A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person.
The kidney may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant.
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The kidneys and urinary system keep chemicals, such as potassium and sodium, and water in balance, and remove a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. Kidneys also regulate fluid and acid-base balance in the body.
Two kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. Their function is to:
The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.
Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
A kidney transplant may be recommended for people with end stage renal disease (ESRD), a permanent condition of kidney failure that often requires dialysis (a process used to remove wastes and other substances from the blood). Some conditions of the kidneys that may result in ESRD include, but are not limited to, the following:
There may be other reasons for doctors to recommend a kidney transplant.
The symptoms of kidney failure vary widely by the cause of the kidney failure, severity of the condition, and the other body systems that are affected. Most people have no symptoms at all in the early stages of the disease, because the kidneys are able to compensate so well for the early impairments in their function. Others have symptoms that are mild, subtle, or vague. Generally, obvious symptoms appear only when the condition has become severe or even critical.
Kidney failure is not painful, even when severe, although there may be pain from damage to other systems. Some types of kidney failure cause fluid retention. However, severe dehydration (fluid deficiency) can also cause kidney failure.
Other common symptoms of kidney failure and end-stage renal disease (ESRD) include the following:
One may be able to prevent kidney failure, or slow the progression of the failure, by controlling underlying conditions. End-stage renal disease cannot be prevented in some cases. Kidney failure has usually progressed fairly significantly by the time symptoms appear.
If a person is at high risk of developing chronic kidney failure, he or she should see their health care professional as recommended for screening tests. If one has a chronic condition such as diabetes, high blood pressure, or high cholesterol, he or she should follow the treatment recommendations of their health care professional.
One should see their health care professional regularly for monitoring. Aggressive treatment of these diseases is essential to preserve kidney function and prevent complications. The person should avoid exposure to alcohol, drugs, chemicals, and other toxic substances as much as possible.
Exams & Tests
Extensive testing must be done before an individual can undergo a renal transplant.
Because of the wide range of information necessary to determine eligibility for transplant, the evaluation process is carried out by a transplant team. The team includes a transplant surgeon, a transplant nephrologist (doctor specializing in the treatment of the kidneys), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Additional team members may include a dietician and an anaesthesiologist.
Components of the transplant evaluation process include, but are not limited to, the following:
The transplant team will consider all information from interviews, medical history, physical examination, and diagnostic tests in determining the patient’s eligibility for kidney transplantation. Once the patient has been accepted as a transplant candidate, the patient is usually placed on a waiting list. When a donor organ becomes available, the patient will be notified and told to come to the hospital immediately.
If the patient is to receive a kidney from a living family member (living-related transplant), the transplant may be performed at a planned time. The potential donor must have a compatible blood type and be in good health. A psychological test will be conducted to ensure the donor is comfortable with the decision.
Before the Surgery
Kidney transplantation requires stay in hospital. Procedures may vary depending on the patient’s condition.
During the Surgery
After the Surgery
After the surgery the patient will be taken to the recovery room for observation. Once blood pressure, pulse, and breathing are stable and the patient is alert, he/she may be taken to the intensive care unit (ICU) or hospital room. Kidney transplantation usually requires an in-hospital stay of several days.
A kidney from a living donor may begin to make urine immediately, but urine production in a cadaver kidney may take longer. Until urine output is sufficient, dialysis may be required. The patient will have a catheter in the bladder to drain urine. The amount of urine will be carefully measured to evaluate the new kidney’s function.
The patient will receive IV fluids until he/she is able to take in adequate food and fluids. Immunosuppression (anti-rejection) medications will be closely monitored to make sure the patient is receiving the optimum dose and the best combination of medications.
Blood samples will be taken frequently to monitor the status of the new kidney, as well as other body functions, such as the liver, lungs, and blood system.
The patient’s diet will be gradually advanced from liquids to more solid foods as tolerated. Liquid intake may be restricted until the new kidney is fully functional.
The patient may begin physical activity by the day after the procedure. He/she should get out of bed and move around several times a day.
Pain relievers may be taken for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence the patients should take only recommended medications.
Nurses, pharmacists, dieticians, physical therapists, and other members of the transplant team will teach the patient how to take care of themselves once discharged from the hospital.
