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Know the basics - Kidney , its failure , reasons , donations and transplant

Kidney Transplant is the transfer of a healthy kidney from one person (Donor) into the body of a person who has little, or no, kidney function (Recipient).

The most common reason for a kidney transplant is when someone loses most, or all, of their kidney function as a result of chronic kidney disease. The loss of kidney function is known as kidney failure.

The kidneys 
The kidneys are two bean shaped organs that are located on either side of the body, just underneath the rib cage. The main role of the kidneys is to filter out waste products from the blood before converting it into urine. Kidneys have several other functions as well.

Living Donations
A major advantage associated with kidney transplant is that a person only needs one kidney to survive. Therefore, unlike other type of organ donations, such as the heart and liver, a living person can provide the donation (ideally a close relative).

This type of donation is known as a Living Donation. Receiving a donation from a dose relative means that there is less risk of the body rejecting the kidney.

Kidney donation is also possible from donors who have recently died. This type of donation called Cadaveric donation. However, this type of kidney donation has a slightly lower chance of long-term success.

How common are Kidney Donations?
The answer to this question Is 'not as Common as they should be. This is because the demand for kidneys is far higher than the available supply of donors both living and brain dead.

Outlook

The outlook for a person who receives a donated kidney will depend to a large extent on a number of risk factors including:

Whether the donation was a living donation or non Iiving donations usually have a more promising outlook).
 
Whether the donation was from a close relative or someone with the same tissue type (this lowers the risk or of the body rejecting the kidney)

The age of the person receiving the donation younger the person, the more promising the prognosis.

Why is transplant necessary?
 
Kidney failure is the most common reason for a kidney transplant.



The kidneys contain millions of tiny filters that are known as nephrons. As blood passes through kidneys, nephrons filter out excess fluid and waste products from the blood. These are released from the body when we urinate. However, if the nephrons become damaged, the kidneys can lose their filtering ability and dangerous leveis of fluid and waste products can build up. Kidney failure occurs once the kidneys have lost around 90% of their filtering ability.

The two most common causes of kidney failure are:
  • Diabetes the high blood glucose levels that are associated with diabetes can damage the filters in the kidneys, leading to chronic (long-term) kidney damage 
  • High blood pressure (hypertension) - hypertension causes damage by putting strain on the small blood vessels in the kidneys, which prevents the filtering process from working properly.
Less common causes of kidney failure include:
  • Kidney infection. 
  • Polycystic kidney disease (an inherited condition where the kidneys become enlarged due to multiple cysts). 
  • Absent kidneys at birth. 
  • Systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as it were foreign tissue).
If left untreated, the amount of waste products In the blood will build up to a dangerous level, resulting in Coma (unconsciousness) followed by death.

There are two main treatment options when artificial kidney support is required.
  • Dialysis where a mechanical device is used to replicate the functions of the kidney
  • Kidney transplant - which, if possible, Is usually the preferred option because its much less inconvenient than having dialysis and never normal life can be lead.
When is transplant necessary?
 
Ideally, a kidney transplant should be performed when testing shows that the extent of the damage to your kidney is so great that you will require dialysis immediately or in the near future

However, due to the lack of available kidneys, it is highly unlikely that you will receive a kidney donation at this time, unless you have a family member or friend who has a similar tissue type to you, and they are willing to make a living donation.

Most people with kidney failure will need to have dialysis while they are waiting for a donated kidney to become available.

Who can use transplant?
 
Most people are able to have a kidney transplant regardless of their age. However, there are a number of factors that could mean that it Is not be sate to perform a kidney transplant.

Factors that signify that a treatment cannot be safely used are known as contraindications.

Contraindications to a kidney transplant include:
  • If you have cancer that has spread to several places in your body (metastatic cancer). 
  • Upto 2 years after cure of cancer. 
  • lf you have severe heart disease, it needs to be corrected before a transplant can take place. 
  • If you have liver failure (where in liver is unable to function properly asa result of damage or disease). 
  • If you have AlDS, which is the final and most serious stage of a HIV infection (due to your vulnerability to infection, it would be too dangerous to weaken your immune system after surgery in order to prevent your body rejecting the kidney). 
  • People who have HIV that is being effectively controlled with medication can have a kidney transplant.

