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Kidney Transplant

Kidney Transplant

Kidney transplantation is a process in which a patient whose kidneys have been damaged is given a second chance at life by receiving a kidney from another person. There are primarily two types of kidney transplantation:

1. Living donation

2. Deceased donation

Purpose of a Kidney Transplant

End-stage kidney disease is a stage where a patient's both kidneys are damaged and the patient is on some form of renal replacement therapy, which could be hemodialysis or peritoneal dialysis. A patient on dialysis is not able to achieve complete clearance of toxins and metabolites that are produced by the body. Unlike dialysis, a kidney transplant provides a second chance at life and the clearance of toxins is continuous, resulting in a very high quality of life.

For example, in hemodialysis or peritoneal dialysis, the clearance of toxins called middle molecules, such as beta-2 microglobulin, is very poor. This incomplete clearance can lead to the accumulation of toxins over time, which may compromise the heart and increase the risk of atherosclerotic coronary artery disease, strokes, hypertensive heart disease, and other ailments.

Moreover, for individuals who undergo a kidney transplant, dialysis may still be necessary in certain cases. This is known as dialysis after kidney transplant, where the transplant recipient requires temporary or intermittent dialysis to support kidney function during the recovery period or manage complications that may arise.

Diseases That May Require Kidney Transplantation

In a patient who undergoes renal transplantation, these risks are significantly reduced. Diseases that may require kidney transplantation include end-stage kidney disease. The most common cause of end-stage kidney disease in India is diabetic kidney disease or diabetic nephropathy. Other causes include hypertension, chronic glomerulonephritis, polycystic kidney disease, among others. There are also regional kidney diseases like Uddanam nephropathy, which contribute to chronic kidney disease due to local factors

1. Diabetes mellitus, particularly type 2 diabetes, is a disease that may necessitate kidney transplantation due to the severe impact it can have on renal function.

2. Uncontrolled high blood pressure, often referred to as hypertension, can lead to kidney damage and ultimately require kidney transplantation as a treatment option.

3. Chronic glomerulonephritis, characterized by inflammation of the kidney's glomeruli, is one of the causes that may result in end-stage renal disease and necessitate kidney transplantation.

4. Polycystic kidney disease, is a genetic disorder characterized by the growth of cysts in the kidneys. Polycystic kidney disease treatment may require kidney transplantation as an option when other interventions fail to effectively manage the condition.

Risks Associated With Kidney Transplants

Although kidney transplantation provides an excellent quality of life, it also has its inherent risks that every patient should be aware of. There are certain short-term and long-term complications of renal transplantation.

* Short-term complications The short-term complications, which occur immediately after transplantation, can be divided into two categories: medical complications and surgical complications.

1. Surgical complications These usually occur within the first week after transplantation and can include bleeding from vascular sites, formation of urinoma, surgical site infections, among others. These are usually managed by doctors before the patient is discharged from the hospital.

2. Medical complications These usually occur within the first week after transplantation and can include bleeding from vascular sites, formation of urinoma, surgical site infections, among others. These are usually managed by doctors before the patient is discharged from the hospital.

3. Surgical complications These include short-term risks of infection and rejection. The risk of rejection is categorized into three types: hyperacute rejection, acute rejection, and chronic rejection. Hyperacute rejection is very uncommon these days due to the advent of present-day immunosuppression and proper patient evaluation before transplantation. Acute rejection, on the other hand, can be unexpected, and the highest risk is in the first three to six months after transplantation. Both acute and chronic rejection can be managed with specific immunosuppressive medications. Infections are another common complication after transplantation, with respiratory infections like pneumonia, urinary tract infections, surgical site infections, and skin infections being the most common. These are usually manageable with proper antibiotic and prophylactic therapies. Rarely, viral diseases like cytomegalovirus can also occur.

* Long-term complications The long-term complications are primarily medical and include the ongoing risk of rejection and infections, which decreases over time after transplantation as immunosuppression is slowly reduced over the subsequent few years.

Kidney Transplant Procedure & Test

As discussed earlier, kidney transplant procedures and testing can be divided into live and diseased donor transplantation. Live transplantation involves the workup of the donor and recipient. The donor is a healthy person who is subjected to donor nephrectomy as they donate to their loved one. Donor workup should be extensive and exhaustive as any undue harm to a donor is ethically incorrect. In our center, the donor evaluation is done in three stages. The first stage is a master health checkup where not only the donor's kidneys but also their cardiac condition, pulmonary risks, blood investigations, ultrasound-abdomen, whole GI system, and nerves are evaluated in detail. The second stage includes renal angio dopplers, renal split function with DTPA, and clearances from other departments including gynecology, dental, and gastroenterology as required. These tests include a nuclear scan called DTPA scan,

which provides split function information for each kidney individually. This assesses the donor's risk of kidney disease. If the DTPA scan shows unequal or low GFR, which is the function of the kidney, the donor is rejected from donation due to the risk of further kidney disease. The last test is the compatibility for transplantation, which is called HLA. HLA testing includes genetic assessment for related donors and what is called a cross-match. The following are some common kidney transplant tests:

1. Chest x-ray A chest X-ray is typically performed as part of the kidney transplant evaluation process to assess the donor's cardiac and pulmonary condition.

