Definition and Overview
Kidney transplant (or renal transplant) is a life-saving surgery that involves transferring a kidney from a donor to a patient whose own kidneys are failing.
The kidneys are a pair of organs that are about four inches in length and found near the abdominal cavity. Their main job is to filter the blood and eliminate impurities through nephrons and maintain electrolyte imbalance. They eliminate by-products from medications as well as secrete hormones that manage the blood pressure, red blood cells, and calcium absorption.
A person, however, can suffer from acute or chronic kidney failure. Usually, an acute failure happens when the kidneys suffer from trauma due to an accident, and the organs stop functioning correctly. Fortunately, acute cases are reversible.
On the other hand, chronic kidney failure is long lasting and progressive. When a person develops this condition, the only treatment options are dialysis and a kidney transplant.
In dialysis, a machine is used to perform the function of the kidneys, filtering the blood of impurities in a regular interval. At some point, though, the kidneys may not be able to sustain any more dialysis procedures and thus need to undergo transplantation.
Several patients also choose a transplant to gain more freedom and get their lives back on track.
As one of the most common surgeries in the world, a kidney transplant is usually covered by health insurance.
Who should undergo and expected results
Often, a kidney transplant is recommended to patients who are already in the end-stage renal disease. This means that the damage to the organ is irreversible and is at risk of becoming worse until new kidneys are provided. Sadly, many patients end up in this stage, as it's possible to lose as much 90% of the organ's functions before symptoms appear.
People who are at risk of chronic kidney disease are those diagnosed with autoimmune diseases like systemic lupus, diabetes, hypertension, familial kidney disease (e.g., polycystic kidney), disorders affecting any of the components of the kidneys, cancers, and HIV or AIDS.
A person who has already received a new kidney can still undergo another transplant if the new organ is rejected.
Contrary to popular belief, dialysis is not cheaper than surgery especially if one has to do it for the rest of his life. Although there are already dialysis options that can be accomplished at home and at night when the patient is asleep, it is still cumbersome and time-consuming. Patients need to constantly adjust their schedules and lives around the procedure.
People who have gone through dialysis would usually feel energetic right after and a few days after the process. However, as impurities and toxins build up in the blood, they can lose their stamina, among other symptoms. This is cyclical until the patients get a new kidney.
How the procedure works
Patients who need to undergo a kidney transplant will receive the new organ from a donor. A donor can be:
- Related living donor (family members and relatives)
- Non-related living donor (friends and strangers)
- Dead donors
Living donors go through a rigorous screening test, along with the recipient. The doctors have to make sure that they can still live healthily even with just one kidney.
The recipient, meanwhile, should pass blood and tissue typing exam to determine whether the body has a higher risk of rejecting the new organ. This also means that both the recipient's and donor's kidney tissue and blood type must be compatible. Cancer tests will also be performed due to the drugs the patient needs to take in the long term.
As soon as the healthy kidneys are harvested from the donor, the organs are placed in cold saline solution. They can be preserved for as long as 48 hours depending on the mode of transport and the environment the kidneys are in.
Once the kidneys are ready for transplantation, general anaesthesia is administered to the recipient before the surgery. Following the creation of an incision in the lower section of the abdomen, the new kidneys are placed and attached to the arteries and veins of the pelvic area. Tubes in the bladder will be connected to the ureter. The old kidney is left untouched unless it leads to complications.
The entire procedure can take hours, and the patient needs to stay in the hospital for at least five days to a week. Close monitoring is carried out for the rest of the life of the patient, especially during the first few years following the transplantation. Full recovery can take half a year.
Possible risks and complications
The biggest complication of the procedure is rejection. The body's immune system is designed to spot any threat. Even if the new kidney has the same tissue and blood type as the old one, the immune system can still attack it. Thus, it's normal for patients who have undergone the procedure to take immune-suppressing medications for the rest of their lives.
However, this can also lead to another problem—that is, cancer. Medications can alter the way the hormones and cells work in the body over time, so kidney transplant patients may eventually develop the disease. For this reason, patients go through cancer screening exams before the surgery.
Despite the promise of a new transplant, it may still be a failure. Diabetic patients, for instance, can suffer from damage to the renal nerves of the new kidneys. Thus, diabetic patients go through two surgeries simultaneously, and these involve both the kidneys and pancreas. In some cases, the new kidney stops working altogether, forcing the patient to look for another donor.
Like any other surgery, the patient is at risk of infection due to the wound. Also, medications taken right after the procedure may lead to allergic reactions and other side effects.
- Barry JM, Conlin MJ. In: Renal transplantation. Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 44.
- Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009 Nov;9 Suppl 3:S1-155.