Kidney Transplant

What Is It ?

A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood.

The department of Transplant Nephrology offers world-leading care for patients who need kidney transplantation:

  • Pre-transplant evaluation and pre-transplant care for transplant recipients
  • Post-transplant long-term care for transplant recipients
  • Pre-transplant evaluation and pre-transplant care for living kidney donors
  • Pre-emptive kidney transplant (leading to better long-term prognosis for certain patients)

Are there different kinds of kidney transplants?

Yes. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse. There are advantages and disadvantages to both types of kidney transplants.

Preparation

Who can donate kidney? 

  • Near relation (as defined by The Transplantation Of Human Organs Act 1994) well-matched live donor, viz Sibling, Parent, Children and spouse can donate kidney to their near ones.
  • Cadaver donor: those whose brain has stopped working permanently, their other body organs including kidney can be utilized for saving other human lives. We very firmly believe that every effort should be made to develop and promote cadaver donor programme. At present this appears like a distant dream in practical terms. However, we are committed to develop such a programme and will spare no efforts to try to achieve the same. 
  • Other than related but emotionally related donors Only if appropriate legal authority permits

Once the identity and relationship between donor and recipient are established by appropriate legal proof, Donor will undergo following procedure 

  • ABO compatibility of the donor is checked. They are evaluated for social and psychiatric aspects.
  • Donor then undergoes examination and a set of investigations as follows: 
  • CLINICAL EXAMINATION: Both by Nephrology and Urology department
  • HAEMATOLOGY: Hemoglobin, WBC-Total & Differential, Platelets, ESR, Bleeding time and Clotting time & Prothrombin time and Malaria Parasites in Peripheral blood.
  • BIOCHEMISTRY: GTT, Urea, Creatinine, Electrolytes, Bicarbonate, Calcium, Phosphorus, Alkaline Phosphatase, Proteins, SGPT, Bilirubin, PSA [if donor is > 50 years Male]..
  • URINALYSIS: Albumin, sugar & Microscopy, Culture and Sensitivity, protein:creatinine ratio or 24 hours protein
  • VIRAL STUDIES & OTHERS: HbsAg, HIV antibodies, HCV, VDRL & CMV antibodies
  • CARDIOVASCULAR & RESPIRATORY STATUS: X-ray Chest PA, ECG, Stress Test, Echo-cardiogram, PEFR , Arterial pH & Gases [as per indications].
  • UROFLOWMETRY IMAGING: X-ray KUB, Ultrasound of abdomen, CT IVU and renal angiography,
  • OTHER: As per need
  • HLA typing for DR, A & B, locus antigens and lymphocytes cross match, is then undertaken. Lymphocyte cross match is done at the time of selection as well as a day prior to transplantation.Once the donor and recipient are found medically suitable, legal formalities will be completed for permission from appropriate authorities. Following which the transplantation date will be finalized.

Is there any risk involved in donating my one kidney to my near one?

As kidney donation is after all a moderate surgical procedure, few / minimal peri operative complications are not unknown but those are not jeopardizing to the life or kidney and easy to manage. However, the long term risk of developing hypertension, proteinuria or kidney failure among kidney donors is almost negligible. In fact it has been noticed even in international literature that kidney donation improves the long term life span as they are prospectively and positively selected and screened for disease. (The risk of living kidney donation. Nephrol Dial Transplant (2003) 18: 871–873)

Risks

What is rejection?

  • The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader."
  • You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil, azathioprine. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection.

What are the side effects of the anti-rejection medications?

Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.

Prevention

Will I need to follow a special diet?

Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed.