Kidney Transplant ?
Kidney transplantation or renal transplantation is the transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.
A person receiving a transplant usually receives only one kidney, but, in rare situations, he or she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.
How do the kidneys work?
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The kidneys and urinary system keep chemicals, such as potassium and sodium, and water in balance, and remove a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. Kidneys also regulate fluid and acid-base balance in the body.
Two kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. Their function is to:
Remove liquid waste from the blood in the form of urine
Keep a stable balance of salts and other substances in the blood
Produce erythropoietin, a hormone that aids the formation of red blood cells
Regulate blood pressure
The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.
Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
Investigations before transplant
Blood tests. Blood tests are performed to help determine a good donor match, to assess your priority on the donor list, and to help improve the chances that the donor organ will not be rejected.
Diagnostic tests. Diagnostic tests may be performed to assess your kidneys as well as your overall health status. These tests may include X-rays, ultrasound procedures, kidney biopsy, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
The transplant team will consider all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for kidney transplantation.
The potential donor must have a compatible blood type and be in good health. A psychological test will be conducted to ensure the donor is comfortable with the decision.
How the transplant will proceed
The following steps will precede the transplant:
Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
If you have been on routine dialysis before the procedure, you will receive dialysis prior to the procedure.
For a planned living transplant, you should fast for eight hours before the operation, generally after midnight. In the case of a cadaver organ transplant, you should begin to fast once you are notified that a kidney has become available.
You may receive a sedative prior to the procedure to help you relax.
Based upon your medical condition, your physician may request other specific preparation.
During the procedure
Kidney transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
Generally, a kidney transplant follows this process:
You will be asked to remove clothing and given a gown to wear.
An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
If there is excessive hair at the surgical site, it may be clipped off.
A catheter will be inserted into your bladder.
You will be positioned on the operating table, lying on your back.
Kidney transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The physician will make a long incision into the lower abdomen on one side.
The physician will visually inspect the donor kidney prior to implanting it.
The donor kidney will be placed into the abdomen. A left donor kidney will be implanted on your right side; a right donor kidney will be implanted on your left side. This allows the ureter to be accessed easily for connection to your bladder.
The renal artery and vein of the donor kidney will be sutured (sewn) to the external iliac artery and vein.
After the artery and vein are attached, the blood flow through these vessels will be checked for bleeding at the suture lines.
The donor ureter (the tube that drains urine from the kidney) will be connected to your bladder.
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to reduce swelling.
A sterile bandage/dressing will be applied.
After the procedure
In the hospital
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room. Kidney transplantation usually requires an in-hospital stay of several days.
A kidney from a living donor may begin to make urine immediately, but urine production in a cadaver kidney may take longer. Until urine output is sufficient, dialysis may be required.
You will have a catheter in your bladder to drain your urine. The amount of urine will be carefully measured to evaluate the new kidney's function.
You will receive IV fluids until you are able to take in adequate food and fluids.
Your immunosuppression (anti-rejection) medications will be closely monitored to make sure you are receiving the optimum dose and the best combination of medications.
Blood samples will be taken frequently to monitor the status of the new kidney, as well as other body functions, such as the liver, lungs, and blood system.
Your diet will be gradually advanced from liquids to more solid foods as tolerated. Your liquid intake may be restricted until the new kidney is fully functional.
You may begin physical activity by the day after the procedure. You should get out of bed and move around several times a day.
Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.
Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
You should not drive until your physician tells you to. You should avoid any activity or position that causes pressure to be placed on the new kidney. Other activity restrictions may apply.
Notify your physician to report any of the following:
Fever, which may be a sign of rejection or infection
Redness, swelling, or bleeding or other drainage from the incision site
Increase in pain around the incision site, which may be a sign of rejection or infection
Fever and tenderness over the kidney are some of the most common symptoms of rejection. An elevation of your blood creatinine level (blood test to measure kidney function) and/or blood pressure (monitored by your physician) may also indicate rejection. The symptoms of rejection may resemble other medical conditions or problems. Consult your transplant team with any concerns you have. Frequent visits to and contact with the transplant team are essential.
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
What is ABO incompatible Transplant
Here kidney transplant are done between different blood group person like A group person will donate to O or B group in the same way B group can donate to O or A group. AB group can give to O or A or B.
Here we do pre transplant plasmapheresis to remove antibodies of incompatible blood group and treat them with Immunoglobulin & Rituximab.
Cost of such transplant is between Rs. 12 to 15 Lacs (Rs. 12,00,000 to 15,00,000 / US $ 25,000 to 30,00,000) Success rate of such transplant is good. 95% at 1 year & 90% at 2 year.