Kidney Transplant

What is a kidney transplant?

A kidney transplant is a surgical procedure to replace kidney failure with a new healthy kidney from a donor.

This happens when you are diagnosed with end-stage chronic kidney disease. Kidneys play a crucial role in eliminating extra fluid and waste from the body.

Kidneys also maintain electrolyte, blood pressure, and fluid balance.

When your kidneys are no longer functioning, this leads to the buildup of waste products and it can be life-threatening.

If you have failed kidneys, your primary healthcare provider will recommend dialysis. This is a treatment process whereby the accumulated waste in the bloodstream is mechanically filtered when your kidneys are no longer working.

Some people with kidney failure are put on a waiting list for a kidney transplant. This is a surgical process that replaces one or both of the kidneys with healthy donor kidneys either from a diseased person or a living person.

A kidney transplant allows you to lead an active life without having to rely on a dialysis machine.

People who are severely overweight or have active infections may not be suitable candidates for a kidney transplant.

Who needs a kidney transplant?

A kidney transplant is recommended for people with end-stage renal disease (ESRD). If your kidneys are confirmed to have completely failed, you will need a kidney transplant.

ESRD may be caused by the following conditions:

• In case of persistent urinary infection

• Inherited kidney disorders

• High blood pressure

• Diabetes

• Inflammation of the kidney’s filtering units (glomerulonephritis)

• Hardening of arteries

• Older age

• Kidney stones

• Prolonged intake of ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs)

• Immune system diseases like lupus

• Congenital kidney defects

• Obstructions

A kidney transplant is better than dialysis for the following reasons:

• Reduces risk of early death

• Limited dietary restrictions

• Improved quality of life

• Reduced treatment cost

For other people, however, dialysis is less risky compared to a kidney transplant. Some conditions that might make you ineligible for a kidney transplant are:

• Severe heart disease

• Dementia

• Advanced age

• Drug abuse or alcohol

Symptoms of kidney failure 

Kidney failure manifests in the following signs and symptoms:

• Seizures

• Blood pressure-induced headaches

• Edema

• Pale skin color

• Depression

• Chronic bad breath

• Fatigue

Types of kidney transplants 

Living-donor kidney transplant

The donor is a healthy person, usually a blood relative, He or she can also be a close friend or stranger with two healthy kidneys. The living donor may choose to donate one of the healthy kidneys. Both the living donor and you as the kidney recipient will need to undergo various tests to assess whether the tissues and blood are a match.

If the living donor is a family member, this would be the best option since you will not be on a waiting list for a deceased donor. It also reduces the risk of the donated kidney being rejected by your body.

Deceased-donor kidney transplant

Also known as cadaver donors, these are individuals who have died due to an accident as opposed to a disease. The deceased donor may have opted to donate their tissues or organs or their family will make that decision.

If you are not related to the donor, there is a high possibility of the donated kidney being rejected by your body. If none of your family members or friends are willing or in a position to donate a kidney, a deceased donor is a good option.

Preemptive kidney transplant

In a preemptive kidney transplant, you undergo a kidney transplant when your kidneys are still functional and your primary healthcare provider has not recommended dialysis.

A preemptive transplant lets you live longer and remain healthy.

Preparing for a kidney transplant

Before a kidney transplant, you will be subjected to an evaluation process by a transplant team. The team comprises a transplant nurse, transplant surgeon, psychologist/psychiatrist, transplant nephrologist, anesthesiologist, and social worker.

The evaluation process comprises the following steps:

Blood tests

To find out whether you are a good match for the donor, you and the donor will have to undertake blood work. The blood tests are also useful in determining the possibility of the donor organ being rejected.

Mental health assessment

An organ transplant comes with various social and psychological issues, including finance, stress, and support from family and friends. Such issues will impact the outcome of a kidney transplant

Diagnostic tests

These help to determine your overall health status and health of your kidneys. Examples of diagnostic tests before a kidney transplant include ultrasound, dental exams, X-rays, and kidney biopsy. Women on the waiting list for a kidney transplant will also undergo extra diagnostic tests, including a gynecology assessment, Pap test, and a mammogram.

The transplant team examines your medical history, and information obtained through interviews, test results, and physical examination to decide if you qualify for kidney transplantation.

If you are eligible for a kidney transplant, the transplant team will place you on a waiting list. As soon as a donor organ is available, the transplant team will notify you promptly and you will be asked to come to the healthcare facility immediately.

If a living family member has decided to donate a healthy kidney and both of you are a match, the transplant team will plan for the procedure. The donor should be in good health and their blood type compatible with yours, the donor will have to undergo a mental health assessment to ascertain he or she is comfortable with such a decision.

You will need to undergo the following steps before the kidney transplant:

• The transplant team will go over the kidney transplant procedure with you. If you have questions regarding the procedure, you are encouraged to ask such questions during the scheduled meetings with the team
• The transplant team will request that you sign a consent form authorizing the transplant team to go ahead with the surgery. Make sure you have read this form carefully and understand the content. If something is not clear to you, make sure the transplant team has clarified it before you sign the consent form
• If you have already started dialysis session, the transplant team will ensure you undergo
• dialysis before a kidney transplant
• If you are getting a kidney from a living donor, the transplant team will ask you to fast for about 8 hours before the procedure. If it is a cadaver organ transplant, fasting begins the minute a kidney is available
• Before a kidney transplant, the anesthetist will administer a sedative to make sure you are relaxed

During a kidney transplant 

A kidney transplant is conducted at the transplant center in a hospital. The transplant team will request a sample of your blood for an antibody test. If the outcome of the antibody test is a negative crossmatch, the transplant team will clear you for the surgery.

