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Kidney transplantation is the transfer of a healthy kidney from a donor, whether deceased or living, to the patient who has severely damaged or diseased kidneys with extensively compromised or no function. It is a surgery performed under general anesthesia on a patient suffering from Kidney failure.
Kidneys filter the blood and eliminate the waste products in the form of urine. Kidney transplantation, also referred to as Renal transplantation, is called for when the patient suffers from End Stage Renal Disease(ESRD). Kidney transplant can be of two types on the basis of the source from where the donor kidney has been retrieved. Deceased–donor transplantation and Living-donor transplantation.Deceased donor transplantation was earlier referred to as Cadaveric transplantation.
When the kidneys fail to function, treatment is required to substitute for the work that a normal kidney would have performed. Two types of treatment modalities come to the rescue of the patient. They are Dialysis or kidney transplant. Dialysis and kidney transplant have their own share of pros and cons. It is believed that kidney transplant offer a better quality of life to the patient as compared to when the patient undergoes dialysis.
Q1 Which is better, Dialysis or a kidney transplant in a patient with kidney failure?
A1 Kidney transplant is a preferred treatment when compared to dialysis because of better clinical outcome in the former and reduced morbidity and mortality rate as well. Kidney transplant people have a longer, active and good quality of life free from dialysis. They have minimal restrictions on food as compared to that in case of dialysis. The patient still needs to take a balanced diet. In nutshell, kidney transplant is a treatment of choice for suitable patients with ESRD.
Q2 What is a preemptive or early kidney transplant?
A2 When a kidney transplant is carried out immediately after kidney fail to function adequately, well before the need of undergoing maintenance dialysis, is referred to as preemptive kidney transplant. It is suggested to be associated with better clinical outcome in terms of graft and the patient survival. However, very small fraction of patients with ESRD are knwon to have undergone preemptive kidney transplant worldwide.
When kidney transplant is carried out with little time taken on dialysis as well, but quite early after kidney fail to function adequately, is referred to as an early kidney transplant.
In both the cases, patient has good chances of leading a longer, active and better quality of life. Besides saving time and money, it gives confidence to the patient and the patient can continue working normally.
Q3 Who can have a kidney transplant?
A3 Anyone with severely compromised or no kidney function can have a kidney transplant, irrespective of age. Children can also have kidney transplant, commonly referred to as Pediatric Kidney transplant. Full clinical evaluation of the patient would be done to ensure that the patient is a suitable candidate for undergoing kidney transplant surgery.
Q4 What happens during the kidney transplant surgery?
A4 Kidney transplant surgery usually takes 3 to 4 hrs. It is performed under general anesthesia. Patient’s kidneys are not removed during the surgery; they are rather kept untouched in their place unless there is a valid medical reason such as an infection or cancer, to remove them.
New kidney is placed in the lower abdomen which can be connected to the major blood vessels and the bladder for ease of work and also in the long run it would be easily accessible, if need be.
Patient is generally up and out of the bed the next day, however, around a week is needed to be discharged from the hospital. If the kidney is retrieved from a living donor, the new kidney may start to function in no time; however, if it is procured from a deceased donor, it may take around 2 to 4 weeks to start to function. Until that time, temporary dialysis may be needed.
Q5 What are anti rejection medicines?
A5 Anything that is perceived as foreign by your body, is rejected by it. The same holds true for the new donated kidney. To counter that effect, the patient needs to take anti rejection medicines or immunosuppressant medicines as they are called in medical parlance, throughout their life till the new kidney is working inside.
In absence of these medicines, the patient’s immune system will attack and try to destroy the new kidney.
Your doctor will educate you about these medicines or other medicines to pacify all your apprehensions. The side effects of these medicines are mostly manageable, if there needs to be a change in the dose or type of medicine, your doctor will take care of that. You can still find yourself way better than in case you had to undergo frequent dialysis.
Q6 What are the problems associated with kidney transplant?
A6 Kidney transplant is successful most of the time. However, like any other surgery, it may also have setbacks. The patient needs to take anti rejection medicines throughout life till the new kidney is working inside. These medicines have certain side effects too. Higher probability of infections and certain types of cancer is there.
Q7 When can I get back to my work after kidney transplant?
A7 Usually 8 weeks. It may take longer in some cases. Your doctor will let you know the exact time in your case as the time varies from patient to patient depending upon your pace of recovery, the nature of work you do and any other medical condition you have.
Q8 Does a kidney transplant affect sex life?
A8 Not exactly. In fact, sex life has been found to become better post kidney transplant, owing to better health. Men who have had kidney transplant have had healthy children.
For women who have had kidney transplant, it is generally recommended to have a pregnancy after at least waiting for a year after undergoing kidney transplant. Talk to your doctor, before planning pregnancy and adopt healthy and safe sex practices. It is advised to have the pregnancy planned, as there are some medications that need to be stopped well ahead before pregnancy, generally 6 weeks, to avoid there harmful effects on the developing baby.
Q9 Is a special diet recommended for a kidney transplant patient?
A9 Not as much as in case of a dialysis. There will be minimal restrictions. Your nutritionist will chalk out a dietary plan for you, best customized to your need. In case you are suffering from other medical conditions as well, the nutritionist will take that also into account while planning your diet. As such, if only kidney transplant has been done, and in absence of any other medical condition low fat and low salt diet will do.
