Kidney transplantation (KT) is the outcome of great advancement in medical science.
Kidney transplantation is the treatment of choice for end-stage kidney disease (ESKD). Successful kidney transplantation may offer better quality of life and longer patient survival compared with dialysis. Life after successful kidney transplantation is almost normal.
Kidney transplantation is discussed in four parts:
- Pre-Transplant Information
- Transplant surgery
- Post Transplant care
- Deceased donor (Cadaveric) kidney transplant
1. Pre-Transplant Information
What is kidney transplantation?
Kidney transplantation is a surgical procedure in which a healthy kidney (from a living donor or deceased - cadaver donor) is placed into the body of a person suffering from end-stage kidney disease (recipient).
When is kidney transplant necessary?
Kidney transplantation is necessary for patients who are suffering from ESKD who are on dialysis (hemodialysis or peritoneal dialysis) or who are approaching ESKD but not yet on dialysis (pre-emptive KT).
When is kidney transplant not required in kidney failure?
A patient with acute kidney injury should not undergo KT. Kidney transplantation is also not done in cases where only one kidney fails and the other kidney is still functioning. Transplantation should only be done if the renal failure is irreversible.
Discovery of kidney transplantation has been a blessing for patients with chronic kidney failure.
Why is kidney transplant necessary in end-stage kidney disease?
Dialysis replaces some degree of the filtration of waste products of the kidneys. Other functions of the kidneys are not accomplished, some of which are better addressed by transplantation. Hence, kidney transplantation, when a suitable donor is available and when no contraindications are present, offers the best treatment option for complete rehabilitation of a patient with end-stage kidney failure. As kidney transplantation saves lives and enables one to enjoy almost normal life, it is referred to as the “Gift of Life”.
What are the advantages of kidney transplantation?
Major benefits of successful KT are:
- Better degree of replacement of renal function and better quality of life: The patient may achieve an almost normal and active lifestyle with more energy, stamina and productivity.
- Freedom from dialysis: Patients avoid the complications, cost, lost time and inconveniences of dialysis treatment.
- Longer life expectancy: Transplant patients have a longer life expectancy than risk-matched patients who remain on dialysis.
- Lesser dietary and fluid restrictions.
- Cost-effectiveness: Although the initial cost of a kidney transplant may be high, the expenses decrease by the second to third year post-transplant and by then, is usually less than that needed for maintenance dialysis treatment.
- There is a reported improvement in sexual life and a higher chance of fathering a child in males and becoming pregnant in females.
Successful kidney transplantation is the best treatment option for CKD-ESKD as it offers almost normal life.
What are the disadvantages of kidney transplantation?
Kidney transplantation offers many benefits but also has disadvantages. These are:
- Risk of major surgery. Kidney transplantation is a major surgical procedure under general anesthesia that has potential risks both during and after the surgery.
- Risk of rejection. There is no 100% guarantee that the body will accept the transplanted kidney. But with the availability of newer and better immunosuppressant drugs, rejections are less likely than they were in the past.
- Regular medication. Transplant patients will need to take immunosuppressive medicines regularly for as long as their donor kidneys are functioning. Discontinuation, missing or not taking the full dosage of immunosuppressant drugs, carries the risk of failure of transplanted kidney due to rejection.
- Risks related to immunosuppressive drugs: Drugs that suppress the immune response and rejection may lead to severe infections . Care to avoid infections and screening for development of some forms of cancer are part of post-transplant care. There are side effects for drugs like high blood pressure, high blood cholesterol and sugar levels.
- Stress. Waiting for a kidney donor before transplant, uncertainty of success of transplant (the transplanted kidney may fail) and fear of losing function of the newly transplanted kidney after transplant, is stressful.
- Initial high cost.
Kidney transplantation is not performed in CKD patients with AIDS, cancer and other serious diseases.
What are the contraindications for a kidney transplant?
Kidney transplantation is not recommended if the ESKD patient has:
- A serious active infection
- Active or untreated malignancy
- Severe psychological problems or mental retardation
- Unstable coronary artery disease
- Refractory congestive heart failure
- Severe peripheral vascular disease
- Antibodies against the donor kidney
- Other severe medical problems.
What is the age limit for a kidney transplant recipient?
Although there is no fixed criteria for the age of a kidney transplant recipient, it is usually recommended for persons from 5 to 65 years of age.
What are the likely sources of kidneys for transplantation?
There are three sources of kidneys for transplantation:
- Living related donors: blood relatives of the recipient up to the 4th degree of consanguinity.
- Living non-related donors: like friends, spouses or relatives.
- Deceased (cadaver) donors: from victims of brain death.
Who is the ideal kidney donor?
An identical twin is an ideal kidney donor with the best chances of survival after transplantation.
Kidney donated by family member donors results in most successful kidney transplantation.
84. Save Your Kidneys
Who can donate a kidney?
A healthy person with two kidneys can donate one kidney as long as the blood group, tissue type and tissue crossmatching are compatible with the receipient. Generally, donors should be between the ages of 18 and 65 years.
How does blood group determine the selection of a kidney donor?
Blood group compatibility is important in KT. The recipient and donor must have either the same blood group or compatible groups . Just like in blood transfusions, a donor with blood group O is considered a “universal” donor. (see table below)
| Recipient’s blood group |
Donor’s blood group |
| O |
O |
| A |
A or O |
| B |
B or O |
| AB |
AB,A, B or O |
Who cannot donate a kidney?
A living donor should be thoroughly evaluated medically and psychologically to ensure that it is safe for him or her to donate a kidney. A person cannot donate kidney if he or she has diabetes mellitus, cancer, HIV, kidney disease, high blood pressure or any major medical or psychiatric illness.
What are the potential risks to a living kidney donor?
A potential donor is evaluated thoroughly to ensure that it is safe for him or her to donate a kidney. With a single kidney, most donors live a normal healthy life. After kidney donation sexual life is not affected. A woman can have children and a male donor can father a child. Potential risks of kidney donation surgery are the same as those with any other major surgery. Risk of contracting kidney disease in kidney donors is not any higher just because they have only one kidney.
Kidney donation is safe and saves lives of CKD patients.