The transplant nurse will provide you with a hospital gown that you need to wear after removing your clothing.

The anesthetists start an IV line in our hand or arm. Extra catheters may be inserted into the wrist or neck to take blood samples and monitor your heart and blood pressure.

Catheters may also be attached to the groin blood vessels and collarbone section.

In case of too much hair at the site of the incision, the surgical team can decide to have it shaven.

A urinary catheter is placed in your bladder to assist with the passage of urine.

The surgical team will ask you to lie with your back on the operating table A kidney transplant is administered under general anesthesia. That means you will not be awake during the procedure.

Your anesthesiologist is on standby during the entire surgery and will closely monitor your vitals, including breathing, heart rate, blood oxygen, and blood pressure.

The surgical nurse will clean the skin around the surgical site using an antiseptic solution.

The surgeon starts by making a long cut into your lower abdomen. He or she will visually examine the door kidney before placing it on your belly.

The surgeon will implant the donor kindly into your belly in the following manner. If the donated kidney is the left one, it will be placed into the left side of your belly. If the donated kidney is the right one, it will be implanted into the left side of your belly. That way, the surgeon can easily access the ureter while connecting it with the bladder.

The surgeon sews the vein and renal artery of the donor’s kidney with the external iliac vein and artery.

Once the vein and artery are sewn, the surgeon will monitor the flow of blood through the blood vessels. The surgeon will check whether the suture lines have any bleeding.

The surgeon connects the donor ureter to your bladder. The ureter is a tube that eliminates urine from your kidneys.

The surgeon uses surgical staples or stitches to close the incision.

To minimize the risk of swelling at the site of incision, the surgeon can decide to place a drain.

The closed incision is covered with a dressing or sterile bandage.

Care in the hospital after a kidney transplant When you wake up after a kidney transplant, you will already have been transferred to a recovery room.

The surgical team will continue monitoring your vital signs closely to make sure you are at a table. You may be transferred to an intensive care unit (ICU) so that the surgical team can continue monitoring you closely.

From the ICU, you will be transferred to a nursing unit where you will continue with recovery.

You are likely to spend a few days in the healthcare facility.

Urine production in a living donor kidney will begin immediately. In the case of a cadaver kidney urine production may take a while.

Your healthcare provider may recommend ongoing dialysis until urine output has normalized.

The urine in the catheter attached to your bladder is measured from time to time to assess how the new kidney is functioning.

The surgical team will continue administering IV fluids until they have ascertained you can drink and eat sufficiently on your own.

The surgical team will continue monitoring the working of antirejection medication. This will help to establish the best combination of medication that works best for you. It also helps to identify the best dose.

The surgical team will take regular blood samples as they continue monitoring how the new kidney is working. Blood maples are also useful in determining other body functions including the lungs and liver.

As your level of tolerance improves, you will be slowly introduced to solid foods.

You will be encouraged to move around in your ward to avoid the development of blood clots.

The incision site may feel sore and for this, your healthcare provider can recommend a pain reliever.

Aspirin is not recommended as it enhances the risk of bleeding.

You will receive detailed guidance and instructions from the transplant team on how to take care of your incision and yourself after your discharge from the hospital.

Once the transplant team has ascertained that the new kidney is in good working condition, your vital signs are stable and you do not require periodic monitoring, you will be allowed to go home.

Care at home

After you are discharged from the hospital, make sure the surgical area remains dry and clean.

You will be instructed on how to bathe. Avoid submerging the incision in water as this predisposes you to an infection.

Wait for your healthcare provider to give you the go-ahead to drive or engage in other physical activities.

For any follow-up appointments at the hospitals, plan with your spouse, relative, or friends to drive you to the hospital.

Monitor your weight and blood pressure daily while at home. An increase in weight or blood pressure can be a sign that the new kidney is not filtering fluid effectively. This calls for prompt assessment by the transplant team.

If you experience the following, contact your healthcare provider immediately:

• In case the incision site has swelling, bleeding, or redness to it

• If the incision site increases in pain, it could indicate an infection or rejection

• Fever could signify an infection or rejection

Benefits of kidney transplant

There are many advantages of a kidney transplant including:

• You will no longer require dialysis

• Improved quality of life

• Most people who have undergone a kidney transplant live longer

• Increased energy levels

• Restrictions on what to drink or eat reduce

• Fertility levels and sex life improve after a transplant

• Easier traveling and ability to work

Risks

A kidney transplant carries certain risks:

• Blood clots

• Infection

• Bleeding

• Rejection of the donated kidney

• Stroke

• Blocked ureter

• Leaking ureter

• Heart attack

Cost of kidney transplant in India

The cost of a kidney transplant in India starts from Rs. 5,00,000 and could go up to Rs. 15,00,000. This cost is for an open kidney transplant. If you opt for a minimally invasive kidney transplant, you are likely to pay more.

The cost of a kidney transplant in India varies based on the following variables:

• The kind of transplant needed

• Length of stay in hospital

• Donor availability

• Hospital location and classification

• Lab tests and other diagnostic tests

• Surgeon’s fee and expertise

• Patient’s condition

References

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