Kidney Transplantion

Kidney Transplantion

Kidney transplant is the treatment of choice for End Stage Kidney Disease (ESRD), provided there is no contraindication to it. 

Other modes of treatment for ESRD, like Hemodialysis and Chronic peritoneal dialysis do not replace the kidney functions completely, for example dialysis can not correct the anemia and the patient needs other medicines concomitantly but a successful kidney transplant almost completely substitutes the normal kidney functions. 

After transplantation the patient has to take drugs to suppress the immunity to minimize the rejection of the kidney. Immunosupressive therapy usually consists of two to three drugs like Cyclosporine, Steroids and Azathioprin or Mycophenolate Mofetil, which have to be taken for whole life. 

It is a double edged sword, on one side suppressing the immunity to protect the kidney from rejection and on the other side rendering the recipient more susceptible for infections and malignancy. So one should be very careful regarding the degree of immunosuppression, neither should be inadequate immunosuppression putting the kidney at risk of rejection nor should there be excessive suppression of immunity by too many medicines. 

From where can the kidney be taken for transplantation?

     Cadaver donor kidney transplantation:

Means to get the kidney along with other vital organs from a person who is brain dead but still his heart is beating and perfusing the vital organs and it is decided by the relatives to stop life support and they agree to organ donation. 

Two or more than two doctors examine the patient before making the decision of brain death and to take the organs from the body. Once the decision is made that patient is brain dead, he is kept alive by artificial respiration until all the arrangement is done. 

     Live donor kidney transplantation: 

means to get the kidney from a live healthy person who may be a close relative of the recipient (Live related kidney transplantation) or may have not any relation with patient (Live non related kidney transplantation). 

Can kidney donation harm the life of the donor? 

Extensive workup is required before taking a kidney from a live person. Not only does the doctor have to be sure that the potential donor is not carrying a transmittable virus like Hepatitis B and C, HIV and active Cytomegalovirus in his body, but also to be certain that both his kidneys are absolutely normal. Until and unless it is not sure that both the kidneys are functioning normally, he is not allowed to donate his kidney. 

There is a marvelous reservoir function in the normal kidneys. When a kidney is removed from a healthy person, the second normal functioning kidney will enlarge within two to three weeks and will attain 80-90% functions of both the kidneys. 

So practically speaking, the kidney functions of the donor remain normal after operation and the quality of life remains as before operation. 

Recipient Contraindications (factors that make the procedure inadvisable) for transplantation:

Any type of cancer is a contraindication for the operation: 

however transplantation can be done after a waiting period of one to two years after successful treatment of the tumor. Severe heart disease like heart failure and severe ischemic heart disease. 

However if ischemic heart disease is treatable by coronary bypass surgery, it should be done before the transplant operation. Impaired blood circulation in the legs Active infections like tuberculosis or active Hepatitis B and C diagnosed by PCR and liver biopsshould be treated before transplantation.

  • Advanced liver disease (Liver cirrhosis).
  • Intolerance of post-transplant medication (immunosuppressive drugs).
  • Lung disease.
  • Physiologic frailty and malnourishment.
  • Psychiatric illness and history of non- compliance to treatment.

Contraindications for kidney donation: 

Extreme age: Most programs do not accept the donor of less than 20 and more than 50 years of age. Deranged kidney parameters of the donor, like raised urea and creatinine or presence of protein or blood in the urine. 

Single functioning kidney or the second kidney is at risk in future like stones in it.

Presence of transmittable infections like hepatitis B or C and tuberculosis in the donor. 

Cancer in the donor. 

Congenital mal formation of the urinary tract of the donor, like horse shoe shaped kidneys