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KIDNEY TRANSPLANT

Why is a Kidney Transplant performed ?

Kidney transplants are given to people who are being treated with an artificial kidney (dialysis) for severe chronic kidney failure. It is also done in patients with chronic kidney failure, who are expected to require dialysis within the next few months. Having a transplant usually means that dialysis will no longer be necessary.

Preparations needed for a Kidney Transplant

Once accepted for transplantation, blood is taken to find out your blood group and tissue type. Tissue typing is a special test which is done on a sample of blood. This allows the transplant team to find a kidney which has a tissue type closest to that of the patient. The closer the match of the tissue types, the less likelihood there is of the kidney being rejected . Depending on the particular tissue type, it can take many months, and sometimes years, before a suitable kidney can be found. Once the correct kidney is identified, a special blood test is done to make sure that the patient's blood does not react badly with cells from the donor (the person from whom the kidney has come). If this test is negative, it is possible to go ahead with the transplant. Patients must be prepared for about 3 months off work.

What Happens during a a Kidney Transplant

Under a general anaesthetic, the new kidney is put into place, just above the groin. The artery to the kidney is sewn on to one of the lower abdominal arteries. The vein coming from the kidney is sewn on to one of the veins in the lower abdomen. The ureter which drains away urine is sewn into the wall of the bladder. Your own kidneys are not removed. A catheter is placed in the bladder and remains for 7 to 10 days until the bladder is healed. Sometimes the new kidney starts working at once. A lot of urine is passed. In a few patients, urine is not passed for some days, and occasionally not for some weeks: dialysis will continue to be needed during this time. Special drugs that suppress the so-called immune system are needed as soon as the kidney is put into place. These drugs aim to prevent the body from rejecting the new kidney. The drugs used are steroid (cortisone-like) drugs like prednisolone, together with azathioprine and cyclosporin. These drugs are taken as tablets once or twice a day. Some transplant centres use an additional drug, ATG, which has to be given directly into a large vein, usually in the neck. If the transplant is successful, with no complications, then the stay in hospital may be as short as 10 days. If there are problems the hospital stay may be several weeks.

Possible Complications during a Kidney Transplant

Acute rejection can occur any time from 6 days onwards. The diagnosis is made by a drop in the output of urine and a deterioration of kidney function. There may be fever and pain over the kidney area. Special kidney tests can be done to confirm the rejection. It can be treated by higher dose steroids or ATG. Most rejections get better on this treatment. If not, the kidney will need to be removed. Drugs that help prevent rejection of the kidney also suppress the immune system. Accordingly, infections occur more easily. Any fever needs to be regarded with concern. Infections continue to be a risk, but much less so as the years go by. Side-effects from the steroids may occur, but these are less often seen with modern low-dose regimes. The commonest are overweight, a tendency to diabetes, raised blood pressure and easy bruising. Azathioprine reduces the white blood cell count so that infections are more likely to occur. Cyclosporin can increase hair growth and cause hands to tremble. The major problem with cyclosporin, however, is that if the dose is too high, then the drug itself can damage the kidney. Blood levels of cyclosporin therefore need to be carefully watched and the dose adjusted accordingly. Chronic rejection can occur from a few months until many years after transplant. It is a gradual process, with slow loss of kidney function. There is no treatment. Eventually when the kidney stops working, dialysis will need to be restarted, or another transplant performed. Heart attacks are a major problem with long-term transplants. This is partly due to steroid treatment and the raised blood pressure caused by steroids and cyclosporin.

After a Kidney Transplant

Upon waking up after the operation, a catheter will be in the bladder and a drip line in the neck. The catheter will remain for 7 to 10 days, the line in the neck will remain for as long as fluids or drugs (such as ATG) need to be given. Sometimes this line is also used for haemodialysis. Dialysis is needed until the new kidney starts to work, and blood tests are done daily to check the progress. Special tests such as ultrasound or renogram will be done two to three times a week. A biopsy is only taken if rejection is suspected. This involves a needle sample of the kidney which is examined under a microscope. You should be able to get out of bed on the day after the transplant. Once home, visits to the hospital are needed for regular blood tests and review by the doctor. Initially this will be two to three times a week, then less often. People who have had their kidneys for over 5 years may need to visit only once or twice a year. Immunosuppressive drugs are needed as long as the kidney continues to work, although the doses are slowly reduced with time. Most people feel considerably better after a transplant, however well they felt on dialysis. Women find that their periods return, and that they are fertile. Ask about contraception, since it is sensible not to get pregnant for the first year. Provided that kidney function is normal, there is no risk in having a baby. There is no increased risk of congenital abnormalities. Success rates with kidney transplants are very good. The chance of having a functioning kidney at one year is 80 to 90% for a first kidney. After a failed transplant, there is no reason why a second or even third transplant cannot be performed. However, the chance of success does get less.

If a Kidney Transplant is not performed

Dialysis would continue to be needed.