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Kidney Transplantation

A kidney transplantation is a procedure where a healthy kidney is placed in a patient who is suffering from failed kidneys and is on dialysis. The kidney usually takes over the function of native kidneys within days to weeks and thus the patient becomes free from dialysis. As compared to dialysis, kidney transplant not only provides better quality of life but also increased survival of the recipient.

  • Deceased kidney transplant:  In deceased donor kidney transplant, the kidney is taken from a deceased donor (brain dead) and is surgically transplanted into the body of a recipient.

  • Living kidney transplant:  In living donor kidney transplant, the kidney is taken from a healthy living donor and is surgically transplanted into the body of a recipient.

Living kidney transplant is better than deceased kidney transplant due to

  • High success rate

  • Kidney from a living donor usually functions immediately

  • Gives time for preparation of donor and recipient.

  • Less chances of rejection , especially when kidney is donated by a blood relative

Based on compatibility of blood, there are two types of kidney transplant

  • ABO compatible kidney transplant

  • ABO incompatible kidney transplant

In this type of transplant, both donor and recipient either have the same blood group (E.g BB) or donor is of O group or recipient is of AB group.

In this type of transplant, the donor and recipient don't share the same blood group (E.g A B).

Due to the presence of preformed antibodies to opposite blood groups, this type of renal transplant requires preparation of the recipient by giving medications and doing a procedure called plasmapheresis or immunoadsorption.

In ABO incompatible transplant, the patient is admitted two weeks prior to date of transplant and started on medicines and above said procedures to prepare his/her body for transplant.

As compared to ABO compatible transplant, ABO incompatible transplant carries higher risks of bleeding, infections, and rejections during the first one month. However, one month after transplantation, these patients survive and behave well just as those patients who underwent ABO compatible transplant.

The procedure of kidney transplantation includes four stages.

Stage 1 and Stage 2 include basic tests to assess fitness of the patient and donor. These tests usually take a period of 6 to 7 days. If the patient and donor are fit in stage 1 and stage 2, then stage 3 tests are done. Stage 3 tests include crossmatch and HLA (HumanLeukocyte Antigens) match. This stage usually takes a 7-day period. So, it takes 10 to 14 days to complete all the tests needed for kidney transplantation.

Once the patient and donor complete all stages of investigations, they are admitted for kidney transplant surgery.

In ABO compatible transplant, the patient is admitted 3 days prior to kidney transplant whereas in ABO incompatible kidney transplant, patient is admitted 14 days prior to kidney transplant.

Donor is admitted 2 days prior to renal transplantation.

Donors are evaluated in detail regarding all their organ functions. If all these tests are normal, only then are they approved to donate their kidney.

In immediate transplant, the donor might experience bloating, pain in the abdomen, weakness, cough, and fever. Rare complications include bleeding and need for re exploration.

In the long term, the donor might develop proteinuria or hypertension and very rarely he/she may develop kidney disease. In the long term, the survival of the donor doesn’t differ from non-donors.

The donor is usually discharged 3 days after the transplant surgery.

The recipient is discharged once he/she is fit physically, and his kidney function is stabilised. This usually takes 7 to 14 days.

Usually, the donor doesn’t require regular follow-up or medications until and unless they have any other medical illness which is detected during the pre-transplant period.

All they need to follow is a healthy lifestyle and avoid drugs that damage kidneys.

The recipient is asked to follow up every week for one month and then every two weeks for two months and then every month until a year after the transplant. After one year, they need to follow up with the nephrologist once in two or three months.

During this follow-up the nephrologist runs blood and urine tests to assess kidney functions, drug levels etc. After doing the tests, the nephrologist adjusts the medications accordingly.

Until the transplanted kidney functions, the patient must be on regular follow-up and medications.

The medications given to the recipient protect the donor kidney from getting rejected or damaged by the patient’s immune system. So, these drugs are called immunosuppressants. They must be taken until the graft kidney is functioning. Irregularity in these medicines will lead to rejection and failure of the transplanted kidney.

These drugs come with various side effects of hypertension, dyslipidemia, anaemia, leukopenia, diarrhoea, infections, cancer, nephrotoxicity etc. So, the patients must be on regular follow up with the nephrologist so that the drugs can be modified accordingly.

Kidney transplant recipients may develop rejection of kidney, infections, recurrence of basic disease, hypertension, diabetes etc. Keeping close follow up with the nephrologist and staying compliant to the doctors’ advice will help diagnose these problems early and treatment modifications can be done accordingly by the treating nephrologist.

The newly placed kidney not only functions to remove body waste and excess fluids but also produces hormones that maintain haemoglobin and calcium phosphorus balance. So, the patient will be off from dialysis, erythropoietin injection, and antihypertensives. Usually, 80-90% of the patients are free from medications to decrease blood pressure within 2 weeks.

In general, kidney transplant recipients must adhere to a low protein vegetarian diet which is fresh and well cooked. They have to take filtered or boiled water to avoid infections.

By using a mask, hand hygiene, drinking filtered water, eating fresh and well cooked food.

Regular follow-up with the nephrologist and compliance to medications are the two important measures to maintain stable kidney function.

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