Kidney Transplant Surgery in India
Kidney transplant surgery is defined as a major surgical procedure that replaces a malfunctioning or diseased kidney with a healthy and functioning kidney sourced from another person (living or dead).
What is the aim of kidney transplant surgery?
Kidney transplants are required in patients suffering from severe kidney diseases, such as end-stage renal disease (ESRD) or chronic kidney failure. ESRD is a congenital (birth) condition which results in the affected kidney to malfunction. This disease removes the ability of the kidney to filter out toxins and other waste from the bloodstream and produce urine from it. It also affects the kidney’s function which allows maintaining an efficient level of chemicals in the body to function in a healthy manner.
An option for ESRD patients is to undergo regular and long-term dialysis or opt for a kidney transplant for an effective resolution.
Kidney transplant is one of the most common and major type of nephrological surgical procedures currently performed. The technique for this major organ transplant has been refined down the decades since its discovery. Today, with the help of advanced surgical and medical technology it has become increasingly efficient to perform kidney transplants.
How do the kidneys function in normal conditions?
Kidneys are small fist-sized bean-shaped organs that are located on each side in the lower abdomen. These are efficiently protected by the ribcage and the back muscles.
Kidneys are mainly responsible for filtering out toxins and waste material from the bloodstream. These are expelled from the body in the form of urine.
Apart from this, the kidneys are also helpful in maintaining the ideal chemical levels in the body to ensure its perfect functioning. The kidneys assist the body to regulate the blood pressure and for maintaining the production of red blood cells in the body, under normal conditions.
When one or both kidneys fail to perform their functions normally, it can result in severe complications, which can even be life-threatening at times. Kidney malfunctioning results in the harmful waste accumulating in the body which causes high blood pressure, increased retention of fluids, imbalance in level of salt and acids in the blood. This also affects the production of the red blood cells in the body.
All these disorders can result in damaging the heart and the brain if not addressed on time and in the appropriate manner.
What causes kidney failure?
Research estimates that almost 90,000 people in the US alone are affected with end-stage renal disease (ESRD) every year. Diabetes, high blood pressure and development of glomerulonephritis along with the inflammation seen in the kidney’s filtering parts are known causes of kidney failure. These have been found to be the causes of around 3/4th of all ESRD cases.
What are the signs and symptoms of kidney failure?
There are several symptoms that indicate towards renal (kidney) failure.
Initially, swelling in the face, hands and feet accompanied by headaches result from high blood pressure. Seizures are noticed in some cases as well.
The complexion may get paler due to anemia. The color of the urine may also change to darkish coffee-colored. Apart from constant bad breath the person affected by kidney failure also feels fatigue and experiences itchy skin.
How is kidney failure treated?
Dialysis is the most common treatment for end-stage kidney disease. This is an external process which helps to remove waste as well as excess water and chemicals – such as sodium, potassium, calcium, etc – from the body.
There are two types of dialysis:
Hemodialysis: In hemodialysis the patient is connected through an IV (intravenous) connection to a machine which acts as an artificial kidney. Hemodialysis is required to be done at least thrice a week and each session can last from 2 to 6 hours.
Peritoneal dialysis: In peritoneal dialysis, the patient is connected to an external machine through a tube which is inserted into the patient’s abdomen. It offers a similar cleansing function as hemodialysis.
Although hemodialysis and peritoneal dialysis may not cure kidney failure these are helpful to live a nearly normal life for longer.
Kidney transplant for kidney failure
Studies show that around 30% of all patients with kidney failure are suitable for a kidney transplant. This is aimed at replacing both malfunctioning kidneys with one healthy donated kidney.
Kidneys are sourced almost half the time from cadavers however the rest of the times, friends, family members and spouses are known to donate one healthy kidney after intensive testing.
A kidney transplant is normally attached in the lower abdomen without removing the malfunctioning and diseased kidneys. The artery of the donated healthy kidney is simply attached to the arteries in the patient’s pelvis. The vein of the new kidney is also connected to one of the veins in the patient’s pelvis. This connects the new kidney with the blood supply of the body.
After this, the surgeon attaches the kidney’s portion of the ureter into the ureter connected with the bladder. This helps to continue the supply of urine from the kidney to the bladder.
When an adult kidney is being transplanted in a child, the surgeon will connect the donor kidney’s blood vessel directly with the child’s aorta and inferior venal cava.
What is the outcome after a kidney transplant for treatment of kidney failure?
For the donor, a hospital stay for a couple of days to around 4 days is normally advised after the surgery. The length of incision for removing the kidney depends on the method used for it. For conventional removal method, the surgeon will need to make an incision into your side measuring around 8 inches in length. In case the surgeon uses minimally invasive laparoscopic methods to remove the donor kidney then the surgeon will need to make four small incisions, the largest being about 4 inches in length.
For the recipient, a catheter is normally attached to the bladder. An IV may also be attached in the arm or the neck for fluid intake for a few days following the kidney transplant surgery. The doctor will help you to regain mobility within 24 hours. The hospital stay required after this is normally between 5 to 7 days. The new kidney may take some time to generate urine properly. This will require a simple temporary dialysis process for remedying.
Studies show that over 90% of transplanted kidneys work perfectly for over a year. Around 3 to 5% of transplanted kidneys are known to stop working every year after that.
There is always the risk of organ rejection for transplanted kidneys. Hence it becomes important for the patient to take regular medications to avoid this situation. A kidney donated by a living donor is generally more successful at being transplanted and survives for longer as well.
Furthermore, the exact cause for the kidney failure will also decide the chances of the disease affecting the transplanted kidney. Generally, hereditary disorders do not affect the new kidney. However conditions such as focal segmental glomerulosclerosis, a rare disorder, may cause problem to the transplanted kidney.
What are the post-surgical after care instructions for kidney transplant procedure?
Both, the donor and the recipient, are likely to experience discomfort near the incision for a few days following surgery. Painkillers are usually prescribed to alleviate the pain. Severed nerves may result in numbness in or near the incision area.
Several anti-rejection immunosuppressive medications are prescribed in order to prevent the immune system from rejecting the transplanted kidney. The recipient of the donor kidney will have to be on immunosuppressant medication for their life time to use the new kidney. Antibodies using IV are normally required during rejection periods.
As the immunosuppressant medications weaken the immune system, there is a higher risk of infection in the body at this time. The patient is instructed to keep the incision and its surrounding area clean. The recipient is also advised to avoid people with cold and other diseases. Animal waste should also be avoided if the patient owns pets. Detailed instructions are provided by the team of experts who perform the complete kidney transplant procedure.
The recipient of the donor kidney will also be instructed to make necessary changes in their dietary habits. As several immunosuppressant medications are known to boost the appetite and retain excess protein and sodium, the calorie and salt intake of the recipient also needs to be strict.
Are there any risks associated with kidney transplant surgery?
As is seen in almost all major surgeries the kidney transplant surgery also carries certain risks of complications. This can result in problems for the donor and the recipient alike.
Potential complications may include:
Lymphocele (in around 20% transplant patients)
Urine leak (in almost 3% of transplant patients)