Once at home, it will be important to keep the surgical area clean and dry. The doctor will give specific bathing instructions. The stitches or surgical staples will be removed during a follow-up visit, if they were not removed before leaving the hospital. The patient should not drive until the doctor says so. The patient should avoid any activity or position that causes pressure to be placed on the new kidney. Other activity restrictions may apply.
Notify the doctor to report any of the following:
Fever and tenderness over the kidney are some of the most common symptoms of rejection. An elevation of blood creatinine level (blood test to measure kidney function) and/or blood pressure (monitored by the doctor) may also indicate rejection. The symptoms of rejection may resemble other medical conditions or problems. The patient should consult the transplant team with any concerns that he/she may have. Frequent visits to and contact with the transplant team are essential.
The doctor may give additional or alternate instructions after the procedure, depending on the patient’s particular situation.
To allow the transplanted kidney to survive in a new body, the patient will be given medications for the rest of his/her life to fight rejection. Each person may react differently to medications, and each transplant team has preferences for different medications. The anti-rejection medications most commonly used singly, or in combination, include:
New anti-rejection medications are continually being developed and approved. Doctors tailor medication regimes to meet the needs of each individual patient.
Usually several anti-rejection medications are given initially. The doses of these medications may change frequently, depending on the patient’s response. Because anti-rejection medications affect the immune system, people who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making the patient very susceptible to infection. Some of the infections the patient will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses. Patients should avoid contact with crowds and anyone who has an infection for the first few months after surgery.
The period immediately following the transplant can be very stressful. The patient will not only be recovering from major surgery, he or she will also be anxious about organ rejection. The patient, his or her family, and the transplant coordinators must keep in contact and close follow-up with the transplant team. Before leaving the hospital, the patient will be given instructions on proper doses of and schedule for anti-rejection medication. Keeping track of these medications is extremely important, because they can actually harm the transplanted kidney if the doses are not appropriate. The patient will be taught how to measure their blood pressure, temperature, and urine output at home, and he or she should keep a log of these readings. The social worker and dietician will counsel the patient before they leave the hospital. In the first few weeks after leaving the hospital, the patient will meet with members of their team frequently to monitor their recovery, review the logs, undergo blood tests, and adjust medication doses.
The outcome for kidney transplants continues to improve with advances in immune-suppressing medications. Usually, the 3-year graft survival rate after transplantation varies between 83% to 94%. The earlier the patient can detect rejection, the better the chance it can be reversed and the new kidney’s function preserved.
The most important thing to do is make sure your blood pressure is under control by having it measured once a year. Also, it is important to maintain good control of your blood sugar level.
There are some basic things that we monitor for risk of kidney disease:
As long as one kidney is healthy, it should not affect a lifespan.
Serum creatinine is a blood test that your doctor uses to measure how well your kidneys are filtering.
The most important thing to do is measure blood pressure and proteins to ensure that the remaining kidney is still healthy. In most cases, when one kidney goes bad, the other will go bad as well.
There are four major causes of kidney failure, listed from most common to least common:
It is usually not necessary to remove a kidney that shuts down.
Around 10 percent of kidney failures are caused by hereditary factors.
Fatigue is a common symptom of kidney failure and there are medications that treat this symptom. If the fatigue is too severe, the best way to manage this might be with dialysis.
Kidney infections and certain obstructions can cause back pain. However, most back pain is unrelated to kidney problems.
Many patients with kidney failure have swelling, which is something we can treat with medicine. Another way patients can keep from swelling is avoiding salt in their diets.
The major function of your kidneys is to filter out impurities from your blood. When kidneys don’t work, we use a dialysis machine to filter out the impurities since your kidneys aren’t able to do so.
After kidney failure begins, the serum creatinine levels are monitored. If they reach a certain point, dialysis is considered.
Most patients get dialysis three times a week.
Some patients remain on dialysis for more than 25 years so there is no upper limit to the amount of time spent on dialysis. However, the survival rate of a patient increases when they get a transplant instead.
Yes, this can be done. This possibility should be discussed with a doctor when considering dialysis as an option. Most patients who do dialysis at home would often have to travel a long distance to get to a dialysis center.
