WHAT IS KIDNEY TRANSPLANTATION

A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly. The kidneys are two bean-shaped organs, the size of a fist, located on either side of the spine just below the rib cage. Their main function is to filter and remove excess waste, minerals and fluid from the blood by producing urine.

When the kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in the body, which can raise the blood pressure and result in kidney failure (end-stage renal disease). It occurs when the kidneys have lost about 90 percent of their ability to function normally.

Common causes of end-stage renal disease include:

• Diabetes
• Chronic, uncontrolled high blood pressure
• Inflammation and eventual scarring of the tiny filters within the kidneys (Chronic glomerulonephritis)
• Polycystic kidney disease

People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.

WHY THE PROCEDURE IS PERFORMED

Kidney transplant is the treatment of choice for kidney failure compared to a lifetime on dialysis. The Kidney transplant procedure can treat chronic kidney disease with GFR less than or equal to 20 ml/min(Glomerular filtration rate is a measure of kidney function).  Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option.

WHO IS ELIGIBLE FOR A KIDNEY TRANSPLANT

Kidney patients of all ages can get a transplant. The patient must be healthy enough to have the operation, also be free from cancer and infection. A complete evaluation is done prior to the procedure.  

However, for certain people with kidney failure, a kidney transplant may be more risky than dialysis. Conditions that may prevent a Doctor recommending against transplant can be old age, heart diseases, cancer, dementia and mental illness, drugs or alcohol abuse. Other health conditions that prevent the ability to have anti-rejection medication.  

HOW IS THE PROCEDURE DONE?

A kidney transplant procedure can take anywhere between 3-5 hours. 

Before the Procedure

1. Detailed medical and psychological evaluation including several diagnostic tests. 
2. Finding a match (Donor). The donor can be a related living Donor or deceased donor. The matching includes blood typing, tissue (HLA) typing and crossmatching. Blood-type incompatible (ABO Incompatible) transplants are also possible but require additional medical treatment before and after transplant to reduce the risk of organ rejection.

During the Procedure

1. The Kidney Transplant Surgery is done under general anaesthesia. 
2. One the patient is under anaesthesia,  the surgeon will make an opening in the abdomen, just above the groin.
3. The patient's own kidneys aren’t removed unless they’re infected or causing pain, the donor kidney is put in and it’s blood vessels are attached. 
4. Finally, the surgeon will connect the ureter (the tube carrying urine from the kidney) to the bladder.

After the Procedure

1. Patients are required to stay for a week in the hospital for close monitoring. The new kidney starts making urine immediately or it may take several days. The patient will need dialysis treatments to filter wastes and extra salt and fluid from the body until it starts working.
2. Frequent check-ups and monitoring is required for few weeks after the discharge
3. Medications are required for the rest of life including immunosuppressants (anti-rejection medications) to help keep the immune system from attacking and rejecting the new kidney.

WHAT ARE THE RISKS INVOLVED IN KIDNEY TRANSPLANTATION 

Some of the risks besides rejection are similar to risks involved in other pelvic surgeries. These may include: 

• Bleeding or blood clots
• Transplant rejection
• Failure of donated kidney
• Hernia
• Heart attack, stroke or death
• infection, especially a bladder infection

IMPORTANT INFORMATION

1. Follow all medication and Doctor advice
2. Transplant recipients should eat a heart-healthy diet (low fat, low salt) and drink plenty of fluids.