Dr. Bhavin Brahmbhatt :: Kidney Transplant

Kidney transplantation (KT) is the outcome of great advancement in medical science.

Kidney transplantation is the treatment of choice for end-stage kidney disease (ESKD). Successful kidney transplantation may offer better quality of life and longer patient survival compared with dialysis. Life after successful kidney transplantation is almost normal.

What is kidney transplantation?

Kidney transplantation is a surgical procedure in which a healthy kidney (from a living donor or deceased - cadaver donor) is placed into the body of a person suffering from end-stage kidney disease (recipient).

When is kidney transplant necessary?

Kidney transplantation is necessary for patients who are suffering from ESKD who are on dialysis (hemodialysis or peritoneal dialysis) or who are approaching ESKD but not yet on dialysis (pre-emptive KT).

When is kidney transplant not required in kidney failure?

A patient with acute kidney injury should not undergo KT. Kidney transplantation is also not done in cases where only one kidney fails and the other kidney is still functioning. Transplantation should only be done if the renal failure is irreversible.

Why is kidney transplant necessary in end-stage kidney disease?

Dialysis replaces some degree of the filtration of waste products of the kidneys. Other functions of the kidneys are not accomplished, some of which are better addressed by transplantation. Hence, kidney transplantation, when a suitable donor is available and when no contraindications are present, offers the best treatment option for complete rehabilitation of a patient with end-stage kidney failure. As kidney transplantation saves lives and enables one to enjoy almost normal life, it is referred to as the “Gift of Life”.

What are the advantages of kidney transplantation?

Major benefits of successful KT are:

Better degree of replacement of renal function and better quality of life: The patient may achieve an almost normal and active lifestyle with more energy, stamina and productivity.
Freedom from dialysis: Patients avoid the complications, cost, lost time and inconveniences of dialysis treatment.
Longer life expectancy: Transplant patients have a longer life expectancy than risk-matched patients who remain on dialysis.
Lesser dietary and fluid restrictions.
Cost-effectiveness:Although the initial cost of a kidney transplant may be high, the expenses decrease by the second to third year post-transplant and by then, is usually less than that needed for maintenance dialysis treatment.
There is a reported improvement in sexual life and a higher chance of fathering a child in males and becoming pregnant in females.

Types of Kidney Transplantation

1. Living Donor Kidney Transplantation:- A living donor kidney transplant is a surgery to give you a healthy kidney from someone who is still alive. A person with two healthy kidneys can donate one kidney to a person with kidney failure.

2. Deceased Donor (Cadaveric Donor) Kidney Transplantation:- A deceased donor is someone who has consented to donating his or her organs upon death. In situations where the wishes of the deceased donor are not known, family members may consent to organ donation.

To get a deceased donor kidney, you will be placed on a waiting list once you have been cleared for a transplant. It can take many years for a good donor kidney to be offered to you. From the time you go on the list until a kidney is found, you may have to be on some form of dialysis. While you’re waiting, you’ll need regular blood tests to make sure you are ready when a kidney is found.

Living Donor Kidney Transplantation

1. Who can donate kidneys?

Donated kidneys can come from a blood relative (like father or mother or brother or sister) or non-blood relative (like a husband or wife) of a kidney disease patient.

2. What are the advantages of Living donor transplantation?

One advantage of receiving a kidney from a living donor is that this type of kidney has been shown to last longer than a kidney from a deceased donor.
Another advantage is that the operation can be planned to suit your schedule, since it is not necessary to wait for a kidney to become available from a deceased donor. Some research shows that an early kidney transplant, with little or no time spent on dialysis, can lead to better long term health.
There may be a reduced risk of rejection, especially if the kidney is donated by a blood relative.
A disadvantage of living donation is that a healthy person must undergo surgery to remove a healthy kidney.

3.What are the steps before Living donor kidney transplantation?

Willingness for Donation (Voluntary Consent)
Thorough History, Physical Examination, Laboratory and Radiological Evaluation for Fitness
Permission from Authorization committee

4.Paired kidney donation :- Paired kidney donation (or paired exchange) is an option when you have a relative who is willing and able to be a kidney donor, but he or she is not a match for you. In a paired exchange, your relative gives a kidney to someone who needs it, and that recipients’ relative or friend gives his or her kidney to you.

5. ABO blood group Incompatible kidney transplantation :- When the donor kidney has a blood type that do not match (are incompatible with) the recipient’s (the person getting the kidney). Transplant specialist use special methods to make the recipient’s body less sensitive to the donor’s unmatched (incompatible) blood.