Which two medicines should the doctor administer before the surgery to prevent the body from reacting to the newly implanted organ?

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Symptoms, Procedure, Risks, Aftercare

• What is a kidney transplant?
• Why is a kidney transplant done?
• Diseases and conditions that may require Kidney transplantation
• Understanding risks associated with Kidney transplants
• Understanding the Kidney Transplant procedure
• Kidney Transplant Criteria and Requirements
• Finding a Donor
• Road to Recovery and Aftercare
• Kidney Transplant FAQs: All concerns addressed.

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What is a kidney transplant?

A kidney transplant is a surgery done to replace a diseased or dysfunctional kidney in a person with a healthy kidney from a living or deceased donor.When a kidney is used from a deceased donor, the procedure is called a cadaveric renal transplant. The kidneys perform the task of waste removal from your body. They filter waste from your blood and expel it from the body through urine. Kidneys also play an important role in the maintenance of the body’s electrolyte and fluid balance. When the kidneys do not do their job, toxic waste builds up in the body and can make you really ill.

Humans have two kidneys, one on each side of the upper abdominal region of the body. The right kidney is located slightly lower than the left one so that there is space to accommodate the liver, which is situated immediately above the right kidney. They are each around 5 inches in length and approximately the size of a big fist. In addition to removing wastes and excess fluid from the body, kidneys also control the metabolism of electrolytes in the body, such as calcium, potassium, sodium, and more. It regulates blood pressure by producing hormones that maintain the pressure. Although humans have two kidneys, the body is capable of surviving with only one functioning kidney.

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Why is a kidney transplant done?

Kidney transplant, also called renal transplant, is performed to treat kidney failure in humans. When kidneys stop functioning,patients are put through the dialysis treatment. It is a process that filters waste from the blood mechanically, and performs the job that the kidneys are unable to.

The other treatment option for kidney failure is an organ transplant. In this procedure, a surgeon takes a donated kidney from a dead or live donor and places it in the body. After this, immune-suppressive medication is given to make sure that their own immune system does not treat the new kidney as a foreign object and attack it.

A kidney transplant may be the only option for people whose kidneys have completely stopped working. This is called end-stage renal disease (ESRD). If you have ESRD, you will need dialysis to survive, and a kidney transplant can remove your dependency on a dialysis machine for the rest of your life. Only one healthy kidney is required to replace two failed ones. This makes it possible for a living person to donate one of their kidneys to a patient with ESRD.

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Diseases and conditions that may require Kidney transplantation

Kidney transplants are required for people who have kidney failure - that is, the kidneys have lost 90% of their ability to function. Various diseases and conditions can cause kidney failure. In India, nearly 60% chronic kidney disease and ESRD cases are attributed to complications from lifestyle diseases like diabetes and hypertension. The major reasons for kidney failure are:

• Type 2 diabetes: Also known as Diabetes mellitus, this is a disease where the body is unable to metabolise glucose properly, resulting in high blood sugar levels. Over a span of time, the excess sugar in the blood vessels destroys millions of little blood-filtering units present inside the kidney. This eventually causes the kidneys to fail.
• High blood pressure: Also called hypertension, this condition is the second leading reason for kidney failure. In the course of time, chronic high blood pressure can make the arteries around the kidneys hard, narrow, or weak. The damaged blood vessels are unable to supply enough blood to the tissues of the kidney, depriving it of oxygen and nutrients. This eventually causes kidney failure.
• Glomerulonephritis: The kidneys contain little filters called glomeruli that filter wastes, electrolytes, and excess fluid from your blood. The inflammation of these filters is called glomerulonephritis. It can be caused by conditions such as diabetes, faulty immune responses, bacterial and viral infections, lupus, and vasculitis.
• Polycystic kidney disease: This is a genetic disorder where clumps of fluid-filled sacs called cysts form in the kidneys and affect the kidney’s ability to filter blood.
• Serious defects in the urinary tract: These may be genetic or birth defects, due to which normal kidney function is affected, leading to kidney failure after a while.

