The second major treatment alternative for ESRD is kidney transplantation. The first kidney transplant was performed in 1954. Transplantation involves removing a healthy human kidney from a donor and surgically placing it into the body of a person with renal failure. This single kidney will expand to handle the workload of two healthy kidneys. Although not a cure for renal failure, transplantation frees the individual from dialysis treatments and the necessary fluid and dietary restrictions that accompany it. An individual interested in receiving a transplant must be in good overall health, and other factors such as age and emotional outlook must be considered. A transplant surgeon, transplant coordinator and other members of the health care team will discuss with you in great detail the risks of surgery, success rates, costs, side-effects of the medications and the actual procedure and recovery process.
Most patients who receive a kidney transplant do not need to have their own kidneys removed. However, long-standing problems such as chronic infection, kidney stone disease or uncontrolled high blood pressure may require a separate hospitalisation to remove the kidneys prior to transplantation. This procedure is called a bilateral nephrectomy.
Three factors while considering in Transplantation:
- Kidney Donors
- Transplant procedure
- After the Transplant
Where Do Kidney Donors come from? Kidney donors come from two sources: a nonliving (cadaver) donor or a living donor.
A cadaver donor is someone who is brain dead and permission has been given for their organs to be used for transplant. Organ procurement and retrieval procedures now enable a kidney from a non-living donor to be medically preserved for 48 to 72 hours outside the body on a machine called an organ perfusion pump. This provides enough time for the transplant team to find the best match for the donor organ.
A living donor can be a blood relative or an unrelated donor such as a spouse. A person can donate a kidney while living because one kidney that functions well is quite sufficient to maintain a normal state of health. To determine if a donated kidney has an optimal chance of working when transplanted, several medical tests must be evaluated. The donors blood type must be compatible with the recipients or the implanted kidney will be rejected by the body. Tissue typing is also checked, although a match is not an absolute requirement. Generally, the closer the blood relative, the better the match. Therefore, the best match is between identical twins, followed by siblings and parents. However, any healthy and willing living donor should be considered. A person who wishes to become a kidney donor undergoes a comprehensive set of medical tests to ensure not only compatibility, but also that the donor will not be placed at risk. Following the short recovery period after the transplant procedure, the donor will be able to resume all normal activities.
Transplant surgery normally takes two to four hours. The donor kidney is placed in the front pelvic area, lower than the natural kidneys. Blood vessels in the pelvis are used as the connectors for the artery and the vein. The ureter from the new kidney is connected to the bladder. Often the kidney begins to function and to produce urine immediately. However, it is not uncommon to need a few dialysis treatments after surgery in cadaver transplant until the new kidney begins to function.
After the Transplant:
Rejection is a very serious concern for any transplant recipient. Our bodies are protected by the immune system which recognizes and attacks any foreign substance. This system actively protects us by attacking viruses and bacteria. It produces antibodies (proteins) and lymphocytes (white blood cells) that converge and try to destroy foreign substances. However, the immune system cannot differentiate between the transplanted organ and a foreign substance. Immuno- suppressive medications are taken by the patient to reduce this response. Since the threat of rejection is always present, these medications must be taken for as long as the transplant functions. Resistance to infection will remain low while taking anti-rejection medications. Thus, it is important to contact your transplant surgeon or nephrologist should fever or other signs of infection develop. Most rejection episodes can be treated effectively if detected in the earliest stages. Before discharge from the hospital, the transplant team reviews the medication schedule. In addition they teach the patient the warning signs of rejection and infection. Because rejection episodes can occur at any time, all transplant patients are regularly followed through an outpatient transplant clinic. These visits allow the transplant team to monitor medications and to ensure the delicate balance between preventing infection and controlling rejection. Success rates for kidney transplantation continue to improve with advances in technique and immunology. Unfortunately though, some patients will still lose their transplanted kidney. For these patients it is important to remember that rejecting the first kidney does not indicate that another transplant will not be successful. Also, dialysis remains a treatment alternative if the transplant should fail.