By Dr. Sunil Prakash, Nephrology,
21A kidney transplant is a surgical procedure in which a kidney from a live or a deceased person is placed into a person whose kidneys are not functioning properly. A kidney transplant is usually the treatment adopted for end-stage kidney disease. For a person afflicted with end-stage kidney disease, the kidneys would be performing at only a fraction of their normal capacity. As a result, the waste body needs to be removed from their body through dialysis or a kidney transplant.
A single donated kidney is enough to replace two failed kidneys. The donated kidney may be from a living related donor or a living unrelated donor or a deceased donor. If a compatible living kidney donor is not available, then the patient may register for a cadaver donation. The wait for a cadaver kidney donation typically takes from a few months to a few years. The quality of treatment and post-surgical care plays a huge role in the success of kidney transplant surgery. A kidney transplant may be performed at any age, from children to seniors.
A kidney transplant is a major surgery that requires general anaesthetic. The surgery lasts for about 2-4 hours. The kidney can be transplanted through “open nephrectomy” or laparoscopic surgical techniques. The former method is followed by most surgeons across the world.
The Gibson incision is the most widely used method for transplanting the donor kidney into the recipient. It is a three-stage process where:
- An incision is made in the lower abdomen through which the donated kidney is placed into the recipient
- Blood vessels from the lower abdomen are attached to the blood vessels of the donor kidney for blood supply
- The ureter of the donor kidney is then connected to the bladder
In case of a cadaveric kidney transplant, the donor kidney may temporarily function in a sluggish manner; this is termed as “sleepy kidney”. However, the sleepy kidney starts functioning normally after 2-4 weeks.
Most recipients are put on immunosuppressant medication after surgery in order to avoid rejection of the transplanted organ.
Due to the immunosuppressant medication prescribed to the recipient, great care needs to be taken in preventing viral or bacterial infections. Most doctors prescribe anti-viral, anti-bacterial and anti-fungal medication until the person’s immune system stabilises. Life expectancy after transplant relies on the quality of treatment, post-surgical care and lifestyle of the recipient. The life expectancy varies from 1 year to 15 years. The longest surviving renal transplant recipients are well up to 40 years after surgery.
In cases where the transplanted kidney fails, a second transplant may be considered. In some cases, the patient is put on dialysis.