Kidney transplant or renal transplant, also known as heterotopic transplant, is a surgery which is done under general anesthesia when a healthy and adequately functional kidney is used to replace a diseased kidney. A single donated kidney can replace the function of two kidneys that have failed or are unable to perform its functions. Living-donor transplantation is therefore a more long-lasting option than dialysis which is a continuing “artificial” blood filtration regime in those with compromised kidney function.
Kidney transplantation surgeries have been in use since the 1950s and have proven to be life-saving for thousands of people with end-stage renal disease. Around 30% of the patients with kidney failures are eligible for a kidney transplant; those who are not willing or are not eligible have to opt for dialysis, a process which cleans the blood by removing toxic waste that would normally have been flushed out of the system by the kidneys.
What are the functions performed by a healthy Kidney?
Kidneys are two bean-shaped vital organs, each the size of a fist and located on each side of the spine below the rib cage and behind the liver, stomach, pancreas and bowels. Its functions are essential to maintain normal life and include the following:
- Produces urine, carried to the bladder (store house of urine) by way of the ureters. The urine is then passed through the urethra whenever the bladder is full
- It filters blood by removing excess products, minerals, fluids which are waste and passing it as urine returning the water and chemicals back to the body as required
- Balancing electrolyte and fluids
- Regulate blood pressure by releasing several hormones
- Stimulates the making of red blood cells by releasing the hormone erythropoietin
- Balances the various elements and electrolytes such as calcium, sodium and potassium in the blood
- Produces hormones that balances the level of red blood cells and blood pressure
What Happens When the Kidneys Fail?
When kidneys fail in performing their functions properly, harmful waste accumulates in the body which can be harmful for the brain, heart or skeletal system leading to:
- High blood pressure
- Fluid buildup (edema)
- Imbalance of salts and acids in the blood
- Decreased red blood cell count
- Weak bones
There are many signs of kidney failure which include the following:
- Swelling of the hands, feet and face (edema)
- Headaches (due to high blood pressure)
- Pale skin color (due to low iron level)
- Coffee-colored urine
- Chronic bad breath that cannot be freshened by brushing your teeth
- Depression, fatigue or itchy skin
When kidney function declines below a certain critical level leading to end-stage renal disease or the failure of the kidney, a dialysis or kidney transplant are necessary to sustain life.
End-Stage Renal Disease: End-stage renal disease mostly occurs when kidneys are not functional and loose about ninety percent of their ability to function and there is accumulation of toxic or waste products leading to failure of. The causes of the disease include:
- Chronic or uncontrolled high blood pressure
- Inflammation or scarring of filters in the kidneys (glomerulonephritis)
- Polycystic kidney disease
- Complications from Diabetes
- Urinary tract difficulties and problems
There is no cure to end-stage kidney disease. The accumulated waste needs to be continually removed from the body through dialysis or, alternatively, the patient has to undergo a kidney transplant surgery.
When should you consider a Kidney Transplant Surgery?
A kidney transplant is advised to people with severe renal disease which includes the following:
- When the kidneys are not functioning adequately leading to accumulation of fluid and waste, are greatly enlarged, have stones or frequently get infected
- When the Glomerular filtration rate (it measures functions of kidney) is less than or equal to 20ml per minute
- When you have consistently high blood pressure that cannot be controlled with medication
- Irreversible or End Stage Renal Disease
In such cases, a kidney transplant surgery can reduce the risk of death and, with certain lifestyle restrictions, can allow for a much better quality of life than is possible while undergoing dialysis treatment.
Some people, however, are not eligible to undergo kidney transplant due to specific conditions or characteristics such as the following:
- Any serious underlying medical conditions like ongoing or recent treatment of cancer
- Serious infections like tuberculosis, bone infections, or hepatitis
- Severe cardiovascular or liver disease
- Excess smoking, drinking alcohol or drug abuse
- Advanced age
- Poorly controlled mental illness or Dementia
How is a kidney transplant surgery carried out?
