Kidney Transplant Surgery: Indications | Process & Complications

Kidney Transplant

We all have a pair of a bean-shaped organ called kidney, present on both sides of the spinal cord.

Kidney Transplant is a surgical method to treat kidney failure or renal failure. Through this surgery, doctors place a functional kidney of a donor in a patient with kidney failure. This surgery is performed when both the kidneys of a patient stop functioning.

Inside Kidney, filtration takes place through some small structures known as Nephrons. Nephrons are the functional unit of the kidney. They help in the separation of waste products (nitrogenous waste) from the blood.

Excess waste, fluid, minerals, etc. leave kidney and travel to urinary bladder via ureter and filtered blood goes back into the bloodstream.

Humans can survive on one kidney but when both the kidneys stop functioning then toxins, minerals, and fluid will start accumulating in the body which may result in kidney failure or End-Stage Renal Disease or End-Stage Kidney Disease (ESKD).

Kidney Transplant is a surgical method to treat kidney failure patients. After the transplant, a person can live a normal life, but you need to follow a healthy diet and take immunosuppressant medicines.

Most renal transplants are successful and last for years, but how long they last vary from person to person. Some people may require more than one kidney transplant during their lifetime.

A person suffering from kidney failure can only survive through dialysis, or he/she has to go through a kidney transplant.

What is Dialysis?

Dialysis performs the function of the kidney when it do not work. It is a process of filtration of blood in a machine. Impure blood is filtered through a dialysis machine, and fresh blood is returned to the body. This process keeps the fluid and electrolyte balance in the blood. Patients with kidney failure undergo dialysis.

Dialysis v/s Kidney Transplant

Dialysis and Kidney Transplant is a treatment for the severe renal disorder. People who are eligible for a kidney transplant but are on a waiting list for a kidney and those who are not eligible, rely on dialysis until they get an operation.

When both kidneys of a person are unable to function, dialysis is used to filter blood and eliminate waste and excess fluids from the body while kidney transplant is a process of placing a new donor’s kidney in a patient suffering from kidney failure.

Dialysis is time taking and requires frequently repeated sessions While a kidney transplant gives you a better and long-term solution. Quality of life and survival rate of a patient going through a kidney transplant is much better as compared to a patient going through dialysis.

Unfortunately, not all who are suffering from kidney failure can have a kidney transplant. The patient should be capable of taking the treatment and bear the post-treatment experiences too.

Eligibility for Kidney Transplant

Before the transplant, doctors check the patient to determine that the transplant is safe for him/her or not. In cases where the patient has some other medical issues, there is less probability of success.

Rejection rate is higher in obese patients and drug or alcohol addicts. In this kind of patient, the life of a newly implanted kidney is reduced and soon requires another transplant.

To be eligible for a kidney transplant, a patient should not be going through any of the following conditions-

  • Heart disease
  • Cancer
  • Dementia
  • Mental illness
  • Obesity
  • Alcohol or Drug addict
  • Indications

A kidney transplant may appear as an option when both the kidneys have stopped working altogether. This condition is known as End-Stage Kidney Disease (ESKD).

The reason for kidney failure could be congenital or developed.

  1. Kidney damage caused by long term health problems that gradually harm kidneys is known as Chronic Kidney Disease. When this damage continues to grow, it leads to kidney failure. That is why it is called “End Stage Kidney Disease”.

Diabetes is the most common cause of kidney failure. Other problems which appear as a reason for Chronic kidney failure are:

    • Genetic disease such as Polycystic Kidney Disease
    • Autoimmune Diseases such as Lupus and Ig A Nephropathy
    • Nephrotic syndrome
    • Urinary tract problems
  1. Sometimes kidneys stop working suddenly, i.e. in a short period, and this is called Acute Kidney Injury or Acute Renal Disease. This type of problem is not permanent; it may go back to normal with treatment and do not always need a kidney transplant.

Some reasons for Acute Renal Disease are:

  • Heart attack
  • Drug abuse
  • The problem in blood supply to kidneys
  • Urinary tract problem

Symptoms of Kidney Damage

If possible, Kidney Transplant should be done when the patient is still in a stable state and can undergo surgery without complications. To get rid of the problem on time, one should keep an eye on possible symptoms of kidney damage.

There are some symptoms of Kidney Damage which one should not avoid and consult the doctor as soon as possible.

  • Itching
  • Muscle cramps
  • Nausea and vomiting
  • Loss of appetite
  • Swelling in feets
  • Frequent urination (Polyuria) or very less urination (oliguria or hypouresis)
  • Insomnia
  • Difficulty in breathing

Symptoms of Kidney Failure

After signs of kidney damage, if the cost is not treated or appropriately controlled, then the kidneys would stop functioning and results in kidney failure. Here are some common symptoms of Kidney Failure (ESKD). If a person is having all these symptoms, he/she should immediately consult a doctor.-

  • Diarrhea
  • Bleeding from nose
  • Abdominal and back pain
  • Rash
  • Fever
  • Vomiting

Treatment for Kidney Failure

Patients with failed kidneys or ESKD need Dialysis or Kidney Transplant to survive. There is no other treatment for kidney failure.

