What happens when your kidneys fail?
When kidneys fail, toxic products, acid and fluid accumulates in body which effects other major organs like heart, brain and lungs leading to multi organ failure. There are two types of treatment presently available for failed kidneys – Dialysis or kidney transplantation. Kidney transplant offers no doubt is the best modality of treatment option for patients with kidney failure as it has shown to have better quality of life and survival is much better than dialys
What is a kidney transplant?
In kidney transplant, a healthy kidney is placed from a healthy living donor or a brain dead (Deceased / Cadaver) donor. After transplant most of the time patient is discharged after 1 week and donor is discharged after 3 days. Patient has to take medications regularly and strictly follow advice of nephrologist and follow a healthy lifestyle. One has to check his maintain his blood pressure and sugars and do regular investigations as advised by the doctor.
Advantages of kidney transplant
Kidney transplant is the best modality of renal replacement therapy, not only the survival is better but quality of life drastically improves. In fact after 3 months one can start normal work/ job, and young women can bear and plan children after 1 year of successful transplant.
Disadvantages of kidney transplant
Kidney transplantation is a major surgical procedure that has risks both during and after the surgery. The risks of the surgery include infection, bleeding, and damage to the surrounding organs. Even death can occur, although this is very rare (As comprehensive pre transplant work up is done for both patient undergoing transplant and person donating).
Although more than 95 % renal transplants are successful and last for many years, how long the new kidney/ graft works varies from patient to patient (average graft functions from 8-10 years). Many people will need more than one kidney transplant during a lifetime.
Can one get kidney transplant without undergoing dialysis?
Absolutely, one can undergo a kidney transplant before starting dialysis, and it is known as a pre-emptive transplant. It is always better to get pre-emptive transplant or a early transplant (if one has started dialysis. Research has shown that a pre-emptive or early transplant is better. One has less chances of acquiring infections like Hepatitis B & C if one spends less time on dialysis and other decreases the risk of other dialysis related complications.
Information for donor:
After donating kidney mostly donors are discharged in 3 days
Laparoscopic surgery is performed to remove kidney from the donor. In this procedure the scar is 3-4 inches and donor is mobilised out of bed next day of surgery.
Rarely open donor nephrectomy is required.
Information for recipient/patient
Mostly patient is discharged after surgery in 6-7 days
Urine formation and flow occurs immediately after surgery. Rarely kidney function does not pick up and patient might require dialysis. In 1 in 1000 cases transplanted kidney may fail and may not work at all.
Who can get a kidney transplant?
Any person whose kidneys have failed can get a kidney transplant irrespective of age (children and adults up to the age of 75 years), if at all one is healthy enough to get the operation. Patient should be free from cancer and infection. Both Patient and donor, undergo a battery of investigations before the procedure, to look into the fitness and psychosocial evaluation to make sure they are fit candidates for transplant.
Where can I get a kidney for transplant?
Anybody from immediate family can donate kidney (siblings, spouse, parents, children) and one can get a kidney transplant from grandparents, in laws, cousins and friends. But for the second group of donors we have to undergo a lot of formalities and there are regulations to be strictly adhered to and followed.
If at all one does not have any living related donor to donate then one can get deceased (cadaver/ brain dead cases) donor registration done with hospital. One is put on a waiting list and whenever a suitable kidney with matching blood group is available, one can undergo transplant after doing the required investigations.
What if patient and donors blood group do not match?
If at all one has a living related donor but blood group is not compatible, one is left with 2 options:
- Swap transplant - A paired kidney exchange, also known as a “kidney swap” occurs when a living kidney donor is incompatible with the recipient, and so exchanges kidneys with another donor/recipient pair. For example, if the patient (patient 1) blood group is A and donors (Donor 1) is B in a family and we have another pair who has a patient with blood group B (Patient 2) and donor (donor 2) is A, we can legally exchange the donors. Donor 2 donates to patient 1 and donor 1 donates patient.
- The other option is we go ahead and perform blood group incompatible (blood group mismatch) transplant. There is a procedure that is performed called plasmapheresis / immunoglobuln filters, which removes the antibodies of the patient that will fight against the donors kidney. There is a mild risk of rejection as compared to that of ABO compatible kidney transplant. With expertise and experience it is shown that the outcome is same as in ABO compatible kidney transplant, and this is now the proven and one of best option for patients with different blood groups.
Life after kidney transplant
After discharge what are the precautions and advise?
At the time of discharge your nephrologist, transplant surgeon will counsel the patient, donor and the family regarding the strict compliance of medications and regular follow up.
For a successful kidney transplant outcome most, important thing is disciplined lifestyle and stent removal after 2 weeks of discharge.
- Do not miss medications
- Get regular investigations
- To get drug levels of (immunosuppressant) medications as advised
- Eat healthy and stay away from dirty environment
- Monitor sugar, blood pressure and urine output at home
- If at all any problem like fall in blood pressure, fever, cough, breathing difficulty or pain please contact your doctor at the earliest
How do I know my new kidney is functioning well?
After transplant in the initial period chances of rejection is maximum almost 4-6 % of patients suffer from rejection, which is treatable with medications. In the first month after renal transplant blood investigations are done twice a week. After that if everything is on course the frequency of tests goes down.
If at all one has any symptoms of pain in kidney area, fever or blood in urine and decrease in urine output, one must report immediately to his nephrologist.
What about my sex life?
After kidney transplant one has improvement in sexual relations. Post-transplant men have fathered children and women patients have successful pregnancies and bear healthy children. It is advisable to plan pregnancy after one year of transplantation under strict care of nephrologist as we need to change some medications and requires strict supervision during the course of pregnancy.
When can one go to work after kidney transplant surgery?
Mostly after 8-12 weeks after kidney transplant surgery one can start work if the patient recovers well. It is always better and advised to discuss with your treating transplant team as it depends on the type of job profile also.
In present day Chronic Kidney disease is considered as a major medical problem and a silent killer worldwide. The Department of Renal Sciences and Kidney Transplantation at Aakash Healthcare is dedicated...