Kidney Transplant

Overview

A kidney transplant is a surgical procedure that involves replacing a diseased or non-functional kidney with a healthy kidney from a donor. It is a treatment option for people with end-stage renal disease or advanced kidney failure. Kidney transplantation can improve the quality of life and increase the lifespan of patients with kidney failure. 

Types

There are two main types of kidney transplant: living donor transplant and deceased donor transplant.

• Living donor transplant involves taking a healthy kidney from a living donor, usually a family member or friend who is a compatible blood and tissue match. This type of transplant is preferred because the success rate is generally higher, and the waiting time for a donor kidney is shorter. Additionally, living donor transplant can be scheduled at a convenient time for both the donor and recipient. In this type of transplant, the donor undergoes surgery to remove one kidney, while the recipient undergoes surgery to receive the donor kidney. Living donor transplants can be either related or unrelated.
• Deceased donor transplant involves taking a kidney from a deceased donor who has signed up to be an organ donor or whose family has given consent for organ donation after their death. This type of transplant requires the recipient to be placed on a waiting list until a suitable donor becomes available. The waiting time for a deceased donor kidney can range from several months to several years. Deceased donor transplants can come from a variety of sources, including brain-dead donors and donation after cardiac death donors.

Regardless of the type of transplant, the donated kidney must be a close match to the recipient's tissue type to minimize the risk of rejection. Matching is determined through blood and tissue typing. In some cases, medications may be used to help reduce the risk of rejection after the transplant. The success of a kidney transplant depends on several factors, including the health of the recipient and the skill of the surgical team performing the transplant.

Donor matching procedure

The process of matching a donor kidney to a recipient involves several steps to ensure the best possible outcome for the transplant. Here are the main steps in the donor match procedure for kidney transplant:

• Blood typing: The first step in determining compatibility between a donor and recipient is to perform a blood typing test. Blood types are classified as A, B, AB, or O, and compatibility is determined based on the blood type of the donor and recipient.
• Tissue typing: The next step is to perform a tissue typing test, which helps to identify the antigens present in the tissue. Antigens are proteins that can trigger an immune response, so it is important to find a donor whose antigens are compatible with the recipient.
• Crossmatching: Crossmatching is a test that is performed to determine if the recipient has any antibodies that may react with the donor's tissue. If the crossmatch test is positive, it means that the recipient has antibodies that may attack the donor kidney, so the transplant may not be possible.
• HLA matching: HLA (human leukocyte antigen) matching is another test that can help to determine compatibility between a donor and recipient. HLA antigens are present on the surface of cells, and a close HLA match between a donor and recipient can help to reduce the risk of rejection.
• Waiting for a match: Once a recipient is listed for a kidney transplant, they may have to wait for a suitable donor match to become available. The wait time can vary depending on factors such as blood type, HLA matching, and the availability of donors.

Why it's done

Kidney transplant is a surgical procedure that is done for a variety of reasons, including kidney failure, end-stage renal disease (ESRD), and kidney cancer.

Kidney failure occurs when the kidneys lose their ability to function properly, leading to a buildup of waste and toxins in the body. ESRD is the most severe form of kidney failure and requires long-term dialysis or kidney replacement therapy. Kidney transplant is considered the best treatment option for ESRD as it can improve the quality of life and increase the lifespan of patients. Transplantation allows patients to regain their kidney function, eliminating the need for dialysis or other forms of kidney replacement therapy.

Kidney cancer, on the other hand, is a type of cancer that originates in the cells of the kidney. Surgery to remove the cancerous kidney is the main treatment for kidney cancer. However, for patients who have kidney cancer and advanced kidney disease, kidney transplant may be considered as an alternative treatment option.

Other reasons for kidney transplant include genetic kidney diseases, such as polycystic kidney disease, and autoimmune diseases, such as lupus nephritis. In some cases, kidney transplant may also be considered for patients who have had a previous failed transplant or who have a rare blood type that makes finding a suitable donor difficult.

Overall, kidney transplant is a valuable treatment option for patients with various kidney diseases and conditions. It can improve their quality of life, provide a new kidney, and increase their lifespan. However, the decision to undergo kidney transplant should be made in consultation with a medical professional and a transplant surgeon, taking into account the individual patient's medical history and condition.

Risks and Complications

Although kidney transplant is a highly successful procedure, it is not without risks and potential complications. Some of the most common risks and complications associated with kidney transplant include:

• Rejection: The body's immune system may recognize the transplanted kidney as foreign and attack it. This can occur at any time after the transplant and may require additional treatment, including medication. These medications work by suppressing the immune system's ability to recognize and attack the transplanted kidney as foreign tissue. This can help to prevent rejection and improve the chances of long-term success for the transplant. 
• Infection: Patients who have undergone kidney transplant are at higher risk for infections due to the immunosuppressant drugs they are required to take to prevent rejection.
• Side effects of immunosuppressant drugs: These drugs can cause a range of side effects, including high blood pressure, high cholesterol, weight gain, and diabetes.
• Surgery-related complications: Kidney transplant surgery involves risks such as bleeding, infection, and blood clots.
• Cancer: Patients who have undergone kidney transplant are at a slightly higher risk for certain types of cancer, such as skin cancer and lymphoma.
• Cardiovascular disease: Patients with kidney disease and those who have undergone kidney transplant are at increased risk for cardiovascular disease.
• Pregnancy complications: Women who have undergone kidney transplant may experience complications during pregnancy, including high blood pressure and preterm birth.