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Understanding risks associated with Kidney transplants

A kidney transplant is a serious surgery, and as with any major surgery, there are several risks associated with this procedure. These risks include:

• An adverse reaction to general anaesthesia
• Formation of blood clots
• Internal bleeding
• Ureter Blockage or leakage
• Infection
• Stroke and heart attack
• Donated kidney being rejected by the body
• Donated kidney also failing

However, despite these risks, kidney transplantation may be the best treatment option for a person with chronic kidney disease or end-stage renal disease. After the procedure, one may have to take anti-rejection medication for the rest of your life. These medicines also come with several risks and side-effects, such as thinning of bones, high cholesterol, hypertension, hair loss or excessive hair growth on the body, weight gain, skin problems like acne, infection, and even increased risk of lymphoma and skin cancer.

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Understanding the Kidney Transplant procedure

A kidney transplant can be done if a suitable match is found from a live or a cadaveric donor. The kidney transplant procedure is done with the patient under general anaesthesia. The team of surgeons, nurses, and anaesthetists monitors the patient’s blood oxygen level, blood pressure, and heart rate continuously during the procedure. The actual renal transplant procedure is as follows:

• An incision is made in the lower portion of the abdomen on one side and the kidney is placed inside.
• The failed kidneys are not removed unless they cause complications like pain, infections, kidney stones, or hypertension. They are left in place.
• The new kidney’s blood vessels are attached to the blood vessels in the lower portion of the abdomen, right above one of the legs.
• The ureter is a tube that runs from the kidney to the bladder and carries urine from the kidney into the bladder for storage. This ureter from the new kidney is attached to the patient’s bladder.

After the surgery, the patient has to stay in the hospital for some time. They will also need several check-ups as they recover, and may have to take medications like immunosuppressants and antibiotics for the rest of their life.

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Kidney Transplant Criteria and Requirements

A person with ESRD qualifies for a kidney transplant. However, there are some requirements and criteria that a person must meet to qualify:

• They need to be healthy enough to withstand a serious surgery and a lifelong medication routine.
• They also have to be willing to follow the doctor’s instructions and take medicines without fail.
• If they have conditions like cardiovascular disease, liver disease, cancer, infections like hepatitis, tuberculosis, or bone infection, they will not make a good candidate for kidney transplantation. The new kidney will most likely fail after it is transplanted.
• One should also be a non-smoker, and avoid alcohol and drugs if they want the kidney transplant to be successful.

The doctor will assess and evaluate in order to determine if a person will make a good candidate for a successful kidney transplant. People at advanced ages, who have mental illness, and people who are alcoholics or drug addicts will not make good candidates for a transplant.

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Finding a Donor

Finding a kidney transplant donor is the toughest part of the kidney transplantation process. There are two types of donors:

Living donor: Since humans can lead healthy lives with just one kidney, a family member or friend can choose to donate one kidney . Familial donors are a better option as they may be a better match and the body is less likely to reject the new kidney. India’s live kidney transplant program is the second- largest in the world, just after the United States.

Cadaveric donor: The kidney of a healthy person who has died in an accident is transplanted into the patient. In India, not many people choose to register as organ donors in the event of an accidental death. As a result, the number of kidney transplants in India via cadaveric donations is quite low. To help with this, the government amended the law in 2011 and introduced a ‘required request’, making it mandatory for intensive care doctors to request the family members to donate the deceased person’s organs in case of a brain death.

Finding a Match: Finding a donor means finding someone whose kidney will be a good match for the patient’s body. This means the donor will have to be tested for matching blood type. Incompatible blood type donations are possible, but the patients need additional medical treatment before and after the transplant. Also, the likelihood of the new kidney being rejected by the patient’s body is much higher in such cases.

Once a donor is found who matches the blood type, they will be tested for tissue typing. This means they will be tested for HLA (Human Leukocyte Antigen) typing. This test matches genetic markers that will increase the possibility that the transplanted kidney will function efficiently in the patient’s body. A good tissue type match means that the body will not reject the new kidney.

The final step in the donor matching process is a ‘crossmatch’. In this process, a tiny bit of the patient’s blood is mixed with the donor’s blood sample in a lab. The lab technician checks for antibodies reaction against antigens present in the donor’s blood. If they don’t react, it is called a negative crossmatch, and this means that the patient’s body will not reject the new kidney. A positive crossmatch means the risk of rejection is higher, and the patient needs extra medical treatment pre and post-transplant.

