KIDNEY TRANSPLANT - WHEN AND HOW IT IS DONE

Annually, chronic kidney diseases affect over 750,000 people in the United States alone. Over 100,000 people are on the kidney transplant waiting list; more are added every year.

A Kidney Transplant is a necessary surgical procedure when your kidneys become severely damaged. Replacing your diseased kidney with a healthy kidney from a donor can effectively restore normal kidney function and improve your health.

Healthy donor kidneys can come from living or deceased donors, both passing through a thorough evaluation to ensure a good match, even a perfect match. Although a physically and emotionally exhausting procedure, a kidney transplant can significantly improve your health and overall quality of life.

What Is A Kidney Transplant?

When a surgeon performs a kidney transplant, they remove a damaged or diseased kidney and replace it with a healthy kidney from a donor.

Jean Hamburger performed the first successful kidney transplant in Paris, 1953. He performed the transplant on a young boy whose mother offered to be the organ donor for the procedure.

Since then, kidney transplantation has treated patients with chronic kidney disease and various disorders affecting normal kidney functions. A kidney transplant is often the last resort when faced with end-stage renal disease or kidney failure.

When your kidneys no longer function properly, you can undergo dialysis to remove waste products and fluids from your body. However, dialysis can be very exhausting and can have negative impacts on your life.

Expected life expectancy and quality of life are often better with a kidney transplant - if it’s a viable option. By restoring kidney function, patients with end-stage kidney failure can resume life without dialysis.

Who Needs A Kidney Transplant?

Before we dive into why you might need a kidney transplant, you have to understand why your kidneys are vital organs. Your kidneys perform several essential functions that keep your body running, such as:

1. Remove toxins in your blood and eliminate them through your urine
2. Regulate the salt and electrolyte content in your body
3. Produce erythropoietin, a hormone that stimulates red blood cell production
4. Regulate blood pressure

Now, if you have just one healthy kidney, it can carry out these functions entirely. But certain severe kidney conditions can damage both of your kidneys and their functions and result in your body shutting down:

• Chronic Kidney Disease (CKD): CKD is characterized by gradual kidney failure. It’s caused by other medical conditions that result in progressive damage to your kidney, including diabetes mellitus and high blood pressure.
• Polycystic Kidney Disease (PKD): PKD is a genetic disease wherein cysts grow in your kidneys. These cysts are non-cancerous, but they cause your kidneys to enlarge and, eventually, lose their function.
• Glomerulonephritis: This is the inflammation of the glomeruli, the blood vessels in your kidney. Inflammation can occur on its own or because of infections or immune diseases like lupus.
• Kidney Stones: Kidney stones are painful mineral deposits that form in your kidneys. Usually, it does not cause permanent damage. But if you have only one kidney, kidney stones can cause failure in the remaining kidney.

Patients with kidney disease and renal failure can experience any of these symptoms:

• Fatigue
• Decreased urine output
• Swelling in your feet or ankles
• Dry skin
• Nausea
• Irregular heartbeat
• Chest pain
• Hyperkalemia, high levels of potassium in your blood
• Anemia
• Seizures

The transplantation of a healthy kidney from a donor can restore the normal function of your kidney and treat kidney failure.

Who Is Eligible For A Kidney Transplant?

Kidney diseases affect an alarming percentage of the worldwide population. If you have end-stage kidney disease or other chronic kidney diseases, including those mentioned above, your doctor might suggest a kidney transplant as the treatment of choice.

To receive a healthy kidney, you must meet specific criteria to be considered a potential transplant candidate. You’ll have to be evaluated by a transplant team and undergo extensive testing at a transplant center:

• Blood Tests: Blood typing helps you find a suitable donor match and decreases the chances that your body will reject the donor’s kidney.
• Diagnostic Tests: Diagnostic tests assess your kidneys’ and your overall health. Tests may include kidney biopsy, ultrasound, X-ray, even a dental exam and gynecology evaluation.
• Mental Health: Psychological or social issues can significantly affect the results of your transplant. Added stress can affect your body’s response to treatment.

However, a kidney transplant is not for everyone. If you have any of these conditions, a kidney transplant may be a risky procedure for you. Contraindications include:

• Advanced age
• Alcohol and drug abuse
• Active infection
• Cancer
• Dementia or other mental illness
• Severe heart disease

Your transplant team weighs all the details of your medical history and tests to ensure you have the best chance of a successful kidney transplant. Once you are accepted as a transplant candidate, they can place you on a waiting list for a kidney donor.

