Kidney Transplantation

Renal transplantation is the alternative name for kidney transplantation. Kidney transplantation is usually carried out when the patient is in the last stage of renal disease. The classification of the kidney transplantation is done as cadaveric (diseased donor) or living donor, according to the recipient's organ source. Living donor is further divide into living related (genetically related) or living unrelated (non-related) transplants, which depends on the existence of the biological relationship between the donor and the recipient.

Need

When the patient is at the end stage of kidney disease and the glomerular filtration rate is reduced to 20-25% of normal functioning, then it is the indication for kidney transplant. Infectious diabetes mellitus, malignant hypertension, glomerulonephotis are some of the common causes of end stage renal disease. The genetic causes of end stage renal disease are autoimmune conditions including lupus and Good pasture's syndrome as well as a number of inborn errors of metabolism. Many patients at the time of transplantation are under some form of dialysis such as peritoneal, hemodialysis or the similar process of hemofiltration. In case of the chronic renal failure, individuals prefer transplantation before dialysis.
If a patient has active substance abuse, recent cancer, or failure to adhere to prescribed medical regimens then he or she may not be able for transplant. A patient is at a higher risk of surgical complications if he has morbid obesity or concurrent tobacco use.

Sources

It is not necessary to have the genetically similarity of the donor with the recipient. There are two types of the deceased donor as brain dead donor and cardiac death donors. Donor and recipient should have the ABO blood group and HLA factor computability.

Procedure

In most of the cases, the less functioning original kidneys are not removed and the transplanted kidney is placed often in the iliac fossa. Hence, it requires a separate blood supply renal artery of the kidney which branches from donor's abdominal aorta and connected to the recipient's external iliac artery. New kidney's renal vein, formerly draining to the inferior vena cava in donor, is connected to the recipient's external iliac vein.
The entire process takes almost three hours for completion. After the completion of process, the blood flow is allowed to flow through the kidney so as to minimize the ischemia time. In most of the cases, urine formation occurs soon. Finally the ureter is connected to the bladder.
Living donor's kidney takes 3-5 days for normal functioning. Cadaveric donor's kidney takes the time of 7-15 days for proper functioning. The patient may have to stay in the hospital stay for 4-7 days. The medications are recommended to help the kidney to produce the urine, if complications arise. The medicines for the suppression of the immune system to accept the new kidney needs to be taken for the rest of life.

Result

Transplant in young age increases the life of a patient to 10 to 15 years or more than dialysis. There are fewer complications. If the patient is on dialysis for a long time before transplantation, then the life extension is less.

Consideration

  • Rejection of transplant
  • Sepsis and infection of the immunosuppressant drugs
  • Post-transplant lymphoproliferative disorder
  • Electrolytic imbalance including phosphate and calcium leading to bone problems
  • Medications have side effects including ulceration of stomach and esophagus, and gastrointestinal inflammation, obesity, hair loss, hypercholesterolemia and others.
  • The donor kidney's average life time is 10 to 15 years so it needs second transplantation or for some time do dialysis again.