Kidney transplant

Overview:

Kidneys function to remove the waste materials from the body by filtering them. When they lose this filtering ability, many changes occur in the body, leading to fluid accumulation and blood pressure alterations, ultimately leading to kidney failure. End-stage renal (kidney) disease (ESRD) is when kidneys lose nearly 90% of their functional capacity. A kidney transplant is done when kidneys fail to function correctly, when the kidney disease worsens, or when an individual is in the end stage of kidney failure.

Kidney failure can be treated in two ways: by dialysis or a transplant. A kidney transplant is when a new healthy kidney is placed in the body to replace the nonfunctional kidney. Kidneys can be transplanted by taking them from a living donor or a dead one. Kidneys transplanted from a living donor last for about 15 to 20 years and those from a deceased donor last for about 8-12 years on average. But this again depends on various factors. 

Sometimes, a transplant is done after an individual has undergone dialysis for the failing kidneys. However, they are occasionally transplanted even before undergoing any dialysis. This is called preemptive or early transplant and can yield better results with better quality of life. 

Indications of Kidney Transplant:

A kidney transplant is done when an individual is suffering from chronic kidney disease or ESRD. Kidney failure due to lack of blood supply causing ischemia, intrinsic kidney diseases affecting structures called glomerulus in the kidneys (glomerulonephritis), any obstructions, or an ESRD with filtering capacity less than 30ml/min/1.73m are some of the indications for a kidney transplant. 

Preparing for the transplant:

A kidney transplant is done in a transplant center. Before the transplant, the individual is evaluated for the surgery by some blood tests, physical examinations, imaging studies, psychological evaluation, and any other necessary tests. The history of previous illnesses, surgeries, medicines taken, and allergies should be shared with the concerned healthcare professional. Based on the test results and evaluation, one will be informed if they can be taken for a kidney transplant. Sometimes, certain medications, like blood thinners and over-the-counter drugs, need to be stopped. Other medications may be prescribed before surgery. 

Matching a donor for transplantation is also very important for a kidney transplant. A donor can be living or deceased, related or unrelated. Donors will also be evaluated and subjected to tests to check for compatibility. These tests include blood typing (to check if the blood groups of donor and recipient are suitable), tissue typing (to check if the transplanted tissue will last for a long time in the recipient's body), crossmatch (to check if antibodies of the recipient will reject the donor tissue). Apart from these, the donor's age and kidney size should also be suitable, and the donor should be free of any infections in the body. 

Family members can most likely be living compatible donors, but a transplant can be received from matched relatives, friends, or unknown people. A paired donation can also be done by exchanging compatible donors with other recipients. Sometimes, if the donors are unavailable, individuals will be kept on the waiting list for the deceased donors. 

An individual has to be active and healthy for a successful kidney transplant. Taking the prescribed medications on time, eating regularly, exercising regularly, and relaxing can keep one healthy and fasten recovery after surgery. 

During the transplant:

For Kidney transplantation, one has to get admitted to the hospital. The procedure is generally done under general anesthesia; hence, individuals will not be aware. Vital signs like pulse and blood pressure are constantly monitored. A small cut is made on the lower part of the abdomen, which is planned to receive the transplant. A new kidney prepared from the donor is placed in the body, and blood vessel and ureter connections are made. The nonfunctional kidney may or may not be replaced. The entire transplant procedure lasts for 3-4 hours. 

Recovery from the transplant:

The recipient is constantly monitored in the hospital for a few days to check for any complications. Sometimes, the transplanted kidney starts functioning immediately, and sometimes, it may take several days. Temporary dialysis is done in such situations. After discharge from the hospital, the patient is advised to rest for a few weeks and be closely monitored for any rejections in the body by constant blood work. Certain medications that prevent infections and suppress the immune system to increase the acceptance of the kidneys are generally prescribed. Regular monitoring with a dermatologist should also be done to identify the risk of skin cancer development. 

The success of Kidney Transplant: 

A kidney transplant is successful if the recipient's body does not reject it and starts functioning normally. 

Risks and complications:

Risks can be due to surgery, such as infections, bleeding, clots, leakage from the ureters, heart attack, stroke, and death. Sometimes, transplant rejection and cancers can also be significant issues. A few side effects include the drugs taken to suppress rejection, which may cause bone damage, hair fall, high blood pressure, diabetes, weight gain, puffiness of the face, and acne. 

Contraindications of kidney transplant:

Individuals who are not eligible for surgery, have recurrent infections, short life expectancy, and are drug/alcohol abusers do not qualify for kidney transplants. 

Conclusion: 

Kidney transplantation is an intervention done to enhance both the quality and duration of life for individuals suffering from end-stage kidney disease. By receiving functional and healthy kidneys, either from living or deceased donors, patients can experience a significant improvement in their overall well-being. Though accompanied by risks and complexities, meticulous post-operative care and adherence to the medication prescribed contribute to the success and long life of kidney transplants.