Kidney Transplant

Kidney Transplant Doctor in Delhi

Patients of End Stage Renal Disease are best managed by Renal Transplantation.

Benefits of Kidney Transplantation

The benefits of Renal Transplant over keeping the patient on Hemodialysis are many:

Criteria for Donors:

• Normal lifestyle
• Freedom from Dialysis
• Higher energy levels and good nutritional status
• Cost Effective in long term.

Transplant Costs

The first step before surgery is review of patient’s insurance certificate by financial counsellors. Our financial counsellors and coordinators advise patients after thoroughly reviewing their insurance certificate. It is quite important before patient’s evaluation. You can find transplant benefits in insurance plans offered by many insurance companies. We are here to help patient understand their insurance and all the rules and regulations with help of our finance team. Much of the cost of kidney transplantation is covered by Medicare and private insurance plans.

Selection criteria for kidney transplant recipients include the following:

Who can have a kidney transplant?

Kidney transplant is done in patients who have existing end-stage renal disease or can have end-stage renal disease in near future i.e. their kidney can fail in near future. There are few criteria to be fulfilled before kidney transplant.

• Patients should not have any malignancies
• There should not be any active infection
• Patient’s urological abnormalities should be treatable or urological functions must be unharmed
• Patient should not indulge in alcohol, drugs or smoking
• Heart and lung of the patient should be consistent so that they can easily cope with kidney transplant surgery
• Patient should be able to go by all the transplant protocols. He should also be fit enough to have medication required without having any other problem.
• The body weight of the patient is another important factor, it should fall in acceptable range of weight

Every potential candidate is considered on an individual basis. A number of radiological, blood and urine tests are done and these are evaluated by the urologist and nephrologists.

Kidney Transplant—Living Donors

Because of the increasing shortage of available deceased donor organs and the resulting long wait times, many kidney transplant candidates choose living donor transplantation as an option.

All of us are born with two kidneys. After donating a kidney, having only one kidney does not mean that a person cannot live a normal life. One kidney is sufficient to lead a healthy life. He can easily do normal day activities and live a long life with one healthy kidney as in case of failure of one kidney or removal of one kidney for donation the other kidney starts working on its place too, i.e. it does work for both the kidneys.

There is no evident proof of decreased kidney function in persons who have donated kidneys. Many long term researches and studies have been done in this field, but there is no evidence that donor suffers any decline in their normal kidney function. Though a regular medical check-up say annual check-up is advised for donor. It will give them a regular monitoring over their kidney function and changes in blood pressure. 

Who Can Be A Living Donors?:

• Near Relatives such as brothers, sisters, children, husband or wife and parents. Children should be over 18 years of age.
• Swap Transplants

• Unrelated Transplant- this is done only in cases where no near relative is available for donation or their kidney does not match. This requires a recommendation from state authorization committee.

Blood and Tissue Types

Blood types are either A, B, AB or O.

A table of compatible blood types is listed below.

Living donors can also donate their kidney through swap donation. It is used when a donor’s blood type does not match with the recipient’s blood type. In such cases two incompatible donor kidneys are swapped with each other if they are compatible to recipient of each other. 

In case of incompatible donor kidney ABO Incompatible Transplant is also done. In this process recipient is treated to accept the other blood type i.e. the blood type of donor’s kidney. 

To check compatibility of donor’s kidney with the recipient the blood type of both is checked. Another test to check compatibility is to check tissue typing or white blood cell/lymphocyte or HLA type. HLA type is generally match in blood relatives as it is inherited. Thus blood relatives are first preference for kidney donation as they are more like to have a kidney compatible with recipient. 

Other tests done before kidney transplant include DTPA Renal scan & CT Angiography of donors. Doctors prefer donor kidneys which have Lesser GFR (Function). Other important factor to consider is vascular anatomy of kidney. Donor kidneys with less complex vascular anatomy are ideal for transplant. 

However in HLA incompatible patients it is possible to do transplant with some immunosuppression & immunofilteration protocols so called as – HLA Incompatible Transplant.