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Road to Recovery and Aftercare

Recovery after a kidney transplant requires several days of hospital stay to ensure that the new kidney is functioning well and that the patient’s body is not rejecting the transplanted kidney.They may have to stay for 1-2 weeks in the hospital, even if they feel well enough to be discharged.

The new kidney may begin working immediately or take a few weeks before it starts to function properly. Kidneys donated by family members start working faster than ones donated by unrelated or cadaveric donors. Patients go through pain around the incision site as they begin healing.

They will also be on immunosuppressant medicines to stop the body from rejecting the new kidney. Instructions are given on aftercare and medication routine, which is needed to be followed strictly. The doctor will advise the level of physical activity that the body can withstand while it is recovering.

The donor’s diet needs to change after a kidney transplant to remain healthy. Thedoctor will specify what kind of foods to eat or avoid. The recommended diet and nutrition instructions may include:

• Having at least 5 servings of fresh vegetables and fruits per day
• Including enough fibre in the diet
• Avoiding fruits like grapefruit that can affect the functioning immunosuppressant drugs
• Including dairy products in their diet to maintain adequate phosphorus and calcium levels.
• Having lean meat, fish, and poultry
• Having a low-salt and low-fat diet
• Drinking enough water and fluids daily to remain hydrated

Once the patient has recovered, they need to make moderate exercise a part of daily routine to ensure they stay healthy and that the new kidney functions properly. Activities like walking, jogging, swimming etc. can become a part of their lifestyle after the transplant. However, the doctor must be consulted before starting exercises post-transplant.

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Kidney Transplant FAQs: All concerns addressed.

Q.   How long does the kidney transplant surgery take? Can I eat or drink before the surgery?

1. Kidney transplant surgery takes two to three hours as it has to be done with the patient under general anaesthesia. You should not eat or drink anything including water after midnight the day before the renal transplant procedure. Avoid heavy meals the evening before surgery. Your doctor will give you detailed instructions on how to prepare for the surgery and what you can eat or drink.

Q.   What is the cost of a kidney transplant in India?

1. Kidney transplant in India cost between Rs. 5-6 lakhs (Purely indicative). After the surgery, it could cost Rs. 15,000 a month for the after care and another Rs.10,000 a month for immunosuppressive drugs. Kidney transplant cost in Delhi, Bangalore and Kolkata can be more than the cost in tier 2 cities like Jaipur.

Q.   What is kidney transplant success rate?

1. The success rate of kidney transplants in India is among the highest in the world. The current success rate is around 90%. However, there are various factors that influence the success rate of a kidney transplant, such as the choice of hospital, the expertise of the surgical and post-operative care teams, the tissue matching and compatibility of the donor, whether the donor is blood-related, and more. Post-surgical infection is a big risk that can affect the success rate, so choose a hospital with the best hygiene standards to make sure you do not get any infections.

Q.   Why do I need a kidney transplant? Why can’t I remain on dialysis instead?

1. Dialysis is a process where a machine does the job of filtering and purifying the blood. However, the kidney also performs other functions, like producing hormones to regulate blood pressure and maintain electrolyte balance. A dialysis machine cannot do this. Haemodialysis is a type of dialysis that uses an artificial kidney (hemodialyzer) to filter wastes from blood.

   Also, the lifelong cost of dialysis can work out to be expensive. You will also have to go to a dialysis centre regularly to get this done. There are many cities where these centres are not available nearby. Also, dialysis makes your blood super-clean and nutrient depleted and this blood keeps getting more and more toxic until the next dialysis session.

   A kidney transplant works out to be more economical than lifelong dialysis. Kidney transplant price in India is much lesser than the cost of dialysis. It also lets you have a normal life as it is natural. Not only this, the survival rate and life expectancy of transplant patients are much better compared to people on dialysis. For example, it was found that the life expectancy of a person in the age group of 40 live 7.3 years on dialysis, but 22 years after a transplant.

