Dialysis performs the work of the kidney, when the kidneys fail. But lifelong dialysis has its own complications and the quality of life certainly deteriorates. A better alternative is Kidney Transplantation. It’s the process wherein a healthy is implanted to enable the individual to undergo normal day to day activities.
Types Of Kidney Transplants
- Deceased-donor kidney transplant
A deceased-donor kidney transplant is conducted when a kidney from a recently deceased (brain dead) donor is removed with the family’s permission. The transplant will happen once we know that both the kidney matches. These are emergency surgeries and normally the doctor will give you 4-6 hours to come into hospital once the call is made.
- Living-donor kidney transplant
A living-donor kidney transplant is when the kidney is donated by a compatible family member is transplanted to a patient. Living-donor kidney transplant is an alternative to deceased-donor kidney transplant since only one given kidney is required to replace two failing kidneys. This kind of surgery is better as this is elective and the donor is screened prior and matching done for good outcomes.
- Preemptive kidney transplant
A preemptive kidney transplant is performed before the kidney function deteriorates. Dialysis is required to replace the kidneys’ usual filtering function. The preferred treatment for end-stage renal disease is a preemptive kidney transplant.
Need for Kidney Transplant
The body’s toxic levels of fluid and waste build up when the kidneys lose their filtering capacity, raising blood pressure and leading to kidney failure in the patient (also known as end-stage renal disease).
End-stage renal disease is frequently caused by:
- Chronic, Uncontrolled high blood pressure
- Chronic glomerulonephritis & interstitial nephritis
- polycystic kidney disease
- End-stage renal disease patients require dialysis (hemodialysis or peritoneal dialysis) or a kidney transplant to keep them alive by removing waste from their bloodstream. All ages of kidney patients—from infants to the elderly—can receive a transplant.
When patients reach end-stage kidney failure, which usually occurs when they have lost between 85 and 90 percent of their kidney function, they must undergo dialysis. Dialysis maintains the body’s equilibrium when the kidneys fail by:
- Eliminating waste, salt, and extra water to stop them from accumulating in the body;
- keeping the blood’s concentrations of certain chemicals, such as potassium, sodium, and bicarbonate, at a safe level
- Aiding in blood pressure management
Initially this is done by a cannula in the neck, but as a permanent procedure an A-V Fistula is created. This is a surgical connection made between a vein & an artery, most of the time in the arm.
A permanent tube is inserted into the peritoneal cavity to deliver a special sterile fluid to the abdomen as part of the peritoneal dialysis (PD) procedure for kidney failure. In order to remove the impurities from the peritoneum’s surrounding vessels, the fluid circulates through the abdomen. Peritoneal dialysis can be done at home, at work, or while travelling, but it needs close supervision.
Kidney Transplant evaluation process
An extensive evaluation is conducted prior to a transplant. This is to ensure that the patient is fit for a major procedure and we can achieve acceptable outcomes. The tests and consultation will include the following
- Surgical Team
- Infectious diseases
- Intensive care
The above are the main departments which need to clear, but nevertheless more doctors will be needed on a case to case basis.
Living on Dialysis
Patients who have failed kidneys must undergo dialysis treatments for the rest of their lives unless they are eligible for a kidney transplant. The length of time a patient will live on dialysis will depend on their other health issues and how closely they adhere to their treatment plan. Although patients can expect to live on dialysis for 5 to 10 years on average, many have successfully maintained their health for 20 or even 30 years.
The fact that many kidney failure patients are of a relatively advanced age is one of the causes of the low survival rates. Younger patients benefit from transplants far more, and living donor kidney transplants are more beneficial than transplants from deceased donors.
The Kidney Transplant Process
When a kidney becomes available, a patient who is on a waiting list for a deceased donor kidney must head straight to the hospital. They must plan the procedure in advance if a friend or family member is providing the kidney that the patient will receive.
Step 1: Donor And Recipient
The transplant team operates on the donor and recipient at the same time
Step 2: General Anesthesia
The surgeon will administer anesthesia to the patients
Step 3: Removal of the kidney
One surgeon will perform the nephrectomy (removal of the kidney from the donor)
Step 4: Surgical Prep
Another surgeon preps the recipient’s body for the donated kidney
Step 5: Attachment of New Kidney
The donated kidney is placed within the donor while the natural non-functioning kidneys remain in their intact position, and the blood vessels and ureters(urinary pipe) and joined so that they can function as normal.
Step 6: Closure of Surgical Incisions
The bodies of both the donor and recipient are then closed
Complications of Kidney Transplant
Although advanced kidney disease and kidney failure can be treated with kidney transplantation, it cannot be cured. After a transplant, some types of kidney disease may recur. Significant risks associated with kidney transplant surgery include:
Leaking from or blockage of the tube (ureter) that links the kidney to the bladder
Failure of the donated kidney
Rejection of the donated kidney
An infection that can be transmitted with the donated kidney
Life After Kidney Transplant
Patients will likely feel sore and sleepy when they awaken following surgery. However, many patients who receive a transplant claim to feel significantly better right away. Long term they will get back to normal very quickly.
Follow-up visits with the nephrologist will be ongoing but get less frequent over time. However, it is crucial that the patient follow up with the doctor frequently for the first year following the operation.
After the kidney transplant, the patient will continue to take a number of medications. Immunosuppressive drugs (also known as anti-rejection drugs) aid in preventing the immune system from attacking and rejecting the new kidney. Additional medications aid in lowering the possibility of other transplant-related issues, such as infections.
Patients must exercise the utmost caution in terms of hygiene and lifestyle choices because even a minor infection can have serious consequences.