Kidney transplant: Know what it is all about

by Dr Chandan Chaudhari from Department of Nephrology at Wockhardt Hospital, Mumbai Central

Kidneys can be defined as two bean-shaped organs which are located on each side of the spine just below the rib cage. Each is about the size of a fist. Moreover, the main functioning of the kidney is to filter and remove waste, minerals, and fluid from the blood by producing urine. A surgical procedure to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly is called as a kidney transplant.

Did you know? When your kidneys lose this filtering ability, harmful levels of fluid and waste tend to get accumulated in the body, which may shoot your blood pressure and result in kidney failure (end-stage kidney disease). One suffers from end-stage renal disease when the kidneys have lost about 90 per cent of their ability to function normally.

What are the common causes of kidney disease?

Diabetes, uncontrolled high blood pressure and polycystic kidney disease can be the causes. Also, the ones suffering from the end-stage renal disease should get waste removed from their bloodstream with the help of a machine (dialysis) or a kidney transplant to be able to stay alive.

Know why kidney transplant is done

Those with kidney failure may opt for a kidney transplant, compared with a lifetime on dialysis. Undergoing a kidney transplant can help one tackle chronic kidney disease or end-stage renal disease to allow one to live longer. Doing so can enhance your quality of life, reduce your risk of death, there may be fewer dietary restrictions for you, along with lower treatment cost. But, are you aware that in some people with kidney failure, a kidney transplant can be dangerous than dialysis. You might not be suitable for a kidney transplant owing to your advanced age, severe heart disease, a cancer which is active or recently treated, alcohol or drug abuse and any other factor which could impact the ability to safely undergo the procedure and take the medications needed after a transplant in order to prevent organ rejection.

Who can donate kidneys?

Kidney donors can be either living or deceased. A family member with two healthy kidneys may opt to donate them as the body will be able to function even with one kidney too.

If your family member’s blood and tissues match your blood and tissues, you can schedule a planned donation. Moreover, receiving a kidney from a family member can lower the risk that the body will reject the kidney, and may enable one to bypass the multiyear waiting list for a deceased donor. Deceased donors who are also known as cadaver donors are people who have died, usually as the result of an accident rather than a disease. Here, either the donor or the family chooses to donate the deceased organs and tissues. One’s body is likely to reject a kidney from an unrelated donor. Thus, cadaver organ is a good alternative if you don’t have a family member or friend who’s willing or able to donate a kidney.

All you need to know about the matching process

While you have been evaluated for a transplant, you will have to undergo a blood test to know your blood type, and human leukocyte antigen (HLA). A group of antigens located on the surface of your white blood cells is HLA, and these antigens are responsible for your body’s immune response. Furthermore, if one’s HLA type matches the donor’s HLA type and then maybe one’s body won’t reject the kidney. After identifying the potential donor, another test is performed to make sure that your antibodies won’t attack the donor’s organ. This can be done by mixing a small amount of your blood with the donor’s blood. The doctor will not go ahead with the transplant if one’s blood forms antibodies in response to the donor’s blood. Here, if your blood shows no antibody reaction, you have what’s called a “negative crossmatch.” This means that the transplant can proceed.

The procedure of kidney transplant

Before undergoing a kidney transplant, one will need to give a sample of your blood for the antibody test. One will only be cleared for the transplant in case the result is a negative crossmatch. After which, a kidney transplant will be carried out under general anesthesia, and one will be given medication which puts one to sleep during the surgery. The anesthetic will be injected into the body via an intravenous (IV) line in your hand or arm. Then, as you are asleep, the doctor will make an incision in your abdomen and places the donor kidney inside.  Then the doctor may connect the arteries and veins from the kidney to your arteries and veins. This will cause blood to start flowing through the new kidney. Moreover, the new kidney’s ureter will be attached to your bladder so that you’re able to urinate normally. The ureter is the tube which tends to connect the kidney to your bladder.

What you must do after a kidney transplant?

After the transplant, you will have to stay in the hospital for a week. One’s new kidney may start to clear waste from the body immediately, or it may take up to a few weeks before it starts functioning. Also, kidneys which are donated by family members may start working more quickly than those from unrelated or deceased donors. Your doctors will monitor you for complications if any. You will also be put on immunosuppressant drugs to stop your body from rejecting the new kidney. Before getting discharged from the hospital, you will be given instructions, and briefed about when you must take medications. You will have to monitor yourself for warning signs that your body has rejected the kidney.  Look for signs like pain, swelling, and flu-like symptoms. Moreover, you will also have to go for regular check-ups, and follow-ups.