Most patients prefer to choose kidney transplant over dialysis as it has many advantages like no frequent visits for dialysis, no strict diet or change in lifestyle and better durability of the treatment. But not everyone is eligible for a transplant.

Patients eligible for kidney transplant follows this procedure to go for an operation.

Step 1: Selection Of The Transplant Center –

When a doctor recommends a kidney transplant, the first step is to choose the right transplant center. Doctors may ask to get the transplant done by themselves or may refer to a transplant center for the same.

If you are planning to get it done in Delhi NCR, here we have provided a list of hospitals from which you can select one of the hospitals for a kidney transplant in Delhi NCR.

Step 2: Evaluation:

Once you have selected a transplant center, you have to go through specific tests to determine if you are healthy enough to undergo surgery, and can follow the directions of doctors.

Doctors will go through your medical history and accordingly, you will undergo some tests and screenings through which the doctors will decide if you are the right candidate for a transplant or not. These tests include a Blood test, X-ray, CT scan, MRI, Physical examination, Psychological evaluation, and Other necessary tests and screenings.

Step 3: Selection of a donor:

As we all know that we have two kidneys by birth, but a person can survive on one kidney too. So, a Kidney donor may be a living person or a deceased.

A family member with two healthy kidneys can choose to donate one. A friend can also give an organ, but a family member is preferred as there are fewer chances of rejection by the body and you don’t have to wait for a long time to get a kidney donation from a deceased donor.

The risk of rejection of transplanted kidneys is higher in the case of an organ from an unknown deceased person. A kidney from a cadaver can only be used if he/she has died in an accident and not from a disease.

Cadaver or deceased donor is a good option if one has no relative or friend who is able or willing to donate a kidney, but it involves a lot of waiting time to find a matching kidney.

Step 4: Matching process:

Some tests are performed to know if the donor and you are a match for transplant or not. First of all, blood groups (i.e. A, B, AB or O) are matched. It should be the same in the receiver and donor.

Before any organ transplant HLA (Human Leukocyte Antigen) is matched. These antigens are present on the surface of white blood cells. These antigens are responsible for immune response.

If the HLA type match between donor and recipient, there is more chance of acceptance of the kidney.

Once blood group and HLA match, a small amount of donor’s blood and patient’s blood are mixed, if antibodies are formed against the donor’s blood, the transplant cannot be done. If no antibody reaction is observed, it is called negative crossmatch and organs can be transplanted.

Step 5: Transplantation

If you are receiving a kidney from a living donor, then your doctor will schedule the day of the transplant. And if you are on a waiting list for a cadaver donor whose tissue matches yours, you must be available to rush to the hospital when the doctor informs you about availability.

First of all, a blood test will be done, and if it is a negative cross-match, you will be prepared for the surgery.

General anesthesia is injected intravenously. Once the patient is asleep, i.e. under the resulting anesthesia, doctors will make an incision in the abdomen.

The donor’s kidney is placed inside, and the arteries and veins of the organ are attached to that of the patient’s.

Ureter of the new kidney is also attached to the bladder so that the patient can urinate frequently.

First kidneys are left inside as it is till they start causing any problem like an infection etc.

Step 6: After transplant:

After surgery, you need to stay in the hospital for almost a week.

The new kidney will start filtering blood immediately, or it may take a few weeks to start functioning. Usually, an organ from a family member starts working soon.

The patient will be monitored for any complications and will be kept under a strict dose of immunosuppressant drugs.

Before discharging doctors will instruct the patient about medications and precautions. After discharge patient needs to keep a regular appointment with his/her doctor so that they can evaluate if the new kidney is functioning well or not.

The patient needs to be aware of symptoms of rejection of the kidney so that they can immediately contact doctors. These symptoms could be a pain, swelling, and flu, etc.

Complications of Kidney Transplant

Rejection:

The most serious risk in any organ transplant is the rejection of the new organ by the body’s immune system. This rejection could be immediate, i.e. acute or delayed, i.e. chronic.

  1. Acute Rejection:
    The transplanted kidney is either rejected within minutes, and it should be removed immediately, or it takes a few weeks. This rarely happens now because the donor’s kidney is first matched before transplantation, but it can happen anytime with anyone.

  2. Chronic Rejection:
    This is the most common reason for kidney transplant failure. It happens when the body’s immune system damages the new kidney.

If you notice unusual soreness on the incision site and less urination, you should immediately consult your doctor. These could be the symptoms of rejection of the newly implanted kidney.

Other Risks in Kidney Transplant:

  • Hematuria: Bleeding after implantation can be observed. In some cases, bleeding in urine can also be seen.
  • Blood Clots: There is a risk of blood clot formation, which may dislodge from its site and can travel to the lungs or brain, causing life-threatening complications.
  • Blockage in ureter: Narrowing of the ureter can obstruct the flow of urine from the kidney to the bladder.
  • Infection: Sometimes, infection in kidneys can happen either in the old damaged kidney or in the newly transplanted kidney.
  • Kidney Stones: Sometimes, stone along with the kidney is transplanted or it may develop afterward.
  • Cancer: Due to immunosuppressive medicines, there may be a risk of cancer. Kidney cancer and in women, cervical cancer is common.
  • Heart Disease: High blood pressure and high cholesterol levels are standard after kidney transplant.

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