Kidney Transplant: A Quick Guide

If you are someone suffering from end-stage renal disease, a kidney transplant could effectively improve the quality of your life. Read to know more about the indications, the procedure, and life after a kidney transplant.

What is a kidney transplant?

A kidney transplant, also called a renal transplant, is a surgical procedure through which the diseased kidney in a person with end-stage kidney disease is replaced with a healthy kidney from another person.

Why are kidneys so important?

Kidneys are important organs involved in the removal of excess salts, minerals, and fluids from the body. If the kidneys do not function properly, the salts, minerals, fluids, and waste products accumulate in the body and hamper the functioning of other organs.

When is a kidney transplant done?

A kidney transplant is recommended for those suffering from end-stage renal failure. It is a state of permanent damage where kidneys aren’t able to perform their function properly. The conditions that lead to end-stage renal failure include:

Diabetes
High blood pressure
Certain inherited kidney diseases (polycystic kidney disease)
Long-standing blockage of the kidneys by stones, an enlarged prostate gland or cancer
Recurrent kidney infections
Glomerulonephritis (swelling of the filtering units of the kidney)

It is noteworthy that both diabetes and hypertension are preventable and manageable conditions, and hence keeping them in check can avoid the need for a transplant altogether.

Who is eligible for a kidney transplant?

Dialysis patients with end-stage renal failure are considered candidates for kidney transplants if they are:

Healthy enough to undergo the surgical procedure
Without any other significant medical problems
Able to handle medicines that suppress immunity for the rest of their life (to prevent transplant rejection)

What are the types of kidney transplants?

Deceased-donor kidney transplant (The kidneys from a brain-dead donor are transplanted to matching recipients with the consent of the family)
Living-donor kidney transplant (Normally, everyone has 2 kidneys. You need only one functioning kidney to live. Hence, the recipient can receive kidneys from a matching healthy donor)

Who can donate a kidney?

Any consenting adult over the age of 18 who is physically and mentally fit can donate their kidney. Ideally, the person best suited to donate a kidney is the patient’s living family member. In the absence of a family member, a donor whose tissue and blood type match the patient’s can be considered.

Kidney donations are also possible from previously healthy individuals who are brain dead (usually from an accident) but are on life support systems.

Why is the left kidney preferred for kidney donation?

Usually, both the right and left kidneys have a single artery and vein. But the left kidney is preferred for donation since the renal vein is longer on the left side, making it easier to access during surgery. In cases where a donor’s kidney has multiple blood vessels, the kidney that is easier to operate on is taken for donation. As a rule of thumb, the better kidney remains with the donor.

What are the tests to be done to determine if I qualify to be a kidney transplant recipient?

Initially, your previous medical history and health status will be evaluated. Your previous medical records will be reviewed, and you will have to inform the doctors about all the medicines you take. A thorough physical examination will be performed to understand your health status. You would be advised to undergo the following tests:

Blood tests (complete blood count, bleeding and clotting studies, liver function test, blood type test, test for HLA antigens, HIV, hepatitis, and cytomegalovirus test)
Chest X-rays
CT, MRI
ECG, Echocardiogram
Any other tests as required

Is there a scoring system to decide who gets priority on the transplant waitlist?

A scoring system was in place until 5 years ago. Now, transplants are decided on a ‘first come first served basis, as well as matching the blood groups of the donor and recipient.

What are the preparations for the kidney transplant procedure?

If a donor’s kidney becomes available, the following tests are to be performed to ensure that the kidneys are suitable for you:

Blood type testing
It is ideal to transplant kidneys from someone with the same blood type as yours. However, if it does not match, the transplant can still be performed with additional treatment.
Tissue typing
Human Leukocyte Antigen (HLA) is a protein which is present in most of the cells in the body. The cells in your immune system use this protein to differentiate between which cells are the body’s own and which are foreign. Our immune system protects us from infections by destroying all foreign cells that enter the body. However, this can be problematic during a transplant because the immune system can also launch an attack against the new organ. Hence, it is important to perform HLA matching between the donor and the recipient to determine and minimise the chances of rejection.
Cross match testing

A small amount of blood from the donor will be mixed with the blood of the recipient to check if there is any cross-reaction between them. If there is any, additional treatment would be required before and after the transplant to prevent rejection.

What happens during kidney transplant surgery?

Kidney transplants are done under general anaesthesia, which means that you will sleep through the whole procedure. You will be required to fast (no food and fluids) for at least 8-10 hours before the procedure.

Your doctor will place an incision in the lower part of the abdomen. The defective kidney of the recipient is removed, and the healthy donor kidney is attached in its place. The blood vessels and ureters are attached to the new kidney. There are two approaches to doing this procedure:

Open nephrectomy – Involves making larger incisions that leave a big scar, require longer healing time, and have a higher rate of infection
Laparoscopic nephrectomy – Involves making minimal incisions that leave minor scars that heal faster and have a lesser rate of infection

After the transplant, the wound will be closed and a bandage will be placed. You will be transferred to the ICU and later to a normal room for recovery.

The new kidney will start functioning immediately in most cases, but sometimes it may take up to 10 days. You will be on temporary dialysis during this period.

What will my life be like after a kidney transplant?

In most cases, people who receive kidney transplants are able to go back to work within about 8 weeks after the procedure. You will have to refrain from lifting heavy weights and exercising during this period.

You will have to report to your doctor for frequent follow-up during the initial few weeks. Your doctor will check if your kidney is functioning properly and if there are any signs of rejection during these appointments.

You will have to refrain from smoking and minimise your alcohol intake after the transplant. In addition, you will be under medication that suppresses your immunity to avoid the chances of your immune system rejecting the kidney.

You will not require dialysis once your kidney starts functioning normally.

What are the risks and complications associated with a kidney transplant?

To the recipient:

Infections
Blood clots and bleeding
Leaking from or blockage of the ureter, which connects the kidney to the bladder
Rejection of the donated kidney
Injury to the intestines or blood vessels
Side effects of the medicines prescribed to prevent rejection (osteoporosis (bone thinning), infections, diabetes, high blood pressure, and high blood cholesterol levels)

To the donor:

Pain
Infections
Blood clots
Anastomotic leak
Rejections to anaesthesia
Need for re-operation

How does a kidney transplant compare to dialysis?

Compared to dialysis, a kidney transplant offers:

Better long-term survival outcomes
Superior quality of life
Better working capacity for the patient
Greater independence and mental well-being
Lesser risk of infection
Lesser expenditure (On average, the kidney transplant process costs Rs. 7-8 lakhs. Comparing this to a patient who has to undergo dialysis 3 times a week, their monthly expenditure comes to roughly Rs. 25,000-30,000, or Rs. 3-3.5 lakhs per year)

What is a swap kidney transplant?

Not a very commonly done procedure, a swap kidney transplant is when 2 renal failure patients in the same age group having opposite blood groups (e.g., A and B) are willing to donate or ‘swap’ their kidneys with each other.

Do kidney donors have a lot of health issues later on in life?

Prior to donation, a thorough evaluation of the donor is done to ensure that the donor does not have any pre-existing medical conditions (like diabetes, hypertension etc.) or end-organ damage. Precautions and pre-operative counselling are taken which include certain guidelines that a donor must follow for the rest of their lives to avoid complications. These include:

Regular health check-ups
Adequate water intake
Avoid taking unnecessary OTC pain medications

Does a kidney transplant have any effect on pregnancy?

Kidney transplants have no effect on pregnancy. However, it is advised that a woman refrains from getting pregnant for 1 year after undergoing kidney transplantation, so that the effect of the immunosuppressant drugs subside.