2. Renal Nuclear Scan Renal nuclear scan, specifically DTPA scan, is used to provide detailed information about the split function of each kidney individually, helping evaluate the donor's risk of kidney disease.

3. Kidney Transplant Ultrasound With Doppler Kidney transplant ultrasound with Doppler is conducted to assess the anatomy and blood flow in the kidneys, aiding in the evaluation of the suitability for transplantation.

4. Kidney Biopsy Kidney biopsy may be performed in certain cases to obtain a tissue sample for microscopic examination, providing valuable insights into the donor's kidney health and potential suitability for transplantation.

5. CT Scans and MRI CT scans and MRI (magnetic resonance imaging) may be utilized to gather more detailed information about the kidneys, surrounding structures, and potential abnormalities prior to the kidney transplant procedure.

6. Blood group (ABO) incompatible Kidney Transplantation Blood group (ABO) incompatible kidney transplantation refers to the transplantation of a kidney from a donor with a different blood group than the recipient, requiring additional measures such as desensitization protocols to prevent rejection and ensure successful transplantation.

Finding a kidney transplant donor

A kidney transplant donor, whether living or deceased, undergoes rigorous evaluation, including cross-match testing to assess the risk of hyper-acute rejection, with a positive result being a contraindication for renal donation or transplantation. At our center, we prioritize live related donors who are first-degree relatives, in accordance with the Human Organs Transplant Act. Deceased donor registration can be done, and the Jeevan Dhan system in Telangana efficiently facilitates the procurement of kidneys from deceased donors, allowing them to be transplanted to unknown patients with chronic kidney disease. Allocation of organs is determined based on a scoring system provided by Jeevandan, and patients can register through the hospital to secure a position for transplantation. Kidneys from deceased donors are sourced from unfortunate victims of accidents or strokes.

The proper dosing and timing of medications are crucial to avoid drug toxicity or inadequate doses, as this can impact drug absorption tendencies and increase the risk of rejection. Additionally, patients may receive medications for managing diabetes and hypertension, if necessary, along with prophylactic medications to prevent infections, which are vital components of post-transplant patient management.

* Deceased-Donor Deceased-donor transplantation, a form of kidney replacement, involves the procurement of kidneys from individuals who have unfortunately passed away, often due to accidents or strokes. These organs are then allocated to unknown patients in need through government-organized systems such as Jeevan Dhan.

* Living donor Living-donor transplantation refers to the transplantation of a kidney from a healthy living donor, often a first-degree relative, who voluntarily donates their kidney to a loved one in need. These donors undergo extensive evaluation and workup to ensure the suitability and safety of the donation.

* Expanded criteria donor Expanded criteria donors (ECD) are deceased donors who may be older or have certain medical conditions that are considered less ideal for transplantation. ECD kidneys may be used for transplantation in select cases to expand the pool of available organs and increase the chances of successful transplantation.

* Kidney Compatibility: Finding the Best Match Kidney compatibility is a crucial factor in transplantation, and finding the best match involves assessing the human leukocyte antigen (HLA) compatibility between the donor and recipient. HLA testing, along with other factors such as blood type compatibility, helps determine the likelihood of a successful transplant and reduced risk of rejection.

Pre and Post Kidney Transplant Care

Post kidney transplant care, also known as kidney transplant aftercare, is an integral part of managing patients after transplantation. At our center, patients receive regular follow-up, initially twice a week for four weeks, followed by weekly visits for the next four weeks, and then biweekly appointments for the subsequent four months, totaling six months. After this period, follow-up frequency typically reduces to monthly visits, tailored to individual patient needs. It is crucial for patients to understand the necessary investigations and adhere to their follow-up schedule at the hospital. The next aspect of care emphasizes personal hygiene, grooming, and practices that minimize the risk of infections. Patients are advised to refrain from work for a period of two to three months, depending on their profession. During the first month post-transplantation, patients are recommended to practice significant isolation, including having a separate room with an attached bathroom, and maintaining stringent personal hygiene.

This includes bathing twice a day and ensuring no hair is left in the groin and axilla. In terms of food safety, patients are instructed to consume only reverse osmosis (RO) or distilled water and freshly cooked meals while avoiding stale food.

Creating a clean and safe environment is paramount, and patients are encouraged to utilize air conditioners or air purifiers in their rooms. Any individual involved in patient care is advised to use hand sanitizer regularly before and after touching the patient. Additionally, oral care involves frequent use of mouthwash.

