Kidney Transplant

A surgical procedure to place a healthy kidney from a deceased or live donor into someone whose kidney is not working properly is called kidney transplant.

Our kidneys are located on either side of the spine just below the rib cage and are shaped as a bean. The sizes of them are just like our fist.

To remove and filter fluid, minerals, and excess waste from our blood by urine is the main function of our kidneys.

A person can experience kidney failure and high blood pressure when the kidneys lose their function.

Kidney failure is also known as end-stage renal and this will happen when the kidneys lose their function up about 90 percent.

The common causes of kidney failure include:

• chronic high blood pressure
• diabetes
• polycystic kidney disease
• chronic glomerulonephritis which is an inflammation and scarring of the glomeruli

A dialysis – a machine used to remove waste from bloodstream – or a kidney transplant will be needed for a person with the end-stage renal disease.

Here are the most common reasons to receive a kidney transplant. People choose a kidney transplant for treating kidney failure rather than having dialysis.

A kidney transplant can give:

• lower risk of death
• better quality of life
• lower treatment cost
• fewer dietary restrictions

A preemptive kidney transplant is receiving a kidney transplant before needing to go on dialysis. This procedure is used for some patients.

A person is not a right candidate for a kidney transplant because of:

• severe heart disease
• advanced age
• mental illness
• recently treated for cancer
• alcohol or drug abuse
• dementia
• other factors that can affect their ability to drink medications or undergo the procedure

Living-donor kidney transplantation might be an option if only one donated a kidney is needed to replace two failed kidneys.

The patient will be put on a waiting list for a kidney transplant from a deceased donor if a compatible living donor isn't available.

Some people get a match only a few months while other has to wait for years to receive a kidney transplant.

Some of the kidney diseases might return after the transplant, so kidney transplant is not secure.

The risks involved with a kidney transplant are related to the surgery itself, side effects of the medicines and rejection of the donor's kidney.

Discuss first with your doctor the risks and benefits of a kidney transplant. Talk to your family if you are going through with it.

The risks of complications of kidney transplant include:

• bleeding
• blood clots
• leaking or blockage of the ureter
• rejection of the donated kidney, and failure of the donated kidney
• cancer or infection that can be transmitted with the donated kidney
• stroke
• heart attack
• death

Your doctor will prescribe you medications to take after the surgery to prevent your body from rejecting the new kidneys.

These medications have side effects such as:

• bone damage
• bone thinning
• acne
• excessive hair loss or hair growth
• diabetes
• high cholesterol
• high blood pressure
• infection
• an increased risk of cancer mostly lymphoma and skin cancer
• weight gain
• edema or puffiness

In preparing for your kidney transplant, you must follow your doctor’s orders. Your doctor will refer you to a transplant center where you can choose.

Consider these factors when choosing a center:

• you can ask about the survival rate in the center
• learn about the types and number of transplants that they perform each year
• check if the center can offer donation chain programs or paired donation
• check the Scientific Registry of Transplant Recipients for centers
• check the center if they offer other services such as support groups or local housing or travel arrangements
• know the cost of the procedure and after the transplant including follow-up appointments

Once you chose the center, they will evaluate you if you are a candidate for kidney transplant.

They will check if you:

• have any medical conditions that might get in the way of the transplant
• are healthy enough to have a surgery, and are able or willing to take medicines.

You will undergo evaluation process that could take up to days as well as a physical exam, blood tests, imaging scans, and psychological evaluation.

If the evaluation failed, you can apply to other centers wherein you can meet their criteria for a kidney transplant.

Read on to learn more about what to expect before, during, and after your kidney transplant.

These factors will determine if you have a good match:

Blood typing – you and your donor’s blood type should be compatible.

Blood-type incompatible transplants – which is known as ABO are also possible but require additional medical treatment before and after transplant, so your body will not reject the new kidney.

Tissue typing – this is called human leukocyte antigen or HLA typing that is done to compare genetic markers that increase the likelihood the transplanted kidney will last a long time.

Cross-match – this will check if antibodies in your blood will react against specific antigens in the donor's blood by mixing a small sample of your blood with the donor's blood. The kidneys are compatible if it is a negative cross-match.

Positive crossmatch needs additional treatment but is possible.

The transplant team will also consider the kidney size, your ages, and if the donor's kidney have been exposed to infection. You can also find a living kidney donor.

Family members are most likely to match your kidneys. There is also an option called paired donation meaning you have a willing kidney donor whose organ is not compatible with you.

Instead of donating the kidney directly to you, your donor will give the kidney to someone who may be a better match, and then you will receive the compatible kidney from that recipient's donor.

You should stay healthy while you are on the waiting list or even if the transplant is already scheduled. This may help in your recovery.

During the procedure, your doctor will give you general anesthesia first. There will be a surgical team that will monitor your blood oxygen level, blood pressure, and heart rate.

The surgeon will make a cut and place the new kidney in your lower abdomen. The blood vessels in the lower part of your abdomen are attached to the blood vessels of the new kidney.

The new kidney’s ureter will now be connected to your bladder. The ureter is the tube that links the bladder to the kidney.

After the procedure:

You will be at the hospital for days or weeks – the team will continue to monitor your condition and vital signs and they will watch for complications. You may feel pain and soreness around the incision area.

Your doctor will ask you not to lift heavy things and you can only do walking as an exercise while you are recovering. You can go back to your daily activities after three to eight weeks.

Have follow-up visits with your doctor – your doctor will order a couple of blood tests and adjust your medications within weeks after the procedure. He will monitor your condition.

Take medications for a lifetime – your doctor will prescribe immunosuppressants or anti-rejection drugs so your immune system will not attack your new kidney.

If you do not understand your kidney transplant results, consult with your doctor.

Your new kidney will filter your blood after a successful kidney transplant. You do not need dialysis anymore. You will need to take anti-rejection drugs to suppress your immune system.

Your doctor may also prescribe antibacterial, antiviral and antifungal medications because these anti-rejection medications make your body more vulnerable to infection.

You will have a skin check up so you can be a screen for skin cancer. According to the Organ Procurement and Transplantation Network:

About 4 percent of deceased-donor kidney transplant recipients within one year after transplant and in 21 percent of cases five years after transplant have failed in the kidney transplant.

Failure rates are about 3 percent at one year and 14 percent at five years after transplant among living-donor kidney transplant recipients.

You can go back to dialysis if your new kidney fails. Your doctor might suggest another kidney transplant.