Frequently asked questions about kidney transplant

At a Glance:

What is a kidney transplant?

Kidney transplant refers to a surgical procedure of placing a healthy kidney from a donor (alive or deceased) in the body of an individual whose kidneys fail to function normally. Kidney transplant is one of the most common transplant surgeries done around the world. This is a life-saving surgery in patients with advanced kidney disease (like kidney failure or chronic end-stage kidney disease) where the kidneys are no longer able to filter out the waste products or toxins from the body.

What are the types of kidney transplant?

There are two types of kidney transplant:

• Deceased-donor kidney transplant
• Living-donor kidney transplant

What is deceased-donor kidney transplant?

Deceased-donor kidney transplant: In this form of transplant surgery, the donor’s kidney is removed from a person who is brain dead and placed in recipient whose kidneys are not functioning properly and have failed. This is done either with the consent of the family or when the deceased person has signed a donor card.

What is living-donor kidney transplant?

Living-donor kidney transplant: In this process, a good functioning kidney is removed from a live donor and placed into the recipient whose kidneys are not functioning properly or have failed. Only one donor kidney is sufficient to replace the non-functioning kidneys in the recipient. The live donor kidney can be availed from any family member or any other person who wishes to donate his/her kidney to the recipient.

What is pre-emptive kidney transplant?

Pre-emptive kidney transplant: This form of transplant surgery is done well before the kidney function of the recipient deteriorates to the point of needing dialysis. Majority of the kidney transplants are done after the kidney function has deteriorated and the individuals are on dialysis. There are several advantages of a pre-emptive kidney transplant like improved survival rates and quality of life parameters, lower transplant rejection rates and lower costs for treatment expenditure. This method of transplant can be especially considered for children and adolescents.

Who might need a kidney transplant?

A kidney transplant may be required in individuals with advanced kidney disease like an End-Stage Kidney Disease (ESKD). ESKD may be a result of kidney damage due to several medical conditions like:

• Chronic kidney diseases or infections
• Acute kidney diseases due to infections or certain medicines
• High blood sugar (diabetes mellitus) with complications related to kidneys
• Uncontrolled high blood pressure (hypertension)
• Some autoimmune diseases

Who is eligible for kidney transplant?

To be an appropriate candidate for a kidney transplant, the individual should meet some criteria set forth by the doctors. These are:

• The individual should not have any serious underlying medical conditions like cancer, advanced heart disease, liver disease, uncontrolled mental illness, etc.
• The individual should not smoke, consume alcohol or use illicit drugs.
• The individual should not be of advanced age.

Who may not be a suitable candidate for a kidney transplant?

Contrary to the popular belief that older individuals cannot undergo kidney transplantation, age is not the main factor for making transplant decisions. The overall general health of a person is an important criterion for determining eligibility. Some of the factors which make a person unsuitable for the kidney transplant procedure include:

• Alcohol or drugs dependence
• Comorbid conditions like cancer, untreatable cardiac conditions
• Inability to adhere to the treatment regime
• Life expectancy below five years
• Contraindications to transplant may also be case specific, hence it is highly recommended to discuss the eligibility with the doctor when considering a transplant.

When is the ideal time to undergo kidney transplant?

It is generally recommended that the sooner a kidney transplant is done the better are the chances of improving the person’s overall quality of life. However, considering the constraints like availability of the donor kidney and the person’s fitness to undergo the transplant, the nephrologist and the transplant team together decide upon the most suitable time.

Do persons with kidney transplant live longer than those on dialysis?

Yes. Kidney transplant is considered to be the most definitive treatment for chronic renal failure and individuals with a transplant generally show improved outcomes and better quality of life as compared to those on dialysis. An important reason for this is the ability of the natural kidney to function continuously to remove toxins from the blood, dialysis, on the other hand, is done 3-4 times a week, thus allowing the waste to accumulate within the body for a longer time. 

Why is kidney transplant preferred over dialysis?

Dialysis is considered to be a life-saving treatment and an option for individuals who are either unable to undergo a kidney transplant due to some reason. Kidney transplant is the treatment of choice for people with chronic kidney failure because dialysis can replace only up to 10-15% of the work of a functioning kidney. Due to prolonged accumulation of toxic waste within the body, a person with dialysis usually faces the risk of other health problems. A kidney transplant, on the other hand, offers more longevity and a much better quality of life.

How can a person requiring transplant get a donor’s kidney?

A living donor kidney transplant is considered to be better as compared to deceased donor transplant. A living donor can be anyone from a person’s family or friend who is willing to donate and provided the removal of the kidney will not be detrimental to the donor’s health. If you have a willing donor, you can seek consultation from your nephrologist for further course of action that would include a thorough medical evaluation and blood work to assess tissue compatibility and the likelihood of organ rejection before transplant is planned.

How is living donor transplant better as compared to deceased donor transplant?

