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Kidney Transplantation

The kidneys are a pair of bean shaped organs whose essential function is to remove excess fluids, minerals and waste products from the blood and regulate fluid levels. When kidneys become nonfunctional, harmful excretory products accumulate in the blood, and the body may retain excess fluid which could be threatening.

Kidney Disease and Indication for Transplant:

Kidney Diseases may be categorized into Acute Kidney Disease and Chronic Kidney Disease.

Acute Kidney Disease: AKD is a temporary, reversible kidney disease which can be corrected through medications and may take several weeks for the function to return to normal.

Chronic Kidney Disease: CKD refers to a permanent, irreversible loss of kidney function. The last stage (Stage-5) of a CKD is known as end stage renal disease (ESRD). Renal transplantation has become the treatment of choice for patients suffering from chronic irreversible kidney disease that has failed to respond to other medications or surgical treatments.

Non-Functional Kidneys Can Be Treated By One of The Following Three Procedures:

  • Haemodialysis
  • Peritoneal Dialysis
  • Kidney Transplant

What is Kidney Transplantation?

Kidney transplant also known as renal transplant is a surgical procedure that involves removal of the defective kidney and its replacement with a healthy functional one.

Classifying Kidney Transplantation

Kidney transplantation has been classified into two categories based on the source of the donor organ.

Cadaveric Donor: In this case the kidney of a deceased person is used in transplantation. Cadaveric Donors can be further categorized into two groups namely:

  • Brain-Dead (BD) Donors:
  • Donation After Cardiac Death (DCD) Donors

Living Donor: In this case the kidney of a living person is used in transplantation. Living donors may be the classified into:

  • Living-blood Related: Siblings, parents, aunts, uncles, children over age 18, cousins or grandparents
  • Emotionally Related: Friends, relatives, spouses, in-laws
  • Altruistic Donors: Anonymous donors who voluntarily donate a kidney as an act of philanthropy

Among all types of kidney donors, living blood related donors are regarded as the best option as there is a greater possibility of matching due to genetic factors.

Matching and Compatibility:

Three tests are conducted to evaluate the eligibility of a suitable kidney donor for transplantation.

Blood and Tissue Types

For a kidney transplantation to take place, the donor blood type must be compatible with the recipient. A, B, AB or O are the four blood types. The same rules apply for transplantation and blood transfusion. Blood type O is considered the universal donor; they can give blood/organ to any other blood type. AB is regarded as the universal recipient; they can receive an organ or blood from people with any blood type.

HLA Typing/ Tissue Typing:

HLA or human leukocyte antigens are proteins on the cells in the body. Of the 100 different antigens have been identified, six antigens are very important in organ transplantation. Of these six antigens, we inherit three from each parent.Since the HLA type is inherited, related living donors have maximum likelihoodof compatibility.

Cross match Test:

This is an important test where blood from the donor and recipient blood is mixed. If there occurs a reaction between the recipient’s cells and the donor cells, the cross match is considered positive, which indicates that the recipient generates antibodies “against” the donor’s cells. If no such reaction occur the cross match is negative, the pair is considered compatible.

The Transplantation Process:

A kidney transplant is done under general anesthesia. A long incision (cut) is made in the abdomen and the donor kidney is positioned on the lower right or left side of the abdomen. Donor’s right kidney is placed on the recipients left side and vice versa as this position allows it to be easily connected to blood vessels and the bladder. The veins and arteries of the new kidney are surgically connected to the renal artery and veins. The new kidney’s ureter is attached to the bladder.

The nonfunctional kidney will not be removed unless they are causing any complications. In such case, the kidney will be removed during the transplantation.

Advantages of Transplantation:

  • It improves the quality of life
  • Fewer dietary restrictions
  • Freedom from regular dialysis

Risks and Complications of Transplant: Kidney transplantation is associated with certain risks and complications.

Practical Complications: Complications that tend to occur immediately post surgery such as:

  • Blood clots in the blood vessels to the kidney
  • Bleeding
  • Blockage of urinary drainage from the kidney to the bladder
  • Urine leak

Risk of Rejection: Rejection happens when the body recognizes the transplanted kidney as foreign and attacks it. To prevent rejection the patient is kept on immunosuppressant medications which will suppress the immune systemand as a consequence, will decrease the chances of rejection.

Infection: Immunosuppressant medications suppress the defense system so as to prevent organ rejection. However they also decrease the body’s ability to fight diseases thereby increasing the risk of infection. Infection risk is maximum during the early period post- transplantation when dosages of medications are at their highest. Thus it becomes important to protect the patient from exposure to infection.

Malignancy: Kidney Transplant patients have a higher risk of cancer; skin cancer being the most common type.

Donor Risk Factors: Though donor organs are screened for various diseases prior to transplantation, transplant recipients may be ata risk for contracting certain diseases from the organ donor, such as infectious diseases and cancers that were not detected during screening process.

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