How Is A Kidney Transplant Donor Selected?

There are two types of donors for a kidney transplant: living donors and deceased donors.

• Living Donors: A living donor transplant gets a kidney from a healthy, living person. Living donors are often family and friends (direct donation), although donors can also be strangers (non-direct donation) helping someone who needs a kidney.
• Deceased Donor: A kidney may also be donated from a deceased person with consent from their family. Deceased donor transplantation makes up two-thirds of kidney transplants in the US. You’ll be placed on a transplant waiting list to get the next kidney available from a deceased donor.

Similar to transplant candidates, living donors must also pass an extensive evaluation by the transplant team. These are some requirements a living donor needs to meet:

• Age: Potential donors are generally between the age of 18 to 60.
• Compatibility: All donors must undergo a series of tests to ensure that they are compatible with the recipient of their kidney.
• Medical History: Your donor must be in good health. If they have high blood pressure, kidney or heart disease, a history of cancer, acute infections, and diabetes, they may be automatically disqualified as a kidney donor.
• Mental Health: Your donor must donate voluntarily and can change their mind at any time. Donors often feel pressure or guilt. They need to meet with a psychologist for a mental health check before deciding to donate their kidney.

A living donor transplant has a higher success rate because there’s a reduced risk of organ rejection, especially if a blood relative donates the healthy kidney.

The average time frame to receive a kidney from a deceased donor can be 3 to 5 years in most transplant centers. It depends on the transplant waitlist, compatibility between you and your donor, and expected survival post-transplant.

How Is A Kidney Transplant Done?

When a living donor is available, your transplant team can schedule the procedure as soon as possible, and you can be prepped for surgery. For a deceased donor kidney, your transplant has to be performed immediately. The kidney is kept alive with an oxygen supply and placed in an icebox.

You’ll be provided an intravenous (IV) line and catheters to monitor your heart rate and blood pressure for your kidney transplant surgery. A urinary catheter will also be placed into your bladder to collect urine throughout the surgery.

You are placed on your back, and an anesthesiologist administers general anesthesia, so the transplant is performed while you’re asleep.

Once your kidney transplant surgeon sterilizes the surgical site, they make an incision on one side of your lower abdomen.

Your surgeon does not remove the diseased kidney. They implant your new, healthy kidney into your belly. It’ll be connected to your renal blood vessels to establish blood flow to the donated kidney. Your surgeon also attaches the ureter that drains into your bladder.

Once the new kidney is in place, your surgeon stitches or staples the skin incision closed and bandages the surgical site.

Transplant surgery typically takes up to 4 hours. Afterward, you’ll be transferred to the intensive care unit (ICU) for recovery.

Recovery After A Kidney Transplant

A kidney transplant will require you to stay several days in the hospital. In the ICU, your transplant team will closely monitor your condition until your blood pressure, pulse rate, and breathing are stable.

Kidneys from a living donor function almost immediately and can make urine right away. However, kidneys from a deceased donor can take several days to weeks to reach normal function. So you may need to continue dialysis until your urine output is normal.

With time and some pain relievers, the soreness in your abdomen will lessen, and you can start moving around.

Remember to follow the medication and dosage prescribed by your doctor. Mixing other medicines can increase your chances of bleeding or other complications.

When your condition is stable and your transplanted kidney is healthy and working, you can be discharged from the hospital. Members of your transplant team, such as pharmacists, nutritionists, and physical therapists, will teach you how to take care of yourself at home.

You’ll likely need to take time off from work and avoid strenuous activities like exercise and sports. Your recovery period can take at least 8 weeks after your kidney transplant. You’re free to go about your regular routine after a quick check-up with your healthcare team.

Risks Of A Kidney Transplant

Rejection may be a complication of a kidney transplant. Your immune system functions to detect foreign substances that enter your body. When your new kidney is transplanted, your immune system may think it’s a threat and attack it.

For your transplanted kidney to survive, your doctor will prescribe immunosuppressants. These are anti-rejection medicines that allow your immune system to accept the transplant.

As with any surgical procedure, certain complications can occur. Although rare, the risks of a kidney transplant include:

• Blood clots
• High blood pressure
• Bleeding
• Weight gain
• Renal artery stenosis, narrowing of your renal arteries

Life After A Kidney Transplant 

Many factors contribute to a successful kidney transplant, even after your surgery. Your transplant team may suggest a few lifestyle changes to help you on your road to recovery.

