Kidneys cleanse the blood of waste and remove excess fluid from the body in the form of urine. The human body can function properly with one kidney also. The decline in the normal working of kidneys is called Kidney Failure. The major cause of kidney failure in India is diabetes followed by high blood pressure. Patients with non-functioning kidneys must filter body waste from their blood mechanically through a process of dialysis. Dialysis must be done periodically and therefore is time taking and labour-intensive. The other option is to opt for a kidney transplant.
A kidney transplant is a surgical procedure to replace a kidney that isn’t functioning properly with a healthy kidney from a donor that is living or deceased. In India, looking for the best kidney hospital in Bangalore, Mumbai, or Delhi is a good idea as these cities provide cost effective treatments.
Before the surgery, a very intensive evaluation is carried out. Firstly physical examination is carried out to see whether the patient and donor are in good health to undergo surgery. The donor should not be suffering from morbid obesity, diabetes, hypertension, kidney disease or a history of cancer or any other disease. Then the patient and the donor must go through several tests and be screened carefully for positive outcomes. Blood tests determine the blood group and HLA (human leukocyte antigen). HLA is a group of six antigens (we get three each from our biological parents). The more antigens from HLA match between patient and donor, the greater chance of a successful transplant. This is followed by the antibody test where a small sample of blood of the donor and receiver are mixed. If the patient’s blood does not create antibodies against donor blood it is called negative crossmatch and then only can the transplant proceed.
There are two types of procedures for a kidney transplant-
- Deceased-donor kidney transplant- The donor kidney must come from either brain dead (BD) donor or a donation after cardiac death (DCD) donor. The donor or his family has chosen to donate the organ. The kidney is stored in ice after being flushed with a storage solution and an anti-coagulation agent.
2 . Living-donor kidney transplant- the donor kidney must come from a living person with their consent. The person might be family, relatives, or friends. There is a greater chance of finding a match for a transplant in the family. The donor’s kidney is either removed from the body through laparoscopy or open surgery. Laparoscopic removal of the kidney is more efficient as it is less invasive than open surgery. In laparoscopy, small incisions are made in the abdomen and a camera and surgical tool, mounted on a thin rod, are inserted inside. The major veins and arteries around the kidney are clipped and the tissue is carefully separated from the kidney. Another small incision is made through which the kidney is then taken out. The kidney is cooled down and taken to be transplanted. The donor’s recovery is less painful and faster in this procedure.
The nephrologist puts the patient under general anaesthesia before the transplant surgery. An incision is made in the abdomen and the healthy kidney is placed in the pelvic region of the abdomen. The major veins and arteries are cut from the non-functioning kidney and attached to the healthy kidney so that the blood can pass through it. The ureter, a tube connecting the bladder to the kidney, is also cut from the non-functioning kidney and attached to the healthy kidney. Therefore, urine can pass from the healthy kidney to the bladder. The surgeon will leave the original kidneys inside the body unless they are causing any problems. The surgeon will close the incision in the end. The recovery takes a lot of time. Most patients have discomfort in urination and pain around the incisions. The patient will be put on a course of immunosuppressive drugs so that the body doesn’t reject the new organ. Even after discharge, the patient must be very careful and go to follow-ups for evaluation.
Risks & Complications
The major risks and complications after the kidney transplant surgery are-
- Post-surgery infection- infections such as urinary tract infections, fever and pneumonia are very common.
- Blood clots- blood clots may block the arteries and the ureter just after surgery or even after months. These complications can be dealt with medicines but in some cases, surgery might be needed.
- Acute rejection- the body might try to reject the new organ despite the use of immunosuppressors.
- Complications due to immunosuppressors- due to the use of immunosuppressors such as increased risk of infections, diabetes and high blood pressure, thinning of bones, diarrhoea, loss of hair, swelling of gums and weight gain.