The experience varies from patient to patient. Some do well on dialysis and some do not do well. Dialysis is always better than the alternative of death, but it is not as good as getting a transplant.
There are rules that determine who is the highest on the transplant waiting list. These are based on expected survival, time on dialysis, and other factors.
On average, transplanted kidneys last between 10 and 12 years.
Two weeks after the surgery, you should start to feel much better; however, you need to take drugs to prevent rejection for the rest of your life. Beyond that, the only other lifestyle change encouraged is for transplant patients not to be involved in contact sports. It is recommended that you stay active, avoid smoking and alcohol, and stick to a healthy diet.
It is recommended that people avoid contact sports: football, basketball, wrestling, soccer, and certain other sports that could result in injury to the area of the body where the transplanted kidney has been placed.
Rejection is due to the same immune response that protects you against colds and other viruses. Though tests are run to indicate how likely rejection will be, there is no way to be sure about whether rejection will happen or not.
Early rejection happens in about 15 percent of patients, which is the lowest it has ever been. However, most people will not lose their kidneys from this kind of rejection.
A certain percentage of transplanted kidneys come from relatives or friends of the person with kidney failure who volunteer to donate a kidney (living donation). The others come from patients who have died suddenly and are organ donors
There are three advantages to living donations versus getting a deceased donor kidney:
The risk of serious injury from a donation is low, around 1 in 10,000. Patients who donate a kidney may also be sore for some period of time, as after any major surgery.
The operation is different depending on whether it is an “open” surgery or by “laparoscopy.” Both start with an incision made in the person’s side, the blood vessels to the kidney get tied off, the ureter (the tube from the kidney to the bladder) is tied off and the kidney is taken out. Typically donors recover from laparoscopic surgery within a week and from the open surgery within a couple of weeks.
Diabetes is now the most common cause of kidney failure. About one third of patients with kidney failure have it because of diabetes. There are three main things that can be done to reduce the likelihood of kidney failure in diabetics:
Yes. In diabetic patients both blood pressure and protein in their urine is monitored. These tests are done at least once a year.
Kidney stones don’t lead to kidney failure often. However, if they cause long-term obstruction of the kidney, they may lead to kidney failure.
No, generally speaking, patients do not get urinary tract infections because of a non-functioning kidney.
No, excessive alcohol consumption does not cause kidney disease.
Typically it means there is scarring or cysts within the kidney that are seen with a special kind of x-ray.
Being overweight is a major contributor to high blood pressure, which often has a relationship with kidney failure. Patients who are seriously overweight should try to get their weight and blood pressure down.
I came from Baghdad to India with the help of the HTW office over there. I got a good driver and the accommodation in the hospital was also good. Doctors are excellent and experienced. Ms. Tahmina (of HTW) was very helpful. The translator (Ahmed) was good. I will call the HTW office for my friends or family if they have to go to India for their operation.Mr. Hussein Ali Al-Egabi
I came to India with a diagnosis of HSIL (High-grade Squamous Intraepithelial Lesion), doctor suggested surgery after my first biopsy results showed negative. Initially, I was afraid to undergo surgery but the doctors and nurses were extremely good and their approach made me feel like home. I would like to thank Health Travellers Worldwide (HTW) for their guidance and support throughout our stay in India.Ms. Ciyizire R Clementine, Rwanda
Knee Arthritis had bedridden me and had deprived me of all the wonderful time for past 4 years. I sought advice from Health Travellers Worldwide. Big thanks to Dr.Shailaja, HTW and Muthira who took care of both me and my family in a professional way.Mr. Unaya Mohammed Salim Alrashdi, Oman
I want to thank you from the bottom of my heart for everything you have done for me. I am delighted with your work. I would, without a shadow of a doubt, not hesitate to recommend Health Travellers Worldwide. I am happy that in this short time I am back with my family and friends.Mr. Salman Abdullah Dawood Salman, Iraq
After years of suffering from knee pain, I decided to undergo surgery. I heard a lot about medical facilities in India. I sought advice from Health Travellers Worldwide. They suggested me the right hospital for Knee surgery. I chose North India and I am really happy with the hospital’s services and care by the entire teamMr. Hind Abdul Amir Hassan, Iraq
[dflip id="37081" ][/dflip]