• Diet and Exercise: You’ll need to keep a diet low in salt and fat to prevent high blood pressure. Your nutritionist can provide a healthy eating plan to keep you and your kidney as healthy as possible. Consult your doctor about the exercises that can improve your health, as well as how often and how long you should do them.
• Immunosuppressants: Also known as anti-rejection medicines, these prevent your immune system from thinking the transplanted kidney is a harmful foreign body. When you take these medicines consistently, it can significantly decrease your risk of rejection.
• Coping and Support: The entire process of kidney transplantation can be extremely draining. It’s normal to feel different emotions: anxiety, depression, guilt. Find support in your family, friends, or transplant team to help you cope with life after a transplant.

How Long Does a Transplanted Kidney Last?  

A newly transplanted kidney can last for decades. How long your transplanted kidney will last depends on many factors. The type of transplant (live donor vs deceased), your health, the success of surgery, immune status, adherence to treatment, and other things can determine how long the transplanted kidney will survive. 

Although the numbers defer across statistical studies, a live donor kidney transplant lasts on average 12 to 20 years. Transplants from deceased donors last 8 to 12 years. Keep in mind that this is the average across many transplant recipients. Your new kidney might last more or less depending on the factors mentioned above. 

Another measure of kidney transplant survival used by doctors is the 5-years survival rate. That’s the percentage of patients whose kidneys survive after 5 years of surgery. After a successful kidney transplant, success rates reach as high as 86% after 5 years in living donor transplants and up to 79% for deceased donor transplants. 

For most patients, a kidney transplant feels like a second chance at life.

Ultimately, you can live a happier and healthier life after getting a new kidney as long as you make the lifestyle changes and stick to your treatment regimen. 

Frequently Asked Questions (FAQ)

Who can get a kidney transplant?

If you have end-stage kidney disease or other chronic kidney diseases and pass the transplant evaluation, you can get a kidney transplant.

How can I pay for a kidney transplant?

Various insurance providers cover kidney transplants. Otherwise, consult the finance coordinator on your transplant team and discuss your financial options.

What is the use of anti-rejection medicines?

Anti-rejection medicines, also known as immunosuppressants, reduce the risk of kidney rejection. They prevent your immune system from treating your transplanted kidney as a harmful, foreign body.

What happens if my body rejects the new kidney?

If your body rejects the new kidney, you may have to undergo the kidney transplant process again. That means you’ll likely have to find a new living donor or join the waiting list once more.

Are kidney transplant rejection episodes frequent?

Over time, rejection episodes have reduced drastically. Anti-rejection medicines have significantly reduced the risk of organ rejection. As long as you take the medication as prescribed by your doctor, you have fewer chances of facing kidney rejection.

Will I need a special diet after kidney transplant?

Your nutritionist on your transplant team can create a healthy diet plan low in salt, fat, and sugar. Eating a healthy diet and staying hydrated is essential in keeping a healthy kidney.

What is the most common reason for a kidney transplant?

End-stage kidney disease is the most common reason for a kidney transplant. The most common cause of end-stage renal disease is diabetes.

Is there an age limit for kidney transplants?

The age range of potential kidney transplant recipients usually ranges from 18 to 60 years old. Patients over the age of 65 may have a better outcome if they have a living donor transplant.

Will a kidney transplant cure kidney disease?

A kidney transplant is a treatment; not a cure for kidney disease. Kidney transplants aim to restore the function of your kidneys and improve your quality of life. If you have a progressive systemic disease that affects your vessels and kidneys, a kidney transplant will not stop it. This is why you’ll need to follow a healthy lifestyle after a kidney transplant; to protect the new kidney.

Can you live with only one kidney?

Absolutely. One healthy kidney may be enough to keep your body running.

How long does a kidney transplant surgery take?

Kidney transplant surgery time is on average 2-3 hours. The open surgical approach requires less time - around 50 minutes less than the laparoscopic approach on average. Your individual anatomy, surgeon skill, and other factors can affect the surgical time of a kidney transplant. Keep in mind also that this is the time from the initial incision to skin closure. The time for anesthesia induction and immediate post-op recovery are not included in these estimates. 

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References

• Kidney Transplant
• Kidney transplant
• How your kidneys work
• Kidney and its Function
• Kidney Transplant Program
• Kidney Transplant Selection Criteria
• Life after transplant - rejection prevention and healthy tips   

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