How is transplant performed?

Preparing for surgery  While you are waiting for a kidney donation, It is important that you take steps to Improve your general level of health and well being. This is because the healthier you are, the greater your chances of the transplant being successful.

Your transplant centre will be able to provide you with more detailed advice for your individual circumstances.

Two important pieces of advice are:
  • Give up smoking (if you are a smoker) continuing to smoke could lead to further kidney damage. 
  • Lose weight (If you are overweight  or Obese) as well as the health risks posed by obesity, performing surgery on someone who is obese is technically more difficult, and has a higher risk of post operative complications.
Your transplant centre will need to able to contact you at short notice, so you should inform staff at the centre if there are any changes to your personal contact details.
You should also inform them about any changes to your health-for example, it you develop an infection.

It is a good idea to prepare an overnight bag, and make arrangements with your friends, family, and your employer so that you are able to go to the transplant centre as soon as a donor kidney becomes available.

When a suitable donor kidney is found, the transplant centre will contact you. It will check that no new medical problems have occurred and will ask you to go to the centre.

When you hear from the transplant centre you should:
  • Not eat or drink anything.
  • Take all current medicines with you.
  • Take a bag of clothes and essential items for your hospital stay.
When you arrive at the transplant centre, you will be quickly reassessed. Some of the tests that you had at your initial assessment may be repeated to ensure  that no new medial conditions have developed since.

At the same time, a second medical team will examine the donor kidney. The procedure must be carried out a quickly as possible in order tor the transplant to have the best chance of being a success. After the medical team has confirmed that the kidney in good condition and
is suitable, you will be given the general anaesthetic

Transplant Surgery
 
There are a number or different methods that can be used to carry out a kidney transplant The most widely used method is known as a Gibson incision.

A Gibson incision involves a three-stage procedure as detailed below
  • Firstly, an incision (cut) Is made in your lower abdomen, through which the donated kidney is put into place Your own kidneys can usually be left where they are, unless they are causing a problem, such as an infection 
  • Secondly, blood vessels from your lower abdomen are attached to the blood vessels of the donated kidney to provide the donated kidney with the blood supply that it needs to function properly. 
  • Finally, the ureter (the tube which carries urine from the kidney to the bladder) of the donated kidney is connected to your bladder.
While the above procedure may sound relatively straight onward, it is demanding and complex surgery that usually takes three to four hours to complete.

After surgery 
 
Once you have recovered from the effects of the anaesthetic, it is likely that you will feel some pain at the site of the incision. if you are in pain, painkillers will be provided.

After the operation, you will immediately begin treatment with medication that is designed to prevent your immune system from rejecting your new kidney

These types of medication are known as immunosuppressants. In around 70% of people who
have a kidney transplant, their new kidney begins working immediately after surgery. However,
transplanted kidneys sometimes take up to six weeks to start working. if this is the case, you will need to use dialysis during this time. Dialysis involves using a mechanical device to replicate the functions of the kidney

Most people are fit to enough to leave hospital 7-10 days after having transplant surgeries. Subsequently you will need to attend frequent appointments at the transplant centre so that your kidney function can be assessed Tests are also used to check how well your
immunosuppressants are working.
 
For the first few weeks after surgery, you may need to have two to three appointments a week. However, over time, your appointments will become less frequent.
 
After a year, providing you do not experience any serious problems, you should only have to attend the centre once every three to four months.

After having kidney surgery, you should be able to return to work and normal activities within a few months provided that you make good progress.
 
Courtesy -  An informative series issued in public interest by Fortis , Bangalore - is meant for informational purpose only , it is not a substitute for a valid opinion from a medical professional. For expert advise , consult medical profession by taking an appointment

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