Living donor transplants are considered to be long lasting when compared with deceased donor transplants. This is so because the living donor kidneys are healthier as the period for which the donor’s kidney remains outside the living environment is shortened. Cold preservation of the deceased donor kidney is likely to reduce its function. Living donor transplants are expected to last as long as 15-20 years or more and deceased donor transplants for 10-15 years on an average.

What are the options for patients if there is no kidney donor?

In case of non-availability of living donors, individuals needing a kidney transplant can consider a deceased donor kidney.

Persons who need a kidney transplant but do not have a living donor can register themselves for inclusion in the waiting list if they are taking treatment from a registered transplant hospital in programs like Jeevandan. Further, advise and information in this regard can be obtained from the kidney transplant centre of the respective hospital.

For how long do individuals needing donor transplant usually wait?

The waiting time for a deceased donor kidney is long, often a few years considering that there are roughly 2 lakh people in the country every year and approximately 15000 get the donor’s kidney. The prolonged wait of several years may lead to deterioration of health as a result, family members, friends and others are strongly urged to make living kidney donation.

What can a person expect before kidney transplants?

After an individual is deemed as an appropriate candidate for a kidney transplant, the following will be done:

First and foremost the transplant team will find a matching donor kidney for the recipient. The donor kidney can be available through a live or deceased donor.

Once a donor’s kidney is found, the doctors will run some tests to determine whether the donor’s kidney is a match for the recipient that include blood typing, tissue typing (HLA typing) and cross-matching. Other tests are also performed on the donor that includes checking for any serious medical illnesses, transmissible diseases or infections and any other tests that are deemed necessary by the doctor.

Another aspect of pre-transplant care is for the recipient to remain healthy. The recipient should follow the regime prescribed by the doctors including any medications, diet, exercise and other activities.

What are the tests to undergo before undergoing kidney transplant?

If the doctor deems an individual fit as a kidney transplant candidate, that person will undergo further tests and evaluation for the transplant process. These include:

• A detailed medical history and physical examination by the doctor.
• Blood tests for basic and advanced parameters to detect underlying infections or conditions that can hamper the transplant process.
• Diagnostic imaging studies like X-rays, MRI or CT scans.
• Psychological evaluation.
• Any other additional tests as deemed necessary by the doctor or transplant surgeon.

After these tests are done and results evaluated by the doctors, they will inform the individual whether he or she has been accepted as a kidney transplant candidate. This individual is then put on a kidney transplant wait list. Once an individual is added to the waiting list, he/she may receive the kidney quickly or may have to wait for a few years. The average waiting time can be in the range of 1-2 years. Factors determining the waiting period are the availability of donors in the local area and matching with the donor and blood group of the individual.

What can a person expect during kidney transplant?

Typically, kidney transplant surgery is performed by a transplant team in a multi-speciality hospital. The team consists of the transplant surgeon/s, anaesthetist, physicians and the medical support staff (including nursing staff, physiotherapists and nutritionists).

The transplant surgery is done while the individual is under general anaesthesia. The surgery lasts from two to four hours. During the surgery, an incision is made on the abdomen and the donor’s kidney is placed inside the abdomen. The incision is then sewn back, and the patient is monitored in the post-operative phase in an ICU.

What is laparoscopic donor nephrectomy? Is it for every donor?

Laparoscopic donor nephrectomy is a minimally invasive procedure to remove the donor’s kidney and it is possible to do this for a majority of kidney donors. A small scope or tube connected to a video camera is inserted into the donor’s abdomen and the kidney is removed using small instruments which are inserted through very small holes. The main advantage of this procedure is less postoperative pain, faster recovery, and less damage to the function of the donor kidney.

What can a person expect after kidney transplant?

Immediately after the transplant surgery, the individual is shifted to the ICU for monitoring. He/she will need to spend a few more days at the hospital. During this time, the recipient is monitored for signs of infection, basic health parameters and urine output (as new kidney will begin to produce urine).

Upon recovery, the recipient is discharged typically after around a week of hospital stay. There will be pain and discomfort at the transplant site after surgery. This will be managed by the doctors and other medical staff by use of appropriate medications and supportive care.

After hospital discharge, the recipient will have to come for frequent check-ups with the doctors to determine the state of recovery as well as to understand the way the new kidney is functioning. This might require additional tests as well.

The recipient will have to be on lifelong medications for the rest of his/her life. Typically, anti-rejection medications or immunity-suppressing medications are given to prevent rejection of the kidney.

How frequently will a person be required to visit the doctor for follow up after the transplant?

Once a kidney transplant is done, the first three to six months are very crucial and need frequent follow-up visits with the treating doctor and frequent laboratory tests. Once the transplanted kidney restores its function and the person restores better health, they can have more for personal activities and the visits may be spaced further.

For how long does a transplanted kidney last?