Benefits of Living Donor Kidney Transplantation:

• Higher success rates
• Shorter waiting time
• Ability to schedule—Living donation allows patients to schedule a surgery time that is convenient for the patient and donor.
• Avoidance of dialysis—early referral may allow for transplant prior to initiation of dialysis therapy Premptive Transplant

Criteria for Donors:

• Age between 18 and 65 yrs.
• Normal renal function with two kidneys
• Free of active infections
• Free of malignancies for at least 2 years (history is evaluated individually) with exception of primary brain solid tumors in whom  kidneys can be taken anytime for donation.
• No history of diabetes.
• No active/untreated substance abuse.
• Excellent physical and mental health.

Criteria for selecting which  kidney to be used for Kidney Donation: Right or Left

Other tests done before kidney transplant include DTPA Renal scan & CT Angiography of donors. Doctors prefer donor kidneys which have Lesser GFR (Function). Other important factor to consider is vascular anatomy of kidney. Donor kidneys with less complex vascular anatomy are ideal for transplant. 

Your surgeon can use open or Laparoscopic operation to extract donor kidney. He will decide which process to use after considering surgical history of donor and complexity of vascular anatomy. Usually open operation is used for right sided donor nephrectomy due to technical reasons. It is done if there is a need of IVC Cuff Endostaplers.

The living donor is thoroughly checked and evaluated before the kidney donation. His or her medical and surgical history is checked in detail. Then he or she undergoes thorough physical examinations and series of tests such as blood tests, imaging, and other tests which gives a clear picture of his overall physical health. A donor must be free of any health complications or conditions such as heart disease, liver problems or any other such health concerns. Female donors also undergo gynaecological examination. Other tests include CT Angiography and a detail evaluation of mental health.

In case of any problem donors need to undergo more detailed testing to find out extent of the problem. When a donor is find fully fit and free from any health complications, then he is considered for kidney donation. After that he or she undergoes testing for compatibility such as blood type and tissue type.

The donor may need to stay for four to five days in the hospital. Before he or she can resume his or her normal life he or she needs to wait for one to one and a half month. Many donors take kidney donation in their stride and feel mentally satisfied and exalted. They are often thrilled to have helped restore health to near & dear relatives despite the risks. It is like playing a hero for your near and dear ones. It strengthens their bond as they save life of their dear ones. The team executing the kidney transplant aims at making it as easy going as possible so neither the recipient nor the donor feel exhausted and harassed.

Kidney Transplant—Deceased Donors

If a recipient does not have a potential living kidney donor, or chooses not to have one, he or she can be placed on the deceased donor waiting list. A seniority list of all registered patients awaiting cadaver transplant is drawn up as per the NOTTO guidelines and allocation is done accordingly.

Transplant Surgery and Hospitalization:
When patient come to the hospital, patient will have preoperative evaluation and testing done before either a living or deceased donor kidney transplant. Blood will be drawn for routine lab tests and final donor/recipient cross matching. If this final evaluation confirms that patient don’t have new medical problems and that the crossmatch is acceptable, then the transplant surgery will proceed. Duration of stay is about 7 to 8 days.
Recipient Surgery
When the donor kidney has been arranged it is transplanted in the lower part of the abdomen of the recipient. It can be placed on either the right or left side of the abdomen above the hipbone, where the kidney should be located. At this location it gets required blood supply and is also close to the bladder. The incision made for kidney transplant surgery may be 4 to 6 inches long as it not only involves to place the kidney but also attachment of blood vessels in the planted kidney to the branches of the iliac artery and vein of the patient to ensure normal blood flow. Further ureter of the kidney is also required to be attached to the bladder. In most of the cases recipient’s own kidneys are not taken out of the body.

Family of the patient may need to wait for five to six hours as it may take three to four hours in a kidney transplant surgery after that patient is shifted to the recovery room. The transplant surgeon’s work does not end with the operation but he also explains the actual condition of the patient after surgery, the follow up regimen and what to expect to the family of the patient.

Long term survival of the renal graft is an average of about 10 years, however range is 8 to 20 years.

We recommend a strict Follow up regimen: Initially twice a week for first  month & thereafter once a week in next 2 month followed by monthly  follow up for first year & then 3 monthly.

We monitor serial KFTS, TAC levels besides wound care, Input/output monitoring & general assessment & DJ stent removal after at about 2 weeks.

The nursing staff and clinical coordinators will teach the patient about proper care and important skills such as blood pressure monitoring, measuring intake and output, taking medications properly.