Kidney Transplant

A Kidney transplant is a surgical procedure that’s done to treat Kidney failure. The Kidneys filter waste from the blood and remove it from the body through your urine. They also help maintain your body’s fluid and electrolyte balance. If your kidneys stop working, waste builds up in your body and can make you very sick.

People whose kidneys have failed usually undergo a treatment called dialysis. This treatment mechanically filters waste that builds up in the bloodstream when the kidneys stop working. Some people whose kidneys have failed may qualify for a kidney transplant. In this procedure, one or both kidneys are replaced with donor kidneys from a live or deceased person.

There are pros and cons to both dialysis and kidney transplant.

  • Undergoing dialysis takes time and is labour-intensive. Dialysis often requires making frequent trips to a dialysis centre to receive treatment. At the dialysis centre, your blood is cleansed using a dialysis machine.
  • If you’re a candidate to have dialysis in your home, you’ll need to purchase dialysis supplies and learn how to use them.
  • A kidney transplant can free you from a long-term dependence on a dialysis machine and the strict schedule that goes with it. This can allow you to live a more active life.
  • However, kidney transplants aren’t suitable for everyone. This includes people with active infections and those who are severely overweight.
  • During a kidney transplant, your surgeon will take a donated kidney and place it in your body. Even though you’re born with two kidneys, you can lead a healthy life with only one functioning kidney.
  • After the transplant, you’ll have to take immune-suppressing medications to keep your immune system from attacking the new organ.
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Reasons of Kidney Transplant

Various conditions can damage the kidneys, including both primary kidney diseases and other conditions that affect the kidneys.

  • If kidney damage becomes too severe, the kidneys lose their ability to function normally. This is called kidney failure.
  • Kidney failure can happen rapidly, usually in response to a severe acute (sudden, short-term) illness in another body system or in the kidneys. It is a very common complication in patients hospitalized for other reasons. It is often completely reversible with resolution of the underlying condition.
  • Kidney failure can also happen very slowly and gradually (chronic kidney failure), usually in response to a chronic (ongoing, long-term) disease such as diabetes or high blood pressure.
  • Both types of kidney failure can occur in response to primary Kidney disease as well. In some cases, this kidney disease is hereditary.
  • Infections and substances such as drugs and toxins can permanently scar the kidneys and lead to their failure.

People with the following conditions are at greater-than-normal risk of developing kidney failure and end-stage renal disease:

  • Diabetes
  • High Blood Pressure, especially if severe or uncontrolled
  • Glomerular diseases (These are conditions that damage the glomeruli, such as glomerulonephritis.)
  • Hemolytic uremic syndrome
  • Systemic lupus erythematosus
  • Sickle cell anemia
  • Severe injury or Burns 
  • Major surgery
  • Heart disease or heart attack
  • Liver disease or liver failure
  • Vascular diseases (These conditions, including progressive systemic sclerosis, renal artery thrombosis [blood clot], and scleroderma, block blood flow to different parts of the body.)
  • Inherited kidney diseases (polycystic kidney disease, congenital obstructive uropathy, cystinosis, prune belly syndrome)
  • Diseases affecting the tubules and other structures in the kidneys (acquired obstructive nephropathy, acute tubular necrosis, acute interstitial nephritis)
  • Amyloidosis
  • Taking antibiotics, cyclosporin, heroin, and chemotherapy (These can cause inflammation of kidney structures.)
  • Gout
  • Certain cancers (incidental carcinoma, lymphoma, multiple myeloma, renal cell carcinoma, Wilms tumor)
  • HIV infection
  • Vesicoureteral reflux (This is a urinary tract problem.)
  • Past kidney transplant (graft failure)
  • Rheumatoid arthritis
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Symptoms of conditions treated by Kidney Transplant

The symptoms of kidney failure vary widely by the cause of kidney failure, the 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.
  • Fluid retention (This causes puffiness, swelling of arms and legs, and shortness of breath.)
  • Dehydration (This results in thirst, rapid heart rate [tachycardia], dry mucous membranes [such as inside the mouth and nose], and feeling weak or lethargic.)

