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KIDNEY TRANSPLANT

Introduction

A kidney transplant is surgery to place a healthy kidney into a person with kidney failure (end stage renal disease).History
The first kidney transplants between living patients were undertaken in 1954 in Boston on December 23 at Brigham Hospital and performed by Joseph Murray, J. Hartwell Harrison, John P. Merrill and others. The first kidney transplantation in Nigeria was done at St. Nicholas Hospital in 2001.Symptoms of End Stage Renal Disease
The symptoms of kidney failure vary widely by cause of the kidney failure, severity of the condition, and the other body systems that are affected.

  • Most people have no symptoms at all in the early stages of the disease, because the kidneys are able to compensate so well for the early impairments their function. Others have symptoms that are mild, subtle, or vague. Generally, obvious symptoms appear only when the condition has become severe or even critical.
  • Kidney failure is not painful, even when severe, although there may be pain from damage to other systems.
  • Some types of kidney failure cause fluid retention. However, severe dehydration (fluid deficiency) can also cause kidney failure.
  • Fluid retention: Puffiness, swelling of arms and legs, shortness of breath (due to fluid collection in the lungs, called pulmonary edema)
  • Dehydration: Thirst, rapid heart rate (tachycardia), dry mucous membranes (such as inside the mouth and nose), feeling weak or lethargic

 Other common symptoms include the following:

  • Urinating less than usual
  • Urinary problems - Frequency, urgency
  • Bleeding - Due to impaired clotting, from any site
  • Easy bruising
  • Fatigue
  • Confusion
  • Nausea, vomiting
  • Loss of appetite
  • Pain - In the muscles, joints, flanks, chest
  • Bone pain or fractures
  • Itching
  • Pale skin (from anemia)

Indications
The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. Common diseases leading to ESRD include: 

  • Hypertension
  • Diabetes Mellitus
  • Infections leading to Glomerulonephritis

 Contraindications
A kidney transplant may not be done in the following instance because that may put a patient at a higher risk of surgical complications:

  • Certain infections, such as TB or bone infections
  • Problems taking medications several times each day for the rest of your life
  • Heart, lung, or liver disease
  • Other life-threatening diseases
  • Recent history of cancer
  • Infections such as hepatitis
  • Smoking, alcohol or drug abuse, or other risky lifestyle habits

 Who Are Potential Kidney Donors?
Kidneys are obtained from the following sources:

Living Donors: This is possible because a normal individual has two kidneys and can live safely in good health with one kidney. Kidney donation does not alter the physical capacity or life-style or longevity of life of such a donor. Types include:

  • Genetically related kidney donors: This are from very close relatives-parents, siblings (brothers & sisters), children, grandparents
  • Emotionally related kidney donors: These are from spouse (husband/wife) cousins, uncles, aunts, in-laws and friends
  • Unrelated kidney donors: When the other living donor types are not available or are found unfit, then unrelated donor kidney transplantation can be considered but it MUST be altruistic. Commercial donation is strictly prohibited.


Deceased donors: They can be divided in two groups:

  • Brain-dead (BD) donors
  • Donation after Cardiac Death (DCD) donors

They are donors who have been declared brain-dead from non-kidney related causes, such as an accident or a stroke and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be removed for transplantation. Since the kidney is from a person not related to the patient, the kidney has less possibility of close antigen matching and thus less chances of success.In view of the growing demand for organs, which exceeds supply, it is essential to initiate a deceased donor program to augment the donor pool. In Nigeria, deceased donor organs are not yet a practically feasible alternative.Before the Procedure
You will be thoroughly evaluated by the transplant team to ensure that you can go through the surgery as safely as possible. This will include blood test, imaging tests and psychological profile. Your donor will also be evaluated to ensure that he/she is a perfect match and is in good health.Tests done before the procedure include:

  • Tissue and blood typing to help make sure your body will not reject the donated kidney
  • Blood tests or skin tests to check for infections
  • Heart tests such as an EKG, echocardiogram, or cardiac catheterization
  • Tests to look for early cancer
     

Procedure for the Person Donating the Kidney (Donor)
This is done under general anesthesia before surgery and the kidney removed using laparoscopic techniques. This means a quicker recovery time.Procedure for the Person Receiving the Kidney (Recipient)
The operation is done under general anesthesia. A cut is first made in the lower belly area. The new kidney is placed inside the lower belly and the artery and vein of the new kidney are connected to the artery and vein in your pelvis. Your blood flows through the new kidney, which makes urine just like your own kidneys did when they were healthy. The tube that carries urine (ureter) is then attached to your bladder.Your own kidneys are left in place, unless they are causing high blood pressure, infections, or are too large for your body. The wound is then closed.Risks

  • Rejection
  • Infection
  • Cancer: Certain cancers occur more frequently in people who have undergone kidney transplantation.
  • Relapse: A small number of people who undergo transplantation for certain kidney disease experience a return of the original disease after the transplant.
  • High blood cholesterol level
  • Liver disease
  • Weakening of the bones

 

Prognosis
There is a better quality of life after the transplant. Those who receive a kidney from a living related donor do better than those who receive a kidney from a donor who has died. (If you donate a kidney, you can usually live safely without complications with your one remaining kidney.)People who receive a transplanted kidney may reject the new organ. This means that their immune system sees the new kidney as a foreign substance and tries to destroy it. In order to avoid rejection, almost all kidney transplant recipients must take medicines that suppress their immune response for the rest of their life. This is called immunosuppressive therapy and its the most critical part of kidney transplantation. Different transplant centers use different drug combinations to fight rejection of a transplanted kidney. Although the treatment helps prevent organ rejection, it also puts patients at a higher risk for infection and cancer.A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed.

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