Alternative Names renal transplant, transplantation of the kidney
Definition Kidney transplantation involves placing a healthy donor kidney into a person whose own kidneys have stopped working. The donor kidney can either come from someone who has died or from a living donor.
Who is a candidate for the procedure? Only people who have complete and irreversible kidney failure are candidates for this procedure. The most common causes of kidney failure are:
diabetes
glomerulonephritis, which is an inflammation of the filtering cells of the kidney
polycystic kidney disease, which is a condition that causes cysts throughout the kidney
high blood pressures
There are a few conditions that would rule out a transplant entirely. These include:
cancer within the past 5 years
infections such as tuberculosis or osteomyelitis, which is an infection of the bones
severe heart, lung, or liver problems
Once a person is deemed suitable as a transplant candidate, a donor must be found. The best situation is for the donor kidney to come from a living family member or close friend.
If no suitable living donor can be found, the person can be placed on a national waiting list for a kidney from someone who has died. There are currently over 1,500 patients awaiting kidneys in Australia. Waiting time can be several years.
How is the procedure performed? The kidney is removed from the living donor in an operating room after the person is put to sleep with anaesthesia. If the donor is dead, the kidney is removed at the same time that many other organs are being removed for transplantation.
The recipient of the kidney transplant is put to sleep with anaesthesia. An incision is made in the lower part of one side of the abdomen. The blood vessels of the donor kidney must be connected to the corresponding vessels in the recipient's pelvis. Blood flow is restored to the donor kidney. The ureter, which is the tubular part of the kidney that carries urine, is connected to the recipient's bladder. There is usually room for the donor kidney to be implanted without having to remove the patient's original kidneys. When all the connections have been made, the incision is closed.
What happens right after the procedure? The hospital stay for a donor is about 2 to 3 days. Recovery after the operation is usually uneventful. The person will have a bladder catheter that is put in place during the surgery. This is usually removed after the first day. The individual is usually up and around within 24 hours. He or she can resume eating as soon as the anaesthesia wears off.
The kidney recipient needs to stay in the hospital from 3 to 7 days. A bladder catheter is inserted during the surgery. It can usually be removed by the second day after the operation. The recipient can generally resume eating within 24 hours. He or she should be able to get out of bed and walk as soon as the anaesthesia wears off.
The recipient of the new organ needs to take drugs to suppress the immune system and prevent the body from rejecting the new kidney. These are started either immediately before or during the transplant procedure. The patient is monitored carefully during the first week or two to determine the proper dosages.
What happens later at home? The donor and the recipient can expect a similar recovery.
Walking is encouraged to prevent lung complications and to restore strength.
Heavy lifting and straining should be avoided for 4 to 6 weeks.
Driving is permitted once the person's incision is pain free.
Sexual activity can be resumed when the person is comfortable.
What are the potential complications after the procedure? There are several potential complications:
infection, which happens in roughly 25% of transplant recipients.
major bleeding, which may require a blood transfusion.
problems with the blood vessel connections between the donor kidney and the recipient's pelvic vessels.
clot in the artery or vein supplying blood to the kidney. If this happens, the kidney may die.
narrowing of the artery within the kidney. This is known as transplant renal artery stenosis. This can limit blood flow to the kidney. It also makes it difficult to keep blood pressure under control. Most of the time, the narrowed segment can be expanded using a small balloon that is inflated where the narrowing is.
leaky ureter connections to the bladder. This problem is treated by inserting a stent. A stent is a very thin, straw-like tube that provides a kind of scaffolding around which tissues can heal.
kidney rejection. The body's normal immune response to the new kidney is to reject it. Drugs to suppress the immune system prevent rejection in most cases.
cancer. Between 6% and 8% of transplant recipients develop cancer as a complication of the drugs that suppress the immune system.
For the most part, kidney transplantation has very good results. Kidney transplant recipients live longer, healthier lives than is possible with dialysis treatments. Although there is a greater short-term risk of death associated with the transplant surgery, this risk is outweighed by the long-term effects of continuous dialysis. Depending on the source and quality of the donor kidney, a successful outcome for kidney transplant can be expected 85% to 95% of the time. A kidney transplant can last an average of 8 to 25 years.
Outcomes for living kidney donors are excellent. The risk of death from kidney donation is less than 4 in 10,000. There are almost no long-term risks. Living kidney donors do not need to undergo any special medical testing, maintain any special diet, or take any medications as a result of kidney donation.
Author: Robert Merion, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