Either one of both of the non-functional kidneys are replaced with a living or deceased donors kidney. The new kidney is placed by making an incision in either the right or left part (front or anterior) of the lower abdomen in the pelvis without removing the failed kidneys unless they are infected with a viral infection or are causing high levels of blood pressure. The healthy kidney is transported in cool saline water which preserves the organ for about 48 hours. During this period blood tests are done to check the compatibility between the blood and tissues of the donor and the recipient. The transplanted new kidney is attached with the blood vessels, artery and veins in the abdomen (lower part) which starts the blood flow through the transplanted kidney. The ureter (tube linking the kidney to bladder) of the new kidney is connected with the bladder. If the patient receiving the kidney is a child, then the blood vessels are connected with the largest artery in the body (aorta) and in the largest vein in the belly.
Blood pressure, pulse, heart and oxygen levels are monitored throughout the surgery. The surgery usually takes round two to three hours. The diabetic patients may also undergo a pancreas transplant along with this surgery. This can add another three to four hours to the surgery duration.
Laparoscopic Surgical Technique: This technique is used in most of the transplant centers in the United States. A thin scope with a camera is used to view the inside of the body of a patient by giving general anesthesia to the patient. The scope is inserted using a small incision and the kidney is removed with a wand-like instrument. The benefits of a laparoscopic kidney transplant are as follows:
- Recovery process and hospitalization is less than that of a regular transplant surgery;
- Fewer medications are required;
- Complications are fewer and the surgery is not as painful as regular kidney transplant.
Regardless of the technique used for the kidney transplant, the donor and recipient need to be monitored for long periods to follow their overall health and kidney function after the procedure.
What tests do you need to undergo to ensure you are eligible for a kidney transplant?
Psychological and Physiological tests are needed to assess whether a person is physically and mentally healthy to withstand a kidney transplant surgery and willing to take post-surgical medicines or immunosuppressants for an entire lifetime to ensure that the body does not reject the transplanted kidney. Blood tests, X-rays, MRI or CT scans are performed to evaluate any risk factors that could compromise the success of the kidney transplant surgery.
What happens after a kidney transplant surgery?
- After the transplant surgery, blood starts flowing through the transplanted kidney which starts to produce urine; the new kidney starts filtering the blood without needing dialysis
- Medications should be taken on a continuing basis to prevent organ rejection which suppresses the immune system
- The anti-rejection medicines may lead to infections and, therefore, antibacterial, antiviral and antifungal medications may also be prescribed
What are the possible risks and complications involved with the kidney transplant surgery?
Kidney transplantation can treat kidney diseases or kidney failure but is not a cure. The health risks involved with the surgery itself may require another surgery to rectify these issues. Possible complications include the following:
- Some of the kidney diseases may relapse after kidney transplant surgery such as high of blood sugar level, bone weakening or liver diseases
- Rejection or failure of the donated kidney few days or weeks after surgery. The immune system treats the transplanted kidney as a foreign body, rejecting the donated kidney and destroying it
- Allergy or reaction to general anesthesia are possible
- There can be certain side effects of anti-rejection or immunosuppressants medicines that need to be taken after the surgery
- Blood clots and leaking due to blockage of the ureter or wound-healing problems
- Infections or any type of cancer that can occur itself or is transmitted through the donated kidney
- Life risk or death, heart stroke or heart attack
- Bleeding, blood clots or difficulty in blood circulation to the kidney
- Problem with flow of urine, leakage or blockage of ureter
- If the new kidney doesn’t start working immediately, dialysis will be required to filter the waste and extra salt or fluid from the body until it starts working effectively
- Bladder infections, pain of a hernia or numbness along the inner thigh that usually goes in some time without any treatment
What are the symptoms of transplant rejection?
Rejection of transplanted kidney is usually expected in around 30% of the people who have undergone the transplant surgery. Most of the rejections occur within few months of the surgery but in few cases it rejects anytime or sometimes after years. If treatment is commenced early, it can reverse the rejection. Signs or symptoms of rejection include the following:
- Readings in routine blood tests helps in revealing early signs of rejection
- Swollen, red, tender surgical site or abdominal pain
- High blood pressure indicating that the functions of the kidney are disrupted
- Swollen or puffy face, arms or legs indicates that there is retention of fluid
- Decreased passage of urine
- Shortness of breath due to fluid retention in lungs
Anti-rejection medications or immunosuppressive agents helps in preventing or treating organ rejection and are required to be taken for a lifetime. Stopping or skipping these medicines places the recipient at high risk of a transplant rejection.
When the transplanted kidney fails to function, dialysis or a second transplant is considered depending on the overall physical health and patient’s ability to withstand a second surgery.