Carefully selected cases of kidney transplants with diligent adherence to the post-surgery treatment plan are likely to succeed in 95% cases or more. A transplanted kidney from a living donor is expected to last for 15-20 years or more and that from a deceased donor may last for as long as 10-15 years on an average.

What are the long-term prospects of a person with a kidney transplant?

Though the health outcomes and quality of life of an individual improve with the transplant, living with a transplant requires life-long care and precautions. Anti-rejection medications need to be taken regularly. Follow-up visits though get spaced but need to be continued lifelong to monitor the person’s progress. It is critical to be aware of the signs of rejection and look for them every day.

Is a special diet required after kidney transplant?

Transplant patients are often placed on medications that reduce their immunity making them more susceptible to infections from germs in foods. Wash of all fruits and vegetables thoroughly is thus of extreme importance before consumption. Similarly, patients with a transplanted kidney are advised to avoid raw or under cooked meat, poultry, fish, eggs etc in any form. Some food items may even interfere with the action and absorption of medications. Hence it is recommended to consult a dietitian for a customized diet plan.

Can a person exercise after transplant?

Even though strenuous exercise may not be advised immediately after surgery, a person who has undergone kidney transplant can resume activities once he/she gains sufficient energy and strength after the surgery. Mild exercises like walking 5 to 10 minutes a day following surgery should be good to start with, followed by a slow increase in the time of walk each week. Do consult your treating doctor about what should be the best exercise regime depending on your case.

Are there any restrictions to be followed after a transplant?

One of the most important factor to consider before and after the surgery is to quit any form of a habit-forming agent like tobacco or alcohol, to prevent any damage to the transplanted kidney. Consult your transplant team to find out a suitable time to resume driving, work, travel, school etc.

How can one donate a kidney to a loved one?

Any healthy individual who is capable of giving consent and is 18 years or more can consider donating a kidney if the blood type is compatible HLA tissue typing is done for compatibility. However, individuals having certain medical conditions may not be suitable for donation.

If you are a potential donor, you may discuss your will with the treating doctor who will advise you to undergo a thorough evaluation for suitability and advise further.

What are the options if a kidney transplant fails?

Due to some reasons such as graft rejection, the transplant doesn’t result in the expected outcomes, a person has the option to:

• Undergo dialysis like before
• Consider another transplant
  

What is graft or transplant rejection?

Rejection is the response of the body to foreign agents like objects, tissues or microbes. In case of a kidney transplant, the body treats the donor kidney as a foreign body and the immune system attacks it with antibodies perceiving it as a threat. Due to this reason, an individual who undergoes a transplant is advised immunity-suppressing medications and prevent the body from attacking the new kidney.

What are the symptoms of rejection? 

Sometimes the only initial sign of rejection may be an elevated level of blood creatinine determined from a laboratory test. Some other symptoms of rejection are:

• Decreased urine output
• Fever 
• High blood pressure
• Malaise, body aches or a flu-like feeling
• Sudden unexplained weight gain
• Tenderness or pain in the region of the kidney
• Should a person with a transplant experience such symptoms, it is recommended to call the transplant coordinator.
  

How is rejection prevented?

The recipient will have to be on lifelong medications for the rest of his/her life. Typically, anti-rejection medications or immunity-suppressing medications are given to prevent rejection of the kidney.

What are the side effects of immunosuppression?

Yes. There are also complications after use of anti-rejection or immunity-suppressing medications like:

• Thinning or damage to the bones or osteoporosis
• Conditions like hair loss, acne, weight gain, puffiness over the body
• High blood pressure and increased cholesterol
• Increased susceptibility to infections
• Increased risk of certain forms of cancer like skin cancer or lymphomas
  

Can immunosuppression therapy be avoided?

Yes. Nephrologists at Yashoda hospitals follow on case to case basis, anti-rejection regimen where it is possible to avoid steroids and their side effects altogether. The person requiring transplant will be first evaluated to deter if she or he can use the steroid-free protocol. Many of the children we see can use the steroid-free protocol and are spared the side effects of steroids.

Whom do I call for more Information?

For more detailed information about medicinal data, legal aspects and guidance with organ donation and organ transplantation, request a callback with us and we will assist you throughout the process.

References:

• Mayo Clinic. Kidney transplant. Available at https://www.mayoclinic.org/tests-procedures/kidney-transplant/about/pac-20384777. Accessed on 23rd January 2019.
• John Hopkins Medicine. Kidney Transplant. Available at https://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/kidney_transplantation_procedure_92,p07708. Accessed on 23rd January 2019.
• Urology Care Foundation. What is a Kidney Transplant? Available at https://www.urologyhealth.org/urologic-conditions/kidney-transplant. Accessed on 23rd January 2019.
• Wiley Online Library. The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis. Available at https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.14018. Accessed on 23rd January 2019.
• World Journal of Transplantation. Past, present and future of kidney paired donation transplantation in India. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409913/. Accessed on 23rd January 2019.