Kidney Transplant

Patients of End Stage Renal Disease are best managed by Renal Transplantation.

 The benefits of Renal Transplant as compared to maintenance on Hemodialysis are many:

• Normal Lifestyle
• Freedom from Dialysis
• Higher energy levels and good nutritional status
• Cost Effective in long term.

Before moving forward with patient’s evaluation and surgery, our financial counselors and coordinators review the patient’s insurance policy carefully and advise patients if they find anything of concern. Many insurance companies have included  transplant benefits. Our finance team will help patient understand the rules. Much of the cost of kidney transplantation is covered by Medicare and private insurance plans.

For patients with  existing or impending end-stage renal disease :

• Free of malignancies 
• Free of active infection
• Intact or correctable urological abnormalities
• No active abuse of alcohol, drugs or smoking
• Heart and lung status consistent with being able to tolerate the surgery and consistent with a predicted good, long-term outcome
• Ability to follow transplant protocols and medication regimens
• An acceptable body weight

Every potential candidate is considered on an individual basis. A number of radiological, blood and urine tests are done and these are evaluated by the urologist and nephrologists.
 

Because of the increasing shortage of available deceased donor organs and the resulting long wait times, many kidney transplant candidates choose living donor transplantation as an option.

All of us are born with two kidneys. After donating a kidney, a person can live a long and healthy life with just one, because the remaining kidney quickly takes over the work that both kidneys were doing previously.

Additionally, long-term studies have not shown any decreased kidney function in living donors. However, donors should have close medical follow-up and see their primary care doctor at least once a year for a blood pressure check and kidney function tests.

Living donors may be the following : 

• Live-related—siblings, parents, spouse or children over age 18 
• Swap Transplants
• Unrelated Transplant- only in exceptional cases under recommendation of state authorization committee

Blood and Tissue Types

Blood types are either A, B, AB or O. 

Living donors who are not a compatible blood type may still be able to donate by doing a “donor swap” with another pair that is incompatible.

A second alternative is ABO Incompatible Transplant.-doing treatment of the recipient before the transplant that would allow his or her body to accept the incompatible blood type.

 In addition to blood type, tissue typing (white blood cell/lymphocyte or HLA type) is tested and examined for compatibility. HLA type is inherited, and this is why related living donors may be more likely to be compatible. A HLA compatibility test is done before every transplant. However in HLA incompatible patients it is possible to do transplant with some immunosuppression & immunofilteration protocols so called as – HLA Incompatible Transplant.

Benefits of Living Donor Kidney Transplantation:

• Higher success rates
• Shorter waiting time
• Ability to schedule—Living donation allows patients to schedule a surgery time that is convenient for the patient and donor.
• Avoidance of dialysis—early referral may allow for transplant prior to initiation of dialysis therapy Preemptive Transplant
   

Criteria for Donors :

• Age between 18 and 65 yrs
• Normal renal function with two kidneys
• Free of active infections
• Free of malignancies for at least 2 years (history is evaluated individually) with exception of primary brain solid tumours in whom kidneys can be taken anytime for donation. 
• No history of diabetes.
• No active/untreated substance abuse.
• Excellent physical and mental health

Criteria for selecting which kidney to be used for Kidney Donation: Right or Left 

We do DTPA Renal scan & CT Angiography of donors & consider Kidney with Lesser GFR (Function) & with less complex vascular anatomy for donation.

The Donor Nephrectomy operation can be Open or Laparoscopic depending upon anatomic complexities, previous history of surgery. Right sided donor nephrectomy is usually done by open method for technical reasons like want of IVC Cuff Endostaplers.

The potential living donor will have a detailed evaluation to enable the transplant team to decide if he or she is eligible to donate. The evaluation includes a complete medical/surgical history and physical exam; blood tests, X-rays and procedures to check for general overall health, cancers, heart and lung diseases, and infections; CT Angiography and a psycho/social evaluation & gynecological examination among females.

If any problems are found with the routine evaluation, additional testing may be necessary. The transplant team may decide a potential donor is unacceptable to donate at any time during the evaluation. 

The donor’s hospital stay is normally four to five days. The ability to return to normal activities and work varies, but generally this is possible within four to six weeks. Many donors find living kidney donation to be extremely rewarding and meaningful. They are often thrilled to have helped restore health to near & dear relatives despite the risks. Many family members say it has strengthened the bond with their loved one by donating. Those who choose to donate a kidney are seen by the recipient and the recipient’s loved ones as a true hero. The transplant team is committed to making the living donation process as easy as possible for the donor .

If a recipient does not have a potential living kidney donor, or chooses not to have one, he or she can be placed on the deceased donor waiting list. A seniority list of all registered patients awaiting cadaver transplant is drawn up as per the NOTTO guidelines and allocation is done accordingly.

When patient come to the hospital, patient will have preoperative evaluation and testing done before either a living or deceased donor kidney transplant. Blood will be drawn for routine lab tests and final donor/recipient cross matching. If this final evaluation confirms that patient don’t have new medical problems and that the crossmatch is acceptable, then the transplant surgery will proceed. Duration of stay is about 7 to 8 days.

The kidney is placed into the lower part of the abdomen, on either the right or left side just above the hipbone. It is put in this spot because it is close to the blood supply it needs and the bladder. The incision for the surgery is usually about 4 to 6 inches long. The kidney blood vessels are attached to branches of the patient’s iliac artery and vein. The ureter is attached to the bladder. In most instances the recipient’s own kidneys are left in place.

The surgery usually takes two to four hours. Family members can expect a five- to six-hour wait from the time patient are taken to surgery until the time patient get to the recovery room.. The transplant surgeon will meet with the family to tell them about patient’s condition after the surgery.

 Long term survival of the renal graft is an average of about 10 years, however range is 8 to 20 years. 

We recommend a strict gollow up regimen: Initially twice a week for first month & thereafter once a week in next 2 month followed by monthly follow up for first year & then 3 monthly.

We monitor serial KFTS, TAC levels besides wound care, Input/output monitoring & general assessment & DJ stent removal after at about 2 weeks. 

 The nursing staff and clinical coordinators will teach the patient about proper care and important skills such as blood pressure monitoring, measuring intake and output, taking medications properly.