   After a successful transplant, you can live a normal, healthy life and even indulge in physical activities like swimming, cycling, etc. However, a person on dialysis will not be able to lead a normal healthy life and may not be able to travel to places where there are no dialysis centres. Thus, kidney transplantation is the best treatment option for a person with end-stage kidney disease.

Q.   Which is the best hospital for kidney transplant in India?

1. Narayana Health’s nephrology department has the most skilled and experienced kidney transplant team. They have specialists who work together to perform even the most complex transplant surgeries. They also provide premium-quality care at affordable costs. The team’s post-operative care and the follow-ups are best-in-class and NH’s hygiene standards are top-notch as well. The hospital has state-of-the-art facilities for peritoneal dialysis and haemodialysis in addition to the latest equipment and a world-class operating theatre.

   For live kidney donors, the surgeons at NH perform a minimally invasive keyhole surgery to remove the donor kidney, to ensure a quick recovery for the donor. The transplant team also make sure the recipient has a rapid recovery. NH also has advanced diagnostic facilities and top-class infrastructure that ensure the best kidney care. Thus, NH is one of the best hospitals for kidney transplants in India.

Q.   What are cadaveric donors? How is it possible for a dead person’s kidney to start working after transplantation?

1. Cadaveric donors are deceased people. They are people who have died as a result of an accident or injury. Either they or their family members have chosen to donate organs after death. When a person is brain dead, the heart still keeps pumping – for hours or even days. As a result, the internal organs are still working and alive, though the person is no more.

   If a person is declared brain dead, and has chosen to donate his/ her organs after death, the person’s body is rushed to the operating room and the organs for donation are removed and preserved until they can be transplanted into the recipient. Thus, it is possible for a dead person to donate a kidney that will start working in the recipient’s body.

Q.   Will my new kidney start working immediately after the transplant surgery?

1. When a newly-transplanted kidney starts working, it depends on how good a match it is to the recipient's body. A kidney from a blood relative is more likely to start working sooner than a kidney from an unrelated donor or cadaveric donor. This is because the family member’s kidney will be a better blood and tissue-type match to the recipient and the body will accept the new transplant faster. A new kidney can start working the same day after surgery or take a few weeks to begin functioning.

Q.   What are paired kidney matches?

1. Paired kidney donors are a pair of people who want to donate their kidney to a family member or friend, but are not a good match. For example, if patient A is not a good match to donor B, but is a good match to an unrelated patient C. At the same time, patient C’s donor D is a good match to patient A. In such a case, donor D will donate a kidney to patient A and donor B will donate a kidney to patient C. Thus, both patients get a kidney from unrelated donors.

Q.   What is the life expectancy after a kidney transplant?

1. People in the age group of 40 can have a life expectancy of around 22 years after a kidney transplant, while people in the age-group of 50 have a life expectancy of 16 years. People in their 60s have a life expectancy of 11.5 years after a successful kidney transplant.

Q.   Why are the existing kidneys not removed when a new kidney is transplanted?

1. Research has found that removing the existing kidneys of a person while transplanting a new donated kidney increases the chances of surgical complications and even death. Therefore, the failed kidneys are left in place and the new kidney is placed in the lower part of the abdomen on one side.

Q.   How dangerous is a kidney transplant?

1. Although kidney transplantation can help treat several kidney diseases and kidney failure, it doesn’t remove the possibility of a kidney disease returning after transplant. The risks of kidney transplant lie with the surgery itself, rejection of the donor kidney and the adverse effects of medications such as immunosuppressants administered to prevent the body from rejecting the new kidney. Some of the risks that may arise during the procedure are:

• Blood clots
• Leaking from the ureter connecting the kidney to the bladder
• Infection
• Rejection of the new kidney
• Heart attack or stroke

Q.   What happens during a kidney transplant?

1. In case you’re receiving the kidney from a living donor, then your doctor can schedule your transplant in advance. However when it comes to a deceased donor, then you’ll have to rush the moment it’s found. To this end, sometimes, pagers are provided by transplant hospitals so that you can be reached quickly. The first step taken after you reach the hospital is collecting your blood sample for the antibody test. This helps to determine whether you’re a match for the surgery or not. The surgery is performed after applying general anaesthesia. An incision is made into your abdomen to put the new kidney. The arteries and the veins to the kidneys are connected. The new kidney’s ureter is attached to your bladder to help your urinate properly. The existing kidneys are kept within the body unless there is a need to remove them like an infection.