Q10 What are the different kinds of donors for kidney transplant?
A10 Donor is the one who donates his/her healthy functional kidney to the patient. The donor can be:
Deceased or Cadaveric Donor: Here kidney is procured from a person who has just died. The permission is sought from the family of the person, to use his/her kidney in order to save life of a patient who needs kidney transplant.
Living Related Donor: Donor of the kidney is a blood relative such as parent or a sibling.
Living Unrelated Donor:Donor of the kidney is not a blood relative such as spouse or friend.
Q11 Who can be a donor?
A11 Anyone between the age of who is
Does not have any infection,disease or injury that effect the kidney adversely
Voluntarily donates his/her kidney in the absence of any kind of pressure, be it physical,mental or financial
Has a compatible or same blood type
Q12 How much is the recovery time for the donor?
A12. The recovery time for the donor is generally 6 to 8 weeks.
Q13. What are the advantages of having a living donor kidney transplant?
A13 As compared to a deceased donor kidney transplant, living donor transplant has many advantages such as:
Less waiting time
Timing of the transplant can be scheduled at the earliest as per your convenience. One can also have the possibility of having a kidney transplant before the need for dialysis. Once the donor has been medically evaluated and compatibility of the donor has been verified and there are no medical issues of the donor to be looked into, the transplant can be undertaken immediately.
Living related donor such as parent or a sibling, makes a better match in case of kidney transplant in terms of blood and antigen match. It translates into better acceptance of the donor kidney by the recipient. Less probability of rejection and also the dose and number of anti rejection medicines required is reduced to a large extent.
The requirement for temporary dialysis is less than that required in the case of deceased donor kidney transplant
Especially in case of unrelated living donor, genetic diseases are not an issue.
It is reported that a kidney from a living donor work better and for a long period of time in comparison to a kidney from a deceased donor.
Q14. How the healthy kidney from the donor is removed?
A14. The healthy kidney from a donor is removed by any one of the following surgeries:
Nephrectomy is the surgical removal of the kidney.
Q15. I do not have a close relative who is willing to donate kidney. Can I have kidney donated from someone else?
A15 Even if you do not have a kidney donated from a close relative, kidney from some other person will work equally well.
Q16 Is kidney donation going to harm the donor in any way?
A16 Not really. Person who donates a kidney will be sore for sometime post surgery as with any other major surgery, otherwise there are no significant issues.
Q17 What does the kidney transplant surgery in a donor involve?
A17 The donor may undergo Open of Laparoscopic Nephrectomy or kidney removal. The blood vessels to the kidney and the ureter to the bladder, from it would be tied and the kidney will be removed for donation.
Q18 How much is the recovery time in a donor from the kidney removal surgery?
A18 It takes around a week in case the kidney is removed Laparoscopically or else it may take few weeks , if the access to the kidney has been through Open Nephrectomy.
Q19 Can I pursue contact sports after getting a kidney tranplant?
A19 Absolutely no. It is highly recommended to avoid contact sports completely such as soccer, football, wrestling and so on to prevent any serious injury to the transplanted kidney.
Q20 What can I expect after kidney transplant?
A20 There are certain things that you need to bring into your life style. They are
Follow healthy diet.
Avoid alcohol consumption and smoking.
Pursue an active life, however, avoid contact sports.
You will have to take anti rejection medicines for the rest of your life to make good use of your tranplanted kidney. Its a small price to pay.
Q21What are the different living donor resources for kidney donation?
A21 The living donor who is going to donate the kidney to the needy patient can be:
Related Living Donor: any blood relative who is healthy enough to donate the kidney. They can be parents,siblings(brother or sister), children above 18 yrs of age and i includes uncles, aunts, niece and nephews as well who are the blood relatives.
Unrelated Living Donor: Anyone who is a relative but not related by blood. They can be spouse, in laws, close friends or acquaintances.
Unknown Donor :Living donors who voluntarily donate their kidney just for the purpose of saving someone's life. They are not even aware of the recipient of the organ donation.
Paired Kidney Donation:Here two pairs of donor-recipient who have a living donor who is willing to give the needed kidney but unfortunately do not form a compatible match with their respective recipients, exchange donors to make the transplant possible for both the cases. Here the kidney recipients will get the compatible match by exchanging their respective donors with each other. This method can work in more than two pairs as well.
Blood type incompatible living donor: It is true. There exist a possibility of a kidney donation in case of blood type incompatibility as well. Here the blood type of kidney donor does not match with that of the recipient. However, with the procedure called Plasmapheresis, done before and after the kidney transplant in the recipient, will remove the antibodies from the blood of the recipient and make the kidney tranplantation successful. It reduces the chances of transplanted kidney rejection by the recipient due to high amount of antibodies.
Dr Anant Kumar
MBBS,MS(General Surgery), M.Ch(Urology), DNB(Urology)
Chairman Urology,Renal Transplant, Robotics and Uro-Oncology
Max Super Specialty Hospital, Saket, New Delhi
Dr Amit K. Devra
MBBS, MS (General Surgery), DNB(Urology)
Senior Consultant, Urology and Kidney Transplantation
Jaypee Hospital, Noida
Dr Ashok Sarin
Indraprastha Apollo Hospital, Sarita Vihar, Delhi
Saket, New Delhi
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