Other common symptoms of kidney failure and end-stage renal disease include the following:

  • Urinating less than usual
  • Urinary problems (frequency, urgency)
  • Bleeding due to impaired clotting, from any site
  • Easy bruising
  • Fatigue
  • Confusion
  • Nausea, vomiting
  • Loss of appetite
  • Pain in the muscles, joints, flanks, chest
  • Bone pain or fractures
  • Itching
  • Pale skin (from anaemia)

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 preserving kidney function and preventing complications. The person should avoid exposure to alcohol, drugs, chemicals, and other toxic substances as much as possible.

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Procedures of Kidney Transplant

As kidneys become diseased, they lose their ability to function, a condition called end-stage renal disease (ESRD) or kidney failure. Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant.

None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.

Living Donors

  • Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor's remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complication. But kidney donors have the same life expectancy, general health and kidney function as others.
  • Any healthy person can safely donate a kidney. The donor must be in excellent health, well informed about transplantation and able to give informed consent.
  • Costs for living donor surgery, hospitalization, diagnostic tests and evaluation usually are paid by the recipient's insurance. Travel and living expenses are not covered. Insurance coverage will be discussed during the transplant evaluation.
  • If you have a potential living donor, he or she will undergo an evaluation and discuss the possibility of organ donation. Tests will be performed to ensure that the donor and recipient are compatible. In some families, several people are compatible donors. In other families, none are suitable.
  • Since 1999, UCSF has been using a procedure, called laparoscopic donor nephrectomy, to remove kidneys from living donors. We have performed more than 850 of these procedures, making our program one of the most experienced in the country. The procedure uses tiny incisions and a scope or camera, similar to one used to remove a gall bladder. The procedure has a shorter recovery period and the complication rate is very low. In addition, the quality and function of the transplanted kidneys are excellent.
  • The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most patients undergoing laparoscopic surgery for kidney donation require a hospital stay of only two to three days. After discharge from the hospital, the donor is seen for follow-up care in the transplant clinic. If the donor resides outside the San Francisco region, he or she should stay in the area for at least a week after discharge. Donors who undergo laparoscopic surgery often return to work within three to four weeks after the procedure.

Special programs for living donor transplants include:

  • Blood Type Incompatible
  • Paired Exchange
  • Positive Crossmatch
  • Waiting List Exchange

Cadaveric Donors

  • A cadaveric kidney comes from a deceased donor. The Uniform Anatomical Gift Act allows us to donate organs for transplant when we die and allows our families to provide permission as well. All donors are carefully screened to prevent disease transmission.
  • If you decide to undergo a cadaveric kidney transplant and you're medically eligible, your name will be placed on a cadaver waiting list. A blood sample for antibody level will be sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.
  • When a kidney becomes available, your referring kidney specialist is contacted for approval. The transplant service will verify that you have no recent infections or medical problems that would interfere with a safe transplant. We will assist you in making arrangements for your transplant.

Transplant Surgery

  • Your surgery may last from two to four hours. During the operation, the kidney is placed in your pelvis rather than the usual kidney location in the back. (Your own kidney will not be removed.) The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.
  • After the operation, you will remain in the recovery room for a few hours and then return to the Kidney Transplant Unit. The surgeon will inform your family when the procedure is over.
  • You will be encouraged to get out of bed 12 to 24 hours after surgery and walk as much as you can. Nurses will instruct you in taking your medications, explain the side effects and discuss making lifestyle changes.
  • A cadaver kidney transplant sometimes will be temporarily slow in functioning, a condition called a "sleepy" kidney or acute tubular necrosis (ATN). You may need to undergo dialysis a few times. A "sleepy" kidney usually starts working in two to four weeks.
  • Most transplant recipients must take a medication called immunosuppressants to prevent rejection of the transplanted organ. One of the side effects of these anti-rejection drugs is an increased risk for cancer, particularly skin cancer and lymphoma. You should be closely monitored for these conditions.
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Risk & Potential Risks

A kidney transplant is a major surgery. Therefore, it carries the risk of:

  • an allergic reaction to general anaesthesia
  • bleeding
  • blood clots
  • a leakage from the ureter
  • a blockage of the ureter
  • an infection
  • rejection of the donated kidney
  • failure of the donated kidney
  • a heart attack
  • a stroke

Potential risks

The most serious risk of a transplant is that your body rejects the kidney. However, it’s rare that your body will reject your donor's kidney.The immunosuppressant drugs you must take after surgery can lead to some unpleasant side effects as well.

These may include:
  • weight gain
  • bone thinning
  • increased hair growth
  • acne
  • a higher risk of developing certain skin cancers
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