have what is called a “negative crossmatch” if your blood shows no antibody reaction. This means that the transplant can proceed.
Surgical Procedure Details
A new kidney is placed during the surgical procedure in the abdomen area. It is attached to the artery that supplies blood to kidneys and to the vein that carries blood away from the kidney and to the ureter, which carries urine from the kidney to the bladder.
There are two kidney transplant procedures: Open nephrectomy and Laparoscopic nephrectomy.
- Open Nephrectomy: You will be given anesthesia and you be will lying on your side. Your surgeon will remove part of a patient’s kidney via an abdominal incision of approximately 12 inches. Muscle, fat and tissues are cut and moved. Your surgeon may need to remove a rib. The ureter is cut between the bladder and the kidney and then the kidney is removed. The incision is closed with stitches. The procedure takes two to four hours. Its advantages are;
- Smaller incisions
- Less blood loss
- Laparoscopic nephrectomy: This is a minimally invasive procedure. Your surgeon will make 3 or 4 small cuts, most often no more than 1 inch (2.5 cm) each, in your belly and side. The surgeon will use tiny probes and a camera called a laparoscope to view the abdominal cavity. Your surgeon will make one cut larger and then remove the kidney. Laparoscopic surgery takes approximately two hours. Its advantages are:
- Shorter recovery time
- Shorter hospital stay
- Fewer postoperative complications
The operation is a heterotopic transplant which means the kidney is placed in a different location in the host that it had been in the donor.
The new kidney usually begins to function right away. In most cases, diseased or damaged kidneys are not removed unless they are causing severe problems such as uncontrollable high blood pressure, frequent kidney infections, or are greatly enlarged.
The failing of the kidney after transplantation is called rejection. After rejection occurs, the patient has to go back on dialysis or prepare for next transplant to extend his life. There are many reasons why a kidney transplant can fail:
- Blood Clot
- Fluid collection
- Side effect of medicines
- Donor kidney problems
- Non Adherence when anti-rejection medicines are not taken or missed doses.
- Recurrent Disease
- Acute Rejection which is a rare occurrence
- Chronic Rejection which means long term damage done by the body’s immune system for a lot of different reasons.
Chances of rejection can be decreased by the following two steps:
- Proper tissue matching and cross matching prior to transplantation and,
- Appropriate and regular dose of immunosuppressive agents.
Utmost care is taken post-surgery to minimize the risk of infection. Both the recipient & donor are closely monitored to make sure that the new organ is accepted by the body and taking the medication of immunosuppressant medication timely, take a good diet and adapt lifestyle changes.
Your doctor will conduct regular blood and urine tests, will monitor your blood pressure, temperature, and urine output. Ultrasounds may be done to see if there are any abnormalities with the transplanted kidney.
The period immediately following your transplant may be very stressful. Due care should be taken after your kidney transplantation surgery.
Here are the benefits of kidney transplant:
- No dialysis
- Increased strength, stamina, and energy
- Longer and improved quality of life
- No restriction on food and liquid
- Improved fertility
Legal requirements for the Transplant: Paperwork is required for a Kidney transplant in India as mandated by the Government of India. You will need your Passport, Driving license, Work permit, Aadhar card or any other government ID, Passport size photographs, Affidavit of patient and donor stating that the patient and the donor are related to each other. If your donor is your wife, then additional document such as marriage certificate with photographs is also required. A declaration from the head of family or the wife of the donor stating that he/she has no objection if the donor donates the Kidney to the recipient.
If the proposed donor or the recipient or both are foreigners and are seeking kidney transplant operation in India, a senior Embassy official of the country of origin or the government of the country concerned (authenticated by the Embassy concerned in India) has to certify the relationship between the donor and the recipient.
Any commercial transaction between the donor and the patient is considered illegal and attracts heavy punishment.
Waiting list: After a patient chooses transplantation as an option for treatment of kidney failure, the patient will either have to search a donor on his own or register himself in a waiting list of a transplant institute. Then the patient has to wait till a suitable kidney has been procured for him. This wait is generally quite long and till that time the patient has to continue on dialysis.