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Definition
A kidney transplant is a surgical
procedure to implant a healthy
kidney into a patient with kidney
failure.
Description
Kidney transplants are second only
to corneal transplant as the most
common transplant operation in the
United States. There are over 9,000
kidney transplants performed each
year.
Patients with chronic kidney disease
can receive life-saving dialysis
therapy until a donor becomes
available. The donated kidney may be
from:
* Living related donor genetically
related to the recipient, like a
parent, sibling, or offspring
* Living unrelated donor like a
friend or spouse
* Deceased donor, a recently
deceased individual who has no known
chronic kidney disease
The healthy kidney is transported in
a cool saline solution that
preserves the organ up to 48 hours.
This gives time to perform blood and
tissue donor-recipient matching
tests, which are done before the
operation.
Procedure For A Living Kidney Donor
While the patient is unconscious and
pain-free (under general
anesthesia), an incision is made in
the side of the abdomen. The kidney
is removed and the incision is
closed. The traditional operation
requires a long incision. However,
improvements in technique use a
short incision (mini-nephrectomy) or
use laparoscopic techniques.
Procedure For The Kidney Recipient
While the patient is unconscious and
pain-free (under general
anesthesia), an incision is made in
the lower abdomen. The new kidney is
stitched into place within the
pelvis and the incision is closed.
Why the Procedure is Performed
A kidney transplant may be
recommended for patients with kidney
failure caused by:
* Severe, uncontrollable high blood
pressure
* Infections
* Diabetes
* Glomerulonephritis
A kidney transplant alone may NOT be
recommended for patients who have:
* Heart, lung, or liver disease
* Other life-threatening diseases
* Certain infections, such as TB or
osteomyelitis
* Difficulty taking medications
several times each day for the rest
of their lives
Risks
The risks for any anesthesia are:
* Reactions to medications
* Problems breathing
The risks for any surgery are:
* Bleeding
* Infection
Additional risks include:
* Infection due to the
immunosuppressive medications that
must be taken to prevent transplant
rejections
Outlook (Prognosis)
Kidney transplants generally offer
the best outlook for patients with
end-stage kidney disease. Most
centers have patient and organ
survivals of over 90% at one year,
and more than 80% at three years. By
10 to 15 years, about 50% of
transplanted kidneys are still
functional. Kidneys from living
related donors do better than from
deceased donors.
However, this success is not without
its costs. The patient's immune
system identifies the transplanted
kidney as a foreign organ and tries
to destroy it. This is called
rejection. In order to avoid
rejection, almost all kidney
transplant recipients require
life-long treatment with medications
that suppress their immune response
(immunosuppressive therapy).
This has several unwanted
consequences. Because the immune
system is suppressed, the patient
has a higher risk of infection and
cancer. This requires aggressive
cancer screening.
The immunosuppressive medicines
themselves have side effects, which
may include high blood pressure and
high cholesterol, increased risk of
diabetes, and other problems.
The success of a kidney transplant
depends in part on close follow-up
and meticulous adherence to the
medicine regimen.
For the donor, studies show that
living with one kidney following
surgery is relatively safe, with few
physical and psychological
complications.
Recovery
For a living donor, the recovery
period is 4-6 weeks. The patient
should avoid heavy activity during
this time. The sutures are removed
after a week or so.
The kidney recipient is usually
observed in the hospital for about a
week. After that, he or she requires
close follow-up in the transplant
clinic and frequent monitoring of
lab work.
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