Q.   When is the best time to get a kidney transplant?

1. If you find a matching live donor kidney transplant, then it’s best to complete the transplant even before you start your dialysis. This is known as a pre-emptive transplant. However, if you have been on dialysis for quite some time, it’s still possible to have a live donor kidney transplant. In most cases, a live donor kidney transplant is recommended more than remaining on dialysis. In case of a deceased kidney transplant, it’s not possible to schedule the transplant in advance.

Q.   How do I know if I’m a good candidate for a kidney transplant?

1. In order to become a potential transplant candidate, you must meet specific requirements, which depend on the specific organ required. Some of the factors that can make you an ideal candidate for a kidney transplant are:

• If you’ve end stage kidney disease and are on dialysis
• If you’ve advanced chronic kidney disease at stage IV or V with an estimated GFR lesser than 20 ml/min
• If you’ve chronic kidney disease at stage IV with GFR less than 30 ml/min
• If you’ve chronic kidney disease with type 1 diabetes that has failed to respond to medical treatment

Q.   Is there a special diet to follow after a kidney transplant?

1. Your diet plays an important role after a kidney transplant. Maintaining an ideal diet is important in keeping a healthy weight and exercising regularly. It will also help in preventing high blood pressure, blood sugar, and excessive weight gain. After a transplant, you should follow a diet which is low in salt and fibre. The ideal diet should contain fresh fruits and vegetables, lean meats, reduced-fat dairy products, whole grains, and lots of fluids. It’s also important to be careful while handling foods like washing hands before touching any food items, reducing eating outside, and avoiding high-risk foods that can cause infection.

Q.   What happens if I reject my new kidney?

1. Immunosuppressants can be used to help your body accept the new kidney, however there still can be times when your body recognises your transplanted organ as a foreign object. Studies reveal 10-20% patients experience at least one episode of rejection. However, rejection doesn’t necessarily mean that your new kidney isn’t working or you’ll lose your new kidney. Rejections generally occur in the first 6 months of the transplant. In case you develop any rejection symptoms such as flu-like tendencies, reduced urine production, excessive weight gain, and fatigue, then you should get in touch with the transplant team.

Q.   Is there a difference between a living or deceased donor transplant?

1. There are subtle differences between a transplant from a living owner and a deceased donor. In case of a living donor transplant, you get a healthy kidney from a person who is alive. In case of a deceased donor transplant, you get the kidney from a person who is dead. Living donor kidneys last longer in comparison to deceased donor kidneys. Moreover, they also work better since they are outside the recipient’s body for a lesser time than the deceased donor. You can get a living donor kidney transplant even before you’re on dialysis.

Q.   How long does it take for a kidney to wake up after transplant?

1. Hospital recovery after a kidney transplant may take four to five days if you are free from complications. On the contrary, the time of your stay in the hospital varies depending upon your medical condition. If you have diabetes or high blood pressure, then after renal transplant, you should have to keep it in control. It can create insurmountable barriers in your kidney transplant recovery.

Q.   How much does a kidney transplant cost in India?

1. The charge of renal transplant varies from the determination and condition of the patient. Along with that, the kidney transplant cost varies from one hospital to another. Most kidney transplant procedures don’t demand any imported material. If we make an estimate, so 5 to 20 lakh, a kidney transplant surgery costs you.

Q.   What precautions should I take before a kidney transplant?

1. A renal transplant is not immune to complications. There are some precautions that a person planning for a transplant should take before opting for a kidney transplant surgery and they are:
1. Deplete your high cholesterol levels
2. Manage your elevated levels of blood pressure
3. If you have diabetes, then keep it in control.
4. Ask your physician about the risk for heart and blood vessel disease with a transplant.
5. Keep your diet and lifestyle healthy.
6. The person has a higher risk of cancer. Talk to your physician about reducing the risk of cancer.
7. Avoid transfusion of blood and other blood products.

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