What is kidney transplant- Kidney transplant is a surgical procedure in which one kidney is removed from the donor’s body and it is implanted in the patient’s body. Its blood vessels and urine tube are joined at appropriate places.
1. Who needs kidney transplant?
Patients whose both kidneys have failed and he or she is dependent on dialysis for sustaining life can be considered for a kidney transplants.
2. How many kidneys are implanted?
Single kidney is implanted commonly or Right side of lower abdomen and sometimes on left side as per surgical need. One kidney is left behind for donor in case of live related transplant. In case of brain dead donor another kidney is given to another patient on the waiting list.
3. Who can donate the kidney?
Person who is above age of 18 years, who is in mentally sound condition and ready to donate without any mental pressure or force can donate kidney. This person should be near relative of the patient as permitted by Human tissue and organ transplant act. It will be better if donors blood group is same that of patient.
Another donor can be brain dead person whose near relatives have given consent for organ donation. These organs are allocated to patients who are top on list of ZTCC i.e. zonal transplantation coordination committee.
4. Where can I enroll my name for waiting list?
You can enroll name on waiting list through hospital where you want to do transplant surgery. Contact your Nephrologist for the same.
5. Do I need to enroll my name at various hospitals?
No. It is a central waiting list. Your name will go on same list. Later if you want to change hospital, you need to contact nephrologist and transplant coordinator of new hospital and you can shift your name to that hospital and name from previous hospital will be deleted.
6. How much time may I have to wait for getting kidney from waiting list?
No one can predict this. There is scoring system and points are allocated to each patient. Depending on points, patient’s number is decided.
7. Can kidney transplantation done even if blood groups are not matching?
Yes. Due to improvement in immunosuppressive drugs, if antibody titers are in permissible limits, we can do such transplant. However procedure for this is little complex and costly compared to transplant in matching blood group. As an alternative to this, option of paired organ donation can also now a days considered.
8. What should be maximum age of donor?
This is subjective. If all tests are normal and estimated kidney function is acceptable, elderly donor can be considered. However in Indian scenario where repeat transplant may not be possible in every case generally age above 65 years is cut off. But this is not hard and fast rule. Final decision will be taken by transplant team.
9. What is the risk to donor after kidney donation?
Before kidney donation donor will undergo battery of investigations. Once reports are acceptable then donor will be accepted. Hence risk of developing kidney problems in donor will be same as that of any common person in the society. Donor will not have to take long term medications unless required for specific conditions.
10. For how many days patient and donor need hospital stay after surgery?
This can vary depending on clinical situation. But on an average, if donor surgery is done by laparoscopy; around 7 to 8 days and if done open around 8 to 10 days of stay in hospital is needed.
For recipient stay is usually around 10 to 12 days.
11. After surgery does patient needs total isolation? For how many days?
After surgery patient doesn’t need total isolation. But it is advised to restrict activities in home and avoid meeting too many people for initial few months. Use face mask to avoid contracting respiratory infections. For first 3 months doses of immunosuppressive drugs are high hence during this time we should be careful. Later doses are reduced, if not contraindicated; hence restrictions can be relieved to some extent. However patients need to take of personal hygiene for their entire life.
12. For how many days patient will have to take medications?
Patient will have to take his medications for rest of his life till new kidney is functioning. If patient stops drugs, kidney will be rejected by the body and it will stop working.
13. What is the time duration required from starting donor evaluation to actual kidney transplant surgery?
Depending on the circumstances, usual time required is around 2 to 3 weeks. This includes donor and recipient evaluation, completing paper work for legal formalities and getting permission from authorization committee. Until permission in writing is given, transplant surgery can’t be done.
14. Can I get kidney from unrelated person or can I buy kidney from someone?
No. It is crime and punishable offence.
15. For how many days new kidney can work?
It depends on age of donor, does he/she has any co morbid illness, baseline function of graft kidney, degree of match with recipient.
Also is patient taking medicines regularly, does he/she gets repeated infections, what was his /her original kidney disease etc.
Depending on these various factors survival of new kidney will depend. In general, 90% kidneys work for 1 year, 80% for 3 to 5 years and 50-70% will work for 5 to10 years.
16. What problems can patient after transplant?
In most cases, people do well after surgery. They can go to work and be active. But some people have problems after a kidney transplant. These problems can happen right after the surgery or years later. They include:
- Rejection of the new kidney – Even though people take anti-rejection medicines, their body might still reject and attack the new kidney. This can happen any time after a kidney transplant. It happens less often when the new kidney is from a living donor than when the new kidney is from a dead donor.
- Side effects from the anti-rejection medicines – The medicines have short-term side effects. For example, they increase a person’s chance of getting serious infections. They also have long-term side effects. For example, they can increase a person’s chance of getting certain types of cancerHigh blood pressure or heart disease
- Diabetes (high blood sugar, also called “diabetes mellitus”)
- Weak bones called osteoporosis, swelling of the face called Cushingoid face due to long term steroid intake.
Precautions to be taken after Kidney transplant surgery
- Take your medications regularly
- Follow all instructions given by your doctor.
- Personal hygiene is of utmost importance.
- Keep the room and surrounding where you live clean.
- Avoid going in closed and crowded places like cinema hall, vegetable market, etc. Use facemask while going out.
- Eat freshly cooked food preferable at home.
- Drink plenty of water as per the advice of your doctor. It should be clean boiled water to avoid water-borne infections.
- Avoid street food.
- • Report immediately to your doctor if any of the following alarming complaints present
o Blood in urine
o Pain in the abdomen, loose motions
o Difficulty during swallowing, oral ulcers
o Burning urination
o Cough, chest pain
o Decrease in urine output
o Rise in blood pressure or blood sugar level
o Giddiness, headache, visual complaints, weakness in extremities
o Any unusual complaint apart from above
- Sometimes at the time of surgery, a tube called DJ stent is kept inside the patient’s body which is to be removed 4 to 6 weeks after surgery as per the advice of your doctor. Never forget to get it removed.
- Regular investigations and follow up with your nephrologist is a must.
- Immediate treatment of any infection if it occurs is very important. Don’t ignore warning complaints.