Kidney Transplant

What exactly is a renal transplant?

During a kidney transplant, a sick kidney is replaced with a healthy kidney from a donor. The kidney may originate from a dead donor or a live donor. Family members or other compatible individuals may be able to donate a kidney. This transplant kind is known as a live transplant. Donors of a kidney may live healthy lives with a single kidney.

A person having a transplant most typically receives just 1 kidney. In very rare cases, he or she may get two kidneys from a dead donor. Typically, damaged kidneys are left in situ. The transplanted kidney is positioned in the lower abdomen on the body’s front side.

Why might I possibly require a kidney transplant?

Those with end-stage renal illness may need a kidney transplant (ESRD). This is a condition of permanent renal failure. It usually requires dialysis. This procedure is intended to eliminate waste and other contaminants from the blood.

The renal system:

• Urination eliminates urea and liquid waste from the circulation. When protein-containing meals, such as meat, poultry, and some vegetables, are broken down in the body, urea is produced. The blood transports urea to the kidneys.
• Balance blood salts, electrolytes include potassium and sodium, and other chemicals.
• Produce erythropoietin, a hormone that assists in red blood cell production.
• Regulate blood pressure
• Regulate the body’s fluid and acid-base balance to maintain neutrality. This is required for the regular functioning of several physiological functions.

Among the renal diseases that may lead to ESRD are:

• Multiple urinary tract infections
• Kidney failure brought on by diabetes or hypertension
• Polycystic kidney disease or other hereditary conditions
• Glomerulonephritis is an inflammation of the filtration units of the kidney.
• Hemolytic uremic syndrome, a rare illness that causes kidney failure, is very uncommon.
• Lupus and other immune system disorders
• Obstructions

Other problems, such as renal malformations present from birth, may need a kidney transplant.

Your healthcare physician may propose a kidney transplant for various reasons.

 

What dangers are associated with a kidney transplant?

As with any surgical procedure, problems may arise. Some such difficulties include:

• Bleeding
• Infection
• obstruction of the blood arteries supplying the new kidney
• Urine leakage or urinary obstruction in the ureter
• Initial lack of function of the new kidney

The kidney transplant may be refused. The body’s typical response to a foreign item or tissue is rejection. When a new kidney is transplanted into the body of a recipient, the immune system perceives the new organ as a danger and assaults it. To ensure the survival of a transplanted organ, it is necessary to take medications that deceive the immune system into accepting the transplant and not rejecting it as a foreign object.

The adverse effects of medications intended to prevent or cure rejection exists. The precise adverse effects will depend on the medications used.

Not everyone qualifies for a kidney transplant. You may not be eligible if you have:

• Existing or recurrent infection that cannot be properly treated
• Cancer that has spread from its initial site to other parts of the body.
• Severe heart or other health conditions that make surgery risky
• Conditions severe besides renal disease that might not improve after transplantation
• Not following the prescribed treatment regimen

There may be additional dangers based on your particular medical condition. Before the transplant, be careful to communicate any concerns with your transplant team.

How should I get ready for a kidney transplant?

To get a kidney from a deceased organ donor (cadaver), you must be put on the United Network for Organ Sharing’s waiting list (UNOS). Prior to being put on the transplant list, extensive testing must be performed.

A transplant team carries out the examination process for a kidney. The transplant team consists of a transplant surgeon, a transplant nephrologist (a specialist in the treatment of the kidneys), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Dieticians, chaplains, and/or anesthesiologists may also be included on the team.

The assessment consists of:

Psychological examination. The psychological and social aspects of organ transplantation, such as stress, financial concerns, and family and/or significant other support, are evaluated. These factors may significantly impact the success of a transplant. The same examination is performed on live donors.

Blood testing. Blood tests are performed to assist discover a suitable donor match, to determine your donor list priority, and to increase the likelihood that the donated organ will not be rejected.

Diagnostic testing. Your kidneys and general health state may be evaluated via diagnostic procedures. These tests may consist of X-rays, ultrasonography, kidney biopsies, and dental examinations. Women may have a Pap smear, gynecological assessment, and mammography.

The transplant team will evaluate all of the information gathered from interviews, your medical history, physical exam, and testing to assess your kidney transplant candidacy.

After acceptance as a transplant candidate, your name will be added to the UNOS list. When a donor organ becomes available, you will be immediately alerted and instructed to go to the hospital.

If you are to get a kidney from a live relative (living-related transplant), the procedure may be scheduled. The donor must have a blood type that is compatible and be in excellent health. A mental health evaluation will be conducted to ensure that the donor is at ease with the choice.

These actions will occur before the transplant:

• Your transplant team will describe the operation to you, and you will have the opportunity to ask questions.
• You will be required to sign a consent document authorizing the surgical procedure. Carefully read the paperwork and ask questions if anything is unclear.
• If you were on normal dialysis before to the surgery, you will have dialysis prior to the treatment.
• For a scheduled live donor transplant, you must fast for eight hours before to the procedure, often beginning after midnight. As soon as you are informed that a kidney is available for a cadaveric organ transplant, you should begin to fast.
• Before the operation, you may be given a sedative to help you relax.
• Depending on your medical condition, your transplant team may need further preparations.

 

What occurs during a kidney transplant?

A kidney transplant necessitates hospitalization. Procedures may differ based on your situation and the procedures of your healthcare practitioner.

