kidney faqs

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.

Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This one new kidney takes over the work of your two failed kidneys.

There are two types of kidney transplants: those that come from living donors and those that come from non-living donors who have just died (cadaveric or diseased donors). A living donor may be someone in your immediate or extended family or your spouse or close friend.

Transplantation isn't for everyone. Your doctor will want to see whether you're healthy enough for surgery. Cancer, a serious infection, or significant cardiovascular disease would make transplantation dangerous or unlikely to succeed. In addition, the medical team will want to make sure that you can understand and follow the schedule for taking medicines.

If a family member or friend wants to donate a kidney, he or she will need to be evaluated for general health and to see whether the kidney is a good match.

Suitability is initially based on the following factors:

  • Blood type. Your blood type (A, B, AB, or O) must be compatible with the donor's blood type.
  • HLA Typing. HLA stands for Human Leukocyte Antigen, a genetic marker located on the surface of your white blood cells. You inherit a set of three antigens from your mother and three from your father. A higher number of matching antigens increases the chance that your kidney will last for a long time. HLA typing or DNA fingerprinting is legally required some time to establish a relationship between the donor and recipients.
  • Tissue cross-match. Your immune system may produce antibodies that act specifically against something in the donor's tissues. To see whether this is the case, a small sample of your blood will be mixed with a small sample of the donor's blood in a tube. If no reaction occurs, you should be able to accept the kidney. Your transplant team might use the term “negative cross-match” to describe this lack of reaction.

If you don’t have a family member who has a compatible blood group, you have one of these three options:

1) A paired kidney exchange, also known as a “kidney swap” occurs when a living kidney donor is incompatible with the recipient, and also exchanges kidneys with another donor/recipient pair. This kidney paired donation transplant enables two incompatible recipients to receive healthy, more compatible kidneys. All medically eligible donor/recipient pairs may participate in the paired kidney exchange program.

2) You can also go for the ABO incompatible kidney transplantation. Usually one has naturally occurring antibodies against blood group antigens carried by the donor which lead to immediate graft failure once kidney from the ABO incompatible donor is placed in the patient’s body. With improvement in the medical technology, it has become possible to remove and suppress production of these antibodies with plasma-filtration, a procedure similar to Hemodialysis, and do the transplantation once antibodies concentration is below a critical level. This involves blood testing, medications and treatments in addition to the standard kidney transplantation, and close follow-up after transplantation. This is done in many centres in India now and results are as good as the normal living donor kidney transplantation.

3) You can also get yourself registered on the transplant program's waiting list to receive a kidney from a deceased donor. While you're on the waiting list, notify the transplant center of changes in your health. Also, let the transplant center know if you move or change telephone numbers. The center will need to find you immediately when a kidney becomes available.

If you have a living donor, you'll schedule the operation in advance. You and your donor will be operated on at the same time, usually in side-by-side rooms. One team of surgeons will perform the nephrectomy-that is, the removal of the kidney from the donor-while another prepares the recipient for placement of the donated kidney.

The operation is different depending on whether it is done by "open or by laparoscopy." In either case, an incision is made into the person's side, the blood vessels to the kidney are tied off, and the ureter (tube from the kidney to the bladder) is tied off and the kidney is taken out. Typically patients recover from laparoscopic surgery within a week and from the open surgery within a couple of weeks.

You'll be given a general anesthetic to make you sleep during the operation, which usually takes 3 or 4 hours. The surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. The ureter from the new kidney will be connected to your bladder. Your blood flows through the new kidney, which makes urine, just like your own kidneys did when they were healthy. Unless they are causing infection or high blood pressure, your own kidneys are not removed.

Often, the new kidney will start making urine as soon as your blood starts flowing through it, but sometimes a few weeks pass before it starts working.

As after any major surgery, you'll probably feel some pain when you wake up. However, many transplant recipients report feeling much better immediately after surgery. Even if you wake up feeling great, you'll need to stay in the hospital for about a week to recover from surgery, and longer if you have any complications.

There is a very small risk of serious injury related to the donation surgery itself (1 in 3 to 10,000). Patients who have donated a kidney may have pain for a period of time. This is less of a problem with a new technique being developed to remove donor kidneys by laparoscopy (a method similar to the new way of doing gallbladder surgery through a very small incision). The long-term risks to being a kidney donor are very small indeed.

The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as viruses and bacteria. This defense system may recognize transplanted kidney as "foreign" and act to combat this "foreign invader" and reject it.

To keep your body from rejecting it, you'll have to take drugs that suppress your immune response. Most patients need to take three types of these immunosuppressant medicines. The major one is usually Cyclosporine A or Tacrolimus. In addition, you will most likely be taking a steroid and a third medication, such as mycophenolate mofetil, azathioprine or rapamycin. You may have to take more medications to treat other health problems. Your health care team will help you learn what each pill is for and when to take it. Be sure that you understand the instructions for taking your medicines before you leave the hospital.

Regular checkups at your transplant center will ensure early detection and treatment of rejection. You can help prevent rejection by taking your medicines regularly, but it is important to watch for signs of rejection-like fever or pain in the area of the new kidney or a change in the amount of urine you make. Report any such changes to your health care team. Additional treatment may be needed if a rejection episode occurs.

With current treatment for kidney transplants, early rejection is now down to about 15 percent. Most of these people will not lose the kidney from rejection. In the longer term, what is called chronic rejection, can cause the loss of about half of kidneys during a patients lifetime. Even if you do everything you're supposed to do, your body may still reject the new kidney and you may need to go back on dialysis.

Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include new onset of diabetes, weight gain, cataracts, bone disease and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.

Since the 1950s, when the first kidney transplants were performed, much has been learned about how to prevent rejection and minimize the side effects of medicines. Results of transplantation are improving steadily with research advances. On average, 50% kidney transplants last somewhere between 10 and 12 years. Some may fail shortly after transplant; some may go on for the life of the recipient. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients.

Kidney transplantation is not a cure; it's an ongoing treatment that requires you to take medicines for the rest of your life. You should inform yourself fully by reading and talking to doctors, nurses and patients who already have kidney transplants. If you would like more information, please contact us.