It is important to note that many of these risks and complications can be managed with proper medical care and regular monitoring. Patients who have undergone kidney transplant should work closely with their medical team to manage any potential complications and ensure the long-term success of the transplant.

How To Prepare

Preparing for a kidney transplant involves several important steps to ensure the success of the surgery and post-transplant recovery. Here are some essential tips on how to prepare for a kidney transplant:

• Consult with a transplant team: Schedule an appointment with a transplant team that includes a transplant surgeon, transplant nephrologist, transplant coordinator, and social worker. The team will provide you with valuable information about the transplant procedure, risks and benefits, and post-transplant care.
• Complete a medical evaluation: The medical evaluation is a comprehensive assessment of your health status, including blood tests, imaging studies, and other diagnostic tests. The evaluation helps the transplant team determine whether you are a suitable candidate for a transplant.
• Maintain a healthy lifestyle: Following a healthy lifestyle is crucial to prepare for a kidney transplant. This includes quitting smoking, avoiding alcohol and drugs, and following a nutritious diet to maintain a healthy weight.
• Prepare for post-transplant recovery: It is important to prepare for post-transplant recovery by arranging a support system, including family and friends who can assist you during the recovery period. You will also need to arrange for transportation to and from the hospital for follow-up appointments.
• Learn about immunosuppressive medications: After a transplant, you will need to take immunosuppressive medications to prevent rejection of the transplanted kidney. Learn about the medications, their side effects, and how to take them as prescribed by your transplant team.

Procedure

The procedure typically takes around three to four hours and involves the following steps:

• Anesthesia: The patient is administered general anesthesia to ensure they are unconscious and pain-free during the surgery.
• Incision: The surgeon makes a small incision in the lower abdomen or side of the patient to access the damaged kidney.
• Preparation of the donor kidney: The healthy kidney is prepared by removing excess tissue and blood vessels to ensure it fits properly in the recipient's body.
• Connection of blood vessels: The surgeon connects the blood vessels of the donor kidney to the recipient's blood vessels. This allows blood to flow to and from the transplanted kidney.
• Connection of the ureter: The surgeon connects the ureter of the donor kidney to the recipient's bladder. This allows urine to flow out of the transplanted kidney and into the bladder.
• Closure: The incision is closed with stitches or staples, and a sterile bandage is applied to the incision site.

Post Care and Follow-ups

After a kidney transplant, there are several important follow-up steps that are essential for successful recovery. These include taking medications, caring for the incision site, following a healthy diet, engaging in appropriate physical activities, and monitoring for potential complications. Here are some other important follow-up steps after a kidney transplant:

• Blood tests: Patients will need to have regular blood tests to monitor kidney function and ensure that immunosuppressive medications are working properly. The transplant team will advise on the frequency of these tests.
• Follow-up appointments: Patients will need to attend regular follow-up appointments with the transplant team to monitor their progress and adjust their care plan as needed. These appointments may include blood tests, physical exams, and consultations with a nutritionist or other specialists. It is possible for international patients to get their tests done locally and consult with a kidney transplant doctor online for follow-up consultations. With the advancement of telemedicine technology, doctors can now remotely access and review test results from anywhere in the world. 
• Infection prevention: Patients with a weakened immune system due to immunosuppressive medications are at increased risk of infections. Patients should take precautions to avoid exposure to infectious agents, such as washing their hands frequently, avoiding crowded places, and wearing a mask when appropriate.
• Mental health support: Recovering from a kidney transplant can be stressful and emotionally challenging. Patients should seek support from loved ones and may benefit from counseling or other mental health services.
• Lifestyle changes: Patients may need to make lifestyle changes to promote their overall health and prevent complications. This may include quitting smoking, limiting alcohol consumption, and managing any other health conditions.

Cost of a Kidney Transplant in India

The cost of a kidney transplant in India can vary depending on several factors, including the hospital, surgeon, and type of transplant (living or deceased donor). On average, the cost of a kidney transplant in India ranges from $12,000 to $15,000 USD. However, this cost can increase depending on additional factors such as hospital stay, medication, and follow-up care. The success rate of kidney transplant in India is generally high, with a success rate of around 85% for the first year and 75% for the fifth year. However, the success rate can vary depending on several factors, such as the age and health of the recipient, and the quality of the donor organ.