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Kidney Transplant Treatment India

Definition

Kidney transplantation is a surgical procedure to remove a healthy, functioning kidney from a living or brain-dead donor and implant it into a patient with nonfunctioning kidneys.

Purpose

Kidney transplantation is performed on patients with chronic kidney failure, or end-stage renal disease (ESRD). ESRD occurs when a disease, disorder, or congenital condition damages the kidneys so that they are no longer capable of adequately removing fluids and wastes from the body or of maintaining the proper level of certain kidney-regulated chemicals in the bloodstream. Without long-term dialysis or a kidney transplant, ESRD is fatal.

Diagnosis/Preparation

Patients with chronic renal disease who need a transplant and do not have a living donor registered with United Network for Organ Sharing (UNOS) to be placed on a waiting list for a cadaver kidney transplant. UNOS is a non-profit organization that is under contract with the federal government to administer the Organ Procurement and Transplant Network (OPTN) and the national Scientific Registry of Transplant Recipients (SRTR).

Kidney allocation is based on a mathematical formula that awards points for factors that can affect a successful transplant, such as time spent on the transplant list, the patient's health status, and age. The most important part of the equation is that the kidney be compatible with the patient's body. A human kidney has a set of six antigens, substances that stimulate the production of antibodies. (Antibodies then attach to cells they recognize as foreign and attack them.) Donors are tissue matched for 0–6 of the antigens, and compatibility is determined by the number and strength of those matched pairs. Blood type matching is also important. Patients with a living donor who is a close relative have the best chance of a close match.

Before being placed on the transplant list, potential kidney recipients must undergo a comprehensive physical evaluation. In addition to the compatibility testing, radiological tests, urine tests, and a psychological evaluation will be performed. A panel of reactive antibody (PRA) is performed by mixing the patient's serum (white blood cells) with serum from a panel of 60 randomly selected donors. The patient's PRA sensitivity is determined by how many of these random samples his or her serum reacts with; for example, a reaction to the antibodies of six of the samples would mean a PRA of 10%. High reactivity (also called sensitization) means that the recipient would likely reject a transplant from the donor. The more reactions, the higher the PRA and the lower the chances of an overall match from the general population. Patients with a high PRA face a much longer waiting period for a suitable kidney match.

Potential living kidney donors also undergo a complete medical history and physical examination to evaluate their suitability for donation. Extensive blood tests are performed on both donor and recipient. The blood samples are used to tissue type for antigen matches, and confirm that blood types are compatible. A PRA is performed to ensure that the recipient antibodies will not have a negative reaction to the donor antigens. If a reaction does occur, there are some treatment protocols that can be attempted to reduce reactivity, including immunosuppresant drugs and plasmapheresis (a blood filtration therapy).

The donor's kidney function will be evaluated with a urine test as well. In some cases, a special dye that shows up on x rays is injected into an artery, and x rays are taken to show the blood supply of the donor kidney (a procedure called an arteriogram).

Once compatibility is confirmed and the physical preparations for kidney transplantation are complete, both donor and recipient may undergo a psychological or psychiatric evaluation to ensure that they are emotionally prepared for the transplant procedure and aftercare regimen.

Aftercare

A typical hospital stay for a transplant recipient is about five days. Both kidney donors and recipients will experience some discomfort in the area of the incision after surgery. Pain relievers are administered following the transplant operation. Patients may also experience numbness, caused by severed nerves, near or on the incision.

A regimen of immunosuppressive, or anti-rejection, medication is prescribed to prevent the body's immune system from rejecting the new kidney. Common immunosuppressants include cyclosporine, prednisone, tacrolimus, mycophenolate mofetil, sirolimus, baxsiliximab, daclizumab, and azathioprine. The kidney recipient will be required to take a course of immunosuppressant drugs for the lifespan of the new kidney. Intravenous antibodies may also be administered after transplant surgeryand during rejection episodes.

Because the patient's immune system is suppressed, he or she is at an increased risk for infection. The incision area should be kept clean, and the transplant recipient should avoid contact with people who have colds, viruses, or similar illnesses. If the patient has pets, he or she should not handle animal waste. The transplant team will provide detailed instructions on what should be avoided post-transplant. After recovery, the patient will still have to be vigilant about exposure to viruses and other environmental dangers.

Transplant recipients may need to adjust their dietary habits. Certain immunosuppressive medications cause increased appetite or sodium and protein retention, and the patient may have to adjust his or her intake of calories, salt, and protein to compensate.

Risks

As with any surgical procedure, the kidney transplantation procedure carries some risk for both a living donor and a graft recipient. Possible complications include infection and bleeding (hemorrhage). A lymphocele, a pool of lymphatic fluid around the kidney that is generated by lymphatic vessels damaged in surgery, occurs in up to 20% of transplant patients and can obstruct urine flow and/or blood flow to the kidney if not diagnosed and drained promptly. Less common is a urine leak outside of the bladder, which occurs in approximately 3% of kidney transplants when the ureter suffers damage during the procedure. This problem is usually correctable with follow-up surgery.

