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Renal Transplant

What is renal transplantation ?

Kidney transplantation means replacement of the failed kidneys with a healthy and working kidney from another person called donor. Kidney transplant can be done by obtaining kidneys from a live donor or can be harvested from a brain dead person. Cadaver kidney transplants are done by harvesting organs from a person who is brain dead. Patients suffering from end stage renal disease (ESRD) or Chronic Kidney Disease (CKD) are usually referred for kidney transplants.

 

What is end stage renal disease ?

Kidneys remove excess fluid and waste from our blood stream. When our kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in the body. Kidneys fail to perform their routine function, it means that the kidneys are slowly failing, and dialysis is required to maintain the kidney function. In end stage renal disease both the kidneys fail to the extent that dialysis is required quite often. The nephrologists may suggest peritoneal dialysis or haemodialysis as per the patients’ prognosis. ESRD ultimately leads to heart failure at any point of time; the only option would be to go in for a kidney transplant.

 

How to treat renal disease ?

End stage renal disease cannot be treated with conventional medications or drugs. Dialysis and kidney transplantation are the only treatments available for this disease at present. Recent research and advancements in medical fields are trying to create artificial 3 D livers and 3D kidneys which can perform the same functions that the normal kidney does. The experiments are still underway and they are still in the testing stages, if successful, we at KIMS would be the pioneers in Hyderabad to gain expertise in the same and treat our patient’s more effectively.

 
Conditions that damage kidneys :

Smoking, alcohol abuse may damage kidneys or a period of time. It is important to eat, drink and exercise in moderation to keep kidney diseases at bay. Genetic conditions may also play a role in kidney damage over the years. It is important to take any medications like pain killers or antibiotics under a supervision of doctors. Uncontrolled diabetes or high blood pressure may damage kidneys over a period of time. It is important to keep them in check at all times.

 
Kidney transplantation :

Kidney transplantation will be successful in patients who are below 55 to 60 years. Kidney transplantation can be taken up only after complete evaluation of the patient and the donor, and how the patient will adapt to the new kidney. Immuno suppressants will be given after the kidney is transplanted to avoid rejection of the kidney.

 
How to perform transplantation :

The transplantation is a surgical procedure where in the donor kidney or the harvested kidney is placed appropriately in the patient’s body. The healthy kidney takes over the functions of the defunct kidneys. A person can usually live normally with one kidney as long as it functions properly. The surgeon inserts the new kidney in the lower abdomen and attaches it to an artery and vein in that area. The kidney is also then attached to the ureter, which carries urine from the kidney to the bladder. The patient’s own original kidneys are usually left in place unless they are causing any problems, such as infection.

 
Risks of the surgery :

Every surgery has potential risks involved. Kidney transplantation is not a particularly difficult or complicated operation.

 
Some complications including :
  • Blood clots which may take time to heal
  • Bleeding that may not be controlled
  • Failure of the donated kidney
  • Rejection of the donated kidney by the patient’s body
  • Infection that may take time to heal

During surgery the risks are less but after the surgery the period is most critical and has to be monitored hands on. Our medical team and experts will watch very carefully to make sure that the new kidney is functioning properly and that the body is not rejecting the kidney, by giving immune-suppressant medications and constantly monitoring the kidney function.

 

How do you prepare for the surgery ?

The Donor has to be found who can give a healthy kidney which will match the patient’s blood group, usually kith and kin will be considered or many cases a person who is not related may also give his kidney.

A cadaver kidney transplant is also being done considering the intensity of the patient’s situation. The kidneys are harvested from a brain dead person after obtaining the consent of the relatives. In India there are about more than 1 million people suffering from renal insufficiencies and their name is placed on the national list as per the emergency at which the kidney needs to be transplanted.

 
Before transplantation :

Before going to the transplantation the patient will be asked many questions to ascertain his life style habits and daily diet intake and a complete check is made through previous medical records as well as fresh medical tests.

Doctors also make sure the patient is mentally prepared for kidney transplantation. The patient’s family members are also counselled on the pros and cons of the transplant and the procedural complications. After obtaining their consent, which is in written the kidney is transplanted.

 
Medical tests :

Both the donor and the accepter need to undergo medical tests such as HIV test, liver function test, tests that determine general health condition as well as heart condition.

 
During surgery :

The patient is administered general anaesthesia and the vital parameters such as heart rate, blood pressure are constantly monitored.

The surgeon makes an incision and places the new kidney in the lower abdomen. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place. The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of the legs.

 
After transplantation :

The patient is posted to the intensive care unit post operation, is monitored until he recovers and is sent to his room for further stay in hospital for another 3 to 4 days. The patient will be under the supervision of our expert care givers at KIMS. Immuno suppressant will be administered from day one of the transplant to avoid the rejection of new kidney.

Like any medication these drugs can have certain unpleasant side effects. Some of the most common immune suppressing drugs used in transplantation are

Cyclosporine : this drug is started immediately after the transplant to suppress the immune system. Common side effects are high blood pressure, and kidney damage in certain patients.

Corticosteroids : these drugs usually given at high doses for a short period immediately after the transplantation and again if the rejection is suspected or detected. These drugs have many different side effects including high blood pressure, high blood sugar, weight gain and osteoporosis

Azathioprine : This is usually used for long term maintenance of immune suppression to avoid kidney rejection. The most common side effect is bone marrow, liver damage. Many transplant centres are now using a new drug called mycophenolate mofetil instead of azathioprine which is working quite positively.

Prognosis after transplantation :

In the first few weeks after leaving the hospital the patient is constantly examined and monitored as per the schedule by our expert team. Medication must not be missed. Dietary restrictions must be followed.

 
After going home :

The period immediately following the transplant can be very stressful and critical. The patient will not only be recovering from a major surgery, he or she will also be anxious about organ rejection and has to be counselled properly. The patient his or her family and the transplant coordinators must keep in contact and close follow-up with the team involved in your kidney transplantation at KIMS.

Women who wish to go in for child bearing are advised to wait for a period of 2 to 3 years, to avoid complications and consult the nephrologist as well as gynaecologist for further guidance.

 
Signs and symptoms of kidney rejection :

The patient’s body or immune system may not accept the donor’s kidney inspite of using immune suppressants. The following symptoms must be reported immediately :

  • High blood pressure is the common sign that the kidney is not functioning properly, or there is some inherent problem.
  • Swelling or puffiness, usually in the arms, legs, or face is a sign of fluid retention
  • Decreased urine output.
  • Fever is a sign of infection
  • Abdominal pain
  • Redness or swelling at the surgical site
  • Shortness of breath.
Follow-up :

The patient must keep follow-up appointments with the transplant team to monitor for signs of rejection as scheduled. The patient will have regular blood and urine tests to detect any signs of organ failure. Ultrasounds of the graft kidney may be done to see if there are structural abnormalities suggesting rejection. An arteriogram or a nuclear scan may be needed to confirm that blood is being supplied to the transplanted kidney.

 
Survival rates :

98% of people who have received kidney transplant usually survive from one year to five years and even beyond thanks to the advancement of medical technologies. At KIMS, our state of the art kidney centre focuses on expert kidney care aimed at improving quality of life, enhancing the survival rates of patients with transplanted kidneys. We have successfully done kidney transplantations with quite positive outcomes. KIMS has a specialised unit for kidney care providing excellent medical care to children as well as adults suffering from kidney ailments.

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