A kidney transplant is an operation that replaces your kidney and places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, and you no longer need dialysis.
Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Living donation takes place when a living person donates an organ or part of an organ to someone in need of a transplant. The donor is most often a close family member, such as a parent, child, brother or sister. A donor can also be a more distant family member, spouse, friend or co-worker.
A number of diseases can directly damage the kidney. Damage to the kidney can seriously affect the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus.
If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life.
Understanding your Kidneys
The kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. They are about the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the body in several very important ways like:
Clean your blood and remove waste products
Balance water and salt to control fluid in the body
Control blood pressure
Help make red blood cells and strong bones
Control the amount of potassium, calcium, magnesium and phosphorus in the blood
When do you know you need a transplant?
The symptoms of kidney failure vary widely by cause of the kidney failure, severity of the condition, and the other body systems that are affected.
Most people have no symptoms at all in the early stages of the disease, because the kidneys are able to compensate so well for the early impairments in their function. Others have symptoms that are mild, subtle, or vague. Generally, obvious symptoms appear only when the condition has become severe or even critical.
Kidney failure is not painful, even when severe, although there may be pain from damage to other systems.
Some types of kidney failure cause fluid retention. However, severe dehydration (fluid deficiency) can also cause kidney failure.
Fluid retention - Puffiness, swelling of arms and legs, shortness of breath (due to fluid collection in the lungs, called pulmonary edema)
Dehydration - Thirst, rapid heart rate (tachycardia), dry mucous membranes (such as inside the mouth and nose), feeling weak or lethargic
Other common symptoms of kidney failure and end-stage renal disease include the following:
Urinating less than usual
Urinary problems - Frequency, urgency
Bleeding - Due to impaired clotting, from any site
Fatigue & Confusion
Loss of appétit
Pain - In the muscles, joints, flanks, chest
Bone pain or fractures
Pale skin (from anaemia)
Complications and Risks
The risks of kidney transplantation are the same as those of any surgery. There is the risk of bleeding, infection, or breathing problems. You also might experience some side effects from the medications, and you could be more prone to infections, since the medicine you will take after transplantation lowers your body's ability to fight infection.
There is also the risk of rejection. Since the body recognizes the new kidney as a foreign object, it will normally try to get rid of it or "reject" it. However, you are given medicine to prevent rejection. A rejection can happen while on anti-rejection drugs, especially during the first few months after surgery. Transplant rejection occurs when a transplanted organ or tissue is not accepted by the body of the transplant recipient. This is explained by the concept that the immune system of the recipient attacks the transplanted organ or tissue.
Immunosuppressant drugs are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the patient's life. The most common medication regimen today is a cocktail of tacrolimus, mycophenolate, and prednisone. Some patients may instead take cyclosporine, sirolimus, or azathioprine. Cyclosporine, considered a breakthrough immunosuppressive when first discovered in the 1980s, ironically causes nephrotoxicity and can result in iatrogenic damage to the newly transplanted kidney. Blood levels must be monitored closely and if the patient seems to have declining renal function, a biopsy may be necessary to determine whether this is due to rejection or cyclosporine intoxication.
Acute rejection occurs in 10–25% of people after transplant during the first sixty days. Rejection does not necessarily mean loss of the organ, but may require additional treatment and medication adjustments.
Problems after a transplant may include
Transplant rejection (hyperacute, acute or chronic)
Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection
Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants)
Imbalances in electrolytes including calcium and phosphate which can lead to bone problems amongst other things
Other side effects of medications including gastrointestinal inflammation and ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a male-pattern distribution), hair loss, obesity, acne, diabetes mellitus type 2, hypercholesterolemia, and others.
The average lifetime for a donated kidney is ten to fifteen years. When a transplant fails a patient may opt for a second transplant, and may have to return to dialysis for some intermediary time.