Kidney Transplant

Kidney Transplant

Who is a candidate for Kidney Transplantation?

Kidney transplantation is the treatment of choice for people with kidney failure. This allows patients to stop dialysis, decrease their fluid and diet restrictions, and enjoy a much better quality of life.

What does it mean to be on a kidney transplant waiting list?

Those who are on the list are waiting for a non-living donor kidney to become available from a transplant center. It is difficult to predict how long a person will be on the waiting list, but, on average, waits of two years or more are not uncommon. A patient can be on multiple lists. One of the criteria usually is that you are able to travel to the transplant center within six to 10 hours. This may increase your chance of getting a transplant, but not significantly.

When a kidney becomes available in any area, information is sent to UNOS and a list is generated of individuals who potentially would be recipients for that kidney. If the kidney is a perfect match for someone on the national list, it will be offered to that person no matter where they are located.

How do you qualify for placement on the waiting list?

To qualify for placement on the kidney transplant waiting list, a potential recipient must be relatively healthy and not have cancer or infection. The patient also must be able to comply with treatment and medication requirements.

Who decides who receives a kidney when one becomes available?

Many things are taken into consideration. The blood and tissue types have to match. Other considerations are how long a person has been on the waiting list and his or her medical condition.

When the list of potential recipients is produced, the medical condition is assessed. Then the transplant surgeon and the nephrologists offer the kidney to the recipient and the recipient decides whether he or she wants to accept it.

What is a perfect match kidney?

Usually, a perfect match is from a brother or sister or a first degree relative. The chance of getting a perfect match from a living-related brother or sister is much higher.

What are antibodies and how does rejection occur?

Antibodies are proteins your immune system makes when it comes into contact with something foreign to your body. When you get an infection, such as a cold or an infection from a wound, your body makes antibodies to fight that infection. Antibodies protect your body. When you have an organ transplant, your body reacts as it would to an infection. Thus, your antibodies try to destroy the organ. Some people have a lot of antibodies, and it is harder to find an organ match.

Who donates kidneys for transplantation?

There are two sources for kidney transplants. One is from a living donor, and the other is from a non-living donor. Patients who have had kidneys donated from living donors usually enjoy higher success rates than those who receive organs from non-living donors, since there is less chance for rejection.

A living donor must be in good health and free from diabetes, high blood pressure, cancer, kidney or heart disease. Living donors usually are between 18 and 60 years old. The living donor must undergo a series of tests to determine if they are truly compatible with the recipient. The decision to become a living donor is completely voluntary, and the donor can change his or her mind at any time. Living donors sometimes feel pressure from their families or guilty if they are reluctant to go through with the procedure. They also may feel angry if the recipient’s body rejects the donated organ. Living donors should discuss their feelings with a transplant professional before making a final decision.

Typically, the donor is admitted to the hospital the day before the kidney donation for all the necessary tests. Shortly before the operation, an IV line is connected to a vein in the donor’s arm for medication and fluid. A catheter is inserted to drain urine from the bladder. The kidney is removed, and the donor then proceeds to recovery. Several hours after the operation, the donor is encouraged to walk around. The IV and catheter remain in place for a few days; as soon as the donor is able to eat and drink, the IV is removed. Typically, the donor goes home in five to eight days. He or she usually can return to work in about four weeks.

There are risks involved in any surgery. All patients have some pain after the operation, and it is possible for donors to develop infections or bleeding. Living donation also may have long-term risks, and it’s important for both the donor and recipient to know what these are.

There are benefits, too. Living donation keeps the recipient off the national waiting list, and surgery can be scheduled at a planned time rather than as an emergency operation. The recipient also can start taking anti-rejection drugs two days before the surgery to decrease the risk of rejection. Transplants from living donors usually are more successful because there is a better tissue match. There also is a psychological benefit. The recipient can feel better knowing that the gift came from a loved one, and the donor knows he or she has made a tremendous contribution to the life of the recipient.

Why may I need a kidney transplant?

When a patient has kidney failure, it causes him or her to feel ill. Over time, waste products and fluid build up in the body. This may result in death if untreated. There are three treatment methods for patients with End Stage Renal Disease (ESRD). The first is hemodialysis, where blood is passed through a dialysis machine and filtered in the same way as done by functioning kidneys. Another technique is peritoneal dialysis, which works by passing special fluid into the abdomen. Some of the toxic chemicals in the blood pass into the fluid. After a couple of hours the fluid is drained along with the toxins. A kidney transplant is the final means of replacing a failed kidney.

When should I consider a kidney transplant?

Start the transplant evaluation process when you and your nephrologist (kidney specialist) think that your kidney disease will eventually require dialysis. Before your evaluation, we will contact your nephrologist to obtain your medical records. After meeting you and reviewing several important medical tests, the transplant team will determine if you are eligible or not eligible for a kidney transplant.

Is a kidney transplant the right answer for everyone?

A transplant involves an operation, and requires you to take medications to stop your body from rejecting the new kidney. For some people—such as those with serious heart disease—the operation and/or the side effects of the medications are too dangerous. Kidney transplantation is too hazardous for patients with conditions such as active infections and cancer.

Does blood type matter for kidney transplants?

The blood type of the kidney recipient and the person giving the kidney—the donor—must be compatible, just as they must be for a blood transfusion. There are four blood types: A, B, AB, and O.

Note: Rh (the negative or positive element of blood type) has no effect on compatibility.

Will I always have to take medications after the kidney transplant?

After a transplant, medications will always be needed to stop the body from rejecting the kidney. These drugs are called immunosuppressants. Because the body can reject the kidney at any time, the medications must be taken every day, for as long as the kidney works.

Where is the kidney placed?

During surgery, the kidney is placed in the lower abdomen, either on the right or left side. It is connected to the blood vessels that supply blood to and from the leg. In general, your kidneys are left in place, unless they are have become very enlarged from a condition like polycystic kidney disease, or become a source of infection.

How long will I be in the hospital?

You will be in the hospital for 2 weeks. You may need to stay longer if a problem occurs and further treatment is needed; however, most people can go home without difficulty.

How often do I have to come back after my kidney transplant?

In the first month after the transplant you will return to the hospital twice a week for laboratory tests and a doctor checkup. The second month after your transplant you will come back once a week. You’ll come in every month until the sixth month, and then come in once a year. For the rest of your life, you will need to get monthly lab tests done, in order to monitor your medications and check for any potential problems.

How long will the tranplanted kidney work?

On average, a transplanted kidney from a cadaveric (deceased) donor lasts 15 years. Some transplanted kidneys only last a few weeks, while others function normally for 20 years or more. In general, kidneys from living donors last longer than those from cadaveric donors. The key to extending the life of your kidney is taking your medications as prescribed.

How long will I have to wait for a kidney transplant?

Because many things can affect the wait time, it is best to check with your transplant center.

What can I do while waiting for a kidney transplant?

• Stay as fit as possible
• Go to all your routine health care visits, including dental checkups, flu shots, EKGs, stress testing, colorectal exams, mammograms and pap smears for women, and prostate exams for men.
• If you have a blood transfusion while on the transplant waiting list, let your transplant center know immediately.
• While on the list you will need to submit monthly blood samples. If you are on hemodialysis, your dialysis center can do this for you. If you are not on dialysis we will help you arrange to have this done.
• Let your transplant center know if you change your address or phone number
• Let your transplant center know if you have any change in your health status
• Finally, you should enjoy your life, family and friends. Don’t spend your days waiting by the phone!

What is a Cadaveric Transplant?

Here the donor is a brain dead patient from whom the kidney is transplanted.