Typically, a kidney transplant involves the following steps:

1. You will undress and don a hospital gown.
2. You will get an intravenous (IV) line in your arm or hand. Additional catheters may be inserted into your neck and wrist in order to monitor your heart and blood pressure and draw blood samples. Other catheterization locations include the region beneath the collarbone and the blood vessels of the groin.
3. If there is an excessive amount of hair near the surgical site, it may be removed.
4. The insertion of a urine catheter into your bladder.
5. You will be placed on the operating table with your back facing up.
6. The kidney transplant procedure will be performed under general anaesthetic while you are unconscious. A tube will be introduced into your lungs via your mouth. During the surgery, the tube will be connected to a ventilator that will breathe for you.
7. During surgery, the anesthesiologist will continuously monitor your heart rate, blood pressure, respiration, and blood oxygen level.
8. Antiseptic solution will be applied to the surgical site to wash the skin.
9. The physician will create a lengthy incision in the lower abdomen on one side. Before implantation, the healthcare practitioner will visually evaluate the donated kidney.
10. The donor kidney will be inserted into the abdominal cavity. A donor kidney from the left will be put on your right side, whereas a donor kidney from the right will be inserted on your left side. This facilitates access to the ureter for attachment to the bladder.
11. The donor kidney’s renal artery and vein will be sutured to the external iliac artery and vein.
12. After the artery and vein have been sutured together, the blood flow via these arteries will be examined for signs of bleeding at the suture lines.
13. Your bladder will be linked to the ureter (the tube that drains urine from the kidney) of the donor.
14. Sutures or surgical staples will be used to seal the wound.
15. To minimize swelling, a drain may be put in the incision site.
16. A sterile dressing or bandage will be applied.

Discuss with your healthcare physician what to expect throughout your kidney transplant.

 

What occurs after a kidney transplant?

Within a hospital

• Following surgery, you will be transported to the recovery area. Once your blood pressure, heart rate, and breathing are stable and you are aware, you may be transferred to the intensive care unit (ICU) for careful observation. As you recuperate and near discharge, you will be transferred from the intensive care unit to a standard nursing facility. Typically, a kidney transplant requires several days in the hospital.
• A kidney from a live donor may begin producing urine immediately. Urine output in a kidney from a deceased individual may take longer. You may need dialysis until your urine production returns to normal.
• A catheter will be placed in your bladder to drain your pee. The quantity of urine will be monitored to assess the functioning of the replacement kidney.
• You will get intravenous fluids until you can eat and drink enough on your own.
• Your team will regularly monitor the efficacy of your antirejection medications to ensure that you are receiving the optimal dosage and drug combination.
• Blood samples will be obtained often to monitor the functioning of the replacement kidney, as well as the liver, lungs, and blood system.
• As tolerated, you will gradually transition from liquids to more solid meals. Your fluid intake may be restricted until your replacement kidney is completely functional.
• Typically, you may resume normal activity on the second day following surgery. You should get out of bed and exercise often during the day.
• As directed by your physician, use pain medication for your discomfort. Aspirin and other pain medications that may raise the risk of bleeding should be avoided. Take just the prescribed medications.
• Once you are discharged from the hospital, nurses, pharmacists, nutritionists, physical therapists, and other members of the transplant team will instruct you on how to care for yourself, including your incisions.
• When your vital signs are stable, the replacement kidney is functioning, and you no longer need continual medical care, you will be allowed to return home.

At home

• After returning home, it is essential to maintain the surgery site clean and dry. Your physician will provide you with precise bathing instructions. As this increases the danger of infection, the incision should not be immersed in water until the skin has completely healed. During a subsequent office appointment, the surgical sutures or staples will be removed.
• You should not drive until your doctor gives you the all-clear. Plan to have someone drive you to and from the hospital and any subsequent visits.
• Avoid any posture or activity that might put strain on the new kidney. Other limitations may also apply.
• Daily blood pressure and weight checks should be performed at home. Increases in these may indicate that your kidneys are not adequately filtering fluid. You must be evaluated immediately by your transplant team.

Inform your healthcare practitioner if you suffer from:

• Fever, which may indicate rejection or an infection
• Redness, swelling, bleeding or other discharge at the site of the incision
• Increased discomfort at the location of the incision, which may indicate rejection or infection.

Fever and kidney discomfort are two of the most prevalent rejection symptoms. A spike in blood creatinine (a blood test that measures renal function) and/or blood pressure may also indicate rejection. The signs and symptoms of rejection may resemble those of other medical diseases or disorders. Inform your transplant team of any concerns you may have. Frequent communication and visits with the transplant team are necessary.

Avoid venues where you may be exposed to ill individuals. Your immune system will be inhibited in order to prevent you from rejecting the replacement kidney. This will be a permanent safety measure.

Your healthcare team may provide you with additional post-procedure instructions, depending on the circumstances.

 

What steps are taken to avoid rejection?

To enable the transplanted kidney to survive in your body, you will be administered antirejection medications for the remainder of your life. Individuals may respond differently to medications.

Continually, new antirejection medications are created and licensed. Your healthcare team will adapt medication regimens to your specific need.

Typically, many antirejection medications are used initially. The dosages of these medications may be altered often based on your reaction. Because antirejection drugs suppress the immune system, you will be more susceptible to infection. There must be a balance between avoiding rejection and increasing susceptibility to infection.

Oral candidiasis (thrush), herpes, and respiratory viruses are among the illnesses for which you will be at an increased risk. During the first several months after surgery, you should avoid crowds and anybody who has an infection.