Following transplantation, patients are advised to abstain from work for at least three months. Subsequently, they may gradually engage in less physically demanding tasks, such as office jobs. However, it is crucial to avoid exposure to public transportation, children, and large groups of people, as the risk of contamination and infection significantly increases.

Advanced Treatment Options by Our Kidney Transplant

Advanced treatment options, provided by our skilled kidney transplant surgeons, are available to patients seeking kidney transplant treatment. Our dedicated team of specialists offers innovative solutions to enhance the chances of successful transplantation. One such option offered at our center is ABO-incompatible transplantation, which allows for the consideration of a living donor within the family, even if their blood group is incompatible. This groundbreaking approach significantly expands the pool of potential donors, increasing the likelihood of receiving a kidney from a beloved family member.

ABO-incompatible transplantation involves the implementation of advanced techniques and protocols by our experienced transplant surgeons. Thorough evaluation, meticulous preparation, and comprehensive monitoring are integral to the success of this procedure.

By utilizing this advanced treatment option, we strive to provide more patients with the opportunity to undergo a life-saving kidney transplant, overcoming the barrier of blood group incompatibility. With our team of skilled kidney transplant surgeons, we remain dedicated to staying at the forefront of advancements in kidney transplant treatment, ensuring the best possible outcomes for our patients.

Our kidney transplant doctor

Our kidney transplant doctors at the Asian Institute of Nephrology and Urology (AINU) are highly skilled and experienced renal transplant surgeons dedicated to providing the best possible care to patients. Our doctors are considered to be among the best kidney transplant doctors in India. They work alongside a distinguished team of doctors, nurses, and technicians who prioritize patient care at every stage of the transplantation journey. From thorough pre-operative assessments to meticulous post-operative follow-up, our team ensures that transplant patients receive the utmost attention and support.

AINU's state-of-the-art facilities, including 500 beds, advanced operating rooms, a dedicated daycare ward, and comprehensive diagnostic support, enable our doctors and the entire medical team to deliver outstanding clinical outcomes.

Our relentless pursuit of excellence, combined with the latest technology and techniques, ensures that patients receive world-class treatment for acute, chronic, and end-stage renal diseases, including access to a top-notch dialysis unit.

When it comes to kidney transplantation, our kidney transplant doctor is committed to providing compassionate care and achieving the best possible outcomes for patients, solidifying AINU's reputation as a premier destination for renal transplant surgery in India.

Frequently asked questions:

Patients are usually advised that there is no need for complete bed rest after discharge if the patient is fit to move around their house. However, the patient is advised to avoid exposure to the public for a period varying between one to three months, depending upon the patient's condition. Usually, patients are allowed to go back to work after three months and do jobs that require less physical strain or exposure to the public.

For information on the cost of kidney transplantation in India, it would be best to consult with the hospital or healthcare provider for specific information. Depending on center-to-center and place-to-place variability, the cost of kidney transplantation can range from 5 to 10, 00,000 approximately.

Kidney transplantation provides an unmatched quality of life compared to dialysis. In dialysis, the clearance of toxins is likely to be inadequate, resulting in the accumulation of toxins, salts, and other metabolites which may produce harmful effects on the heart, resulting in an increased risk of coronary artery disease and atherosclerotic disease. The risk can significantly come down with renal transplantation.

The immediate success rate of transplantation can range from 95 to 99% in various centers, and the long-term outcomes vary from the average. The average kidney life after transplantation is 70% at 10 years and 50 to 60% after 15 to 20 years.

There are many centers that provide transplantation care. The Asian Institute of Nephrology and Urology provides ethical medical care at economical costs to our patients. We strive to achieve the best possible outcomes for all of our transplant patients.

Before a kidney transplantation, the patient is extensively evaluated by their doctor. Both the patient and the donor undergo thorough evaluations as well. The quality of dialysis and the risk of infection should be minimized, so it is advised to follow up at a center with the highest standards of care after the transplantation. This care primarily includes infection prevention and meticulous follow-up regarding medications.

An unfortunate victim of an accident, road traffic accident, or a vascular event such as a stroke is declared brain dead and medically dead, but their heart continues to function. Such patients are eligible for cadaver donation as per government policies. Kidney donation from these patients is allocated according to the concerned state government policies, which include Jeevan Dhan. To be eligible for donation, you must be registered with the diseased donor transplantation register in your state, such as Jeevan Dhan in Telangana.

The newly transplanted kidney typically starts functioning immediately after transplantation in 90 to 99% of patients, especially if it is from a live donor. However, in deceased or cadaveric donation, the chances of immediate kidney functioning are nearly 50 to 70%.

The minimum restrictions on excessive salt and meat consumption will continue after transplantation. However, the most important aspect of food in renal transplantation is avoiding stale food.