A transplanted kidney may be rejected by the patient. Rejection occurs when the patient's immune system recognizes the new kidney as a foreign body and attacks the kidney. It may occur soon after transplantation, or several months or years after the procedure has taken place. Rejection episodes are not uncommon in the first weeks after transplantation surgery, and are treated with high-dose injections of immunosuppressant drugs. If a rejection episode cannot be reversed and kidney failure continues, the patient will typically go back on dialysis. Another transplant procedure can be attempted at a later date if another kidney becomes available.

The biggest risk to the recovering transplant recipient is not from the operation or the kidney itself, but from the immunosuppressive medication he or she must take. Because these drugs suppress the immune system, the patient is susceptible to infections such as cytomegalovirus (CMV) and varicella (chickenpox). Other medications that fight viral and bacterial infections can offset this risk to a degree. The immunosuppressants can also cause a host of possible side effects, from high blood pressure to osteoporosis. Prescription and dosage adjustments can lessen side effects for some patients.

Normal results

The new kidney may start functioning immediately, or may take several weeks to begin producing urine. Living donor kidneys are more likely to begin functioning earlier than cadaver kidneys, which frequently suffer some reversible damage during the kidney transplant and storage procedure. Patients may have to undergo dialysis for several weeks while their new kidney establishes an acceptable level of functioning.

Studies have shown that after they recover from surgery, kidney donors typically have no long-term complications from the loss of one kidney, and their remaining kidney will increase its functioning to compensate for the loss of the other.

Alternatives

Patients who develop chronic kidney failure must either go on dialysis treatment or receive a kidney transplant to survive.

Why Go to India for Kidney Transplant Surgery? 

More than 12,000 kidney transplants are performed each year in India. In the last 35 years, this area of medicine has seen amazing advances. More and more patients from Europe, US and other affluent nations with high Medicare costs look for effective options. India offers world-class healthcare that costs substantially less than those in developed countries, using the same technology delivered by competent specialists attaining similar success rates.

Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. The idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. Here you can enjoy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is like rejuvenation and cleans up process on all levels - physical, mental and emotional.

Many people from the developed world come to India for the rejuvenation promised by yoga and Ayurveda massage, but few consider it a destination for hip replacement or brain surgery. However, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US.

Frequently Asked Questions: 

What are the risk factors for kidney failure?

Any number of risk factors can contribute to kidney failure including high blood pressure, hardening of the arteries and diabetes. It can be brought on by untreated strep infections, recurrent and chronic kidney infections, systemic lupus erythematosus, severe forms of diarrhea, kidney stones or even chronic use of non-steroidal anti-inflammatory drugs.

I'd like to donate one of my kidneys to my brother but our blood types are not identical. Does it matter?

No. Blood types do not have to be identical, just compatible. Markers or "antigens" on the surfaces of your red blood cells determine your type. 

ABO blood group incompatibility between the donor and recipient can provoke an immediate rejection. This means that a donor with "O" blood type can donate a kidney to a patient who has "O," "A," "B" or "AB" blood type and that transplant candidates with "A" or "B" blood types are usually limited to kidney transplants from donors with the same blood type or "O" blood type.

Antibodies, proteins manufactured by the immune system that react specifically to donor tissue. A "negative cross-match" or lack of reaction when blood samples from a donor and recipient are test tube mixed confirms when a kidney is acceptable.

How long will I have to wait for a kidney transplant if I do not have a living donor?

The waiting period for a deceased donor kidney varies from patient to patient, depending most on patient blood group and degree of antibodies in the blood. Since there are not enough deceased donor organs for every person who needs a transplant, potential recipients are placed on a national list, administered by the United Network for Organ Sharing (UNOS), a private nonprofit organization contracted by the federal government.

Each time an organ becomes available, a recipient is chosen based on a point system reflecting blood type, waiting time, tissue match and antibody levels. Although some people receive their organ within several months, the median delay is two to three years. In contrast, a living-donor transplant can be scheduled immediately, thus making it an optimal choice.

My father had autosomal dominant polycystic kidney disease. What is the chance that I will have the same disease?

The chance that you have inherited this condition is about 50 percent. Autosomal dominant polycystic kidney disease should not be confused with multiple simple cysts of the kidneys, which occur commonly with age. Instead, this disease results in a build-up of benign growths that gradually increase in size until they destroy the normal tissue of both kidneys.

Symptoms like abdominal swelling, pain, bloody urine and frequent urinary tract infections may occur at any time but they usually begin in middle age. High blood pressure and renal failure may result as the disease progresses. Although there is no effective treatment to preserve kidney function in patients with autosomal dominant polycystic kidney disease, dialysis or a kidney transplant can be used to treat the kidney failure.