Kidney Transplant Treatment of choice in kidney failure

Dr Asheesh Kumar
Kidney failure is a major public health challenge, and its burden is projected to increase dramatically because of the rising prevalence of diabetes and hypertension and the aging general population. Renal replacement therapy is either unavailable or prohibitively expensive, and patients with end-stage renal failure die prematurely. Although dialysis is the most commonly used treatment for kidney failure worldwide, studies have shown that kidney transplantation (KT) is more cost-effective and associated with better quality of life, increased survival, fewer dietary restrictions, and higher economic productivity. Currently, there is a significant gap between the supply and demand of organs for transplantation. In India, there is an annual need for 2,00,000 kidney transplants, but only around 10, 000 transplants are performed each year.
The kidney transplant was the first of the organ transplant procedures to develop. The first successful experiment kidney transplant was done in 1902 in dogs. Thereafter, it takes around 50 years to perform the first successful renal transplantation on humans. It was first performed on identical twins. Since then, there has been improvement in surgical and immunosuppression aspects, and the longest survival after renal transplantation is 50 years. The ten-year survival rate ranges from 55% to 83%, depending on various factors.
Types of Renal transplantation based on donor:
Living-donor kidney transplantation: In this type of renal transplantation, the donor can be either a family member (brother/sister/parent/children) or other relatives who may be related to the patient through the maternal or paternal side. Only one kidney is needed to replace two failed kidneys. Before anyone donates a kidney, there is a need for a full medical examination. The donor will be checked to ensure he/she has no health problems that could be made worse by donating a kidney. The long-term survival rate after kidney donation is about the same as that for generally healthy people who aren’t kidney donors. After kidney donation, it’s important to have regular health checkups. These include kidney function tests and blood pressure checks.
Deceased donor kidney transplantation: When a kidney from someone who has recently died or is brain dead is removed with the family’s consent or from a donor card. A person with brain stem death is usually the victim of a road accident or brain hemorrhage and does not have kidney disease or infection.
Most common queries in mind regarding renal transplants:
What are the investigations needed in renal transplantation?
Investigations are needed to determine whether a donated kidney may be suitable for the recipients. Among them, important investigations are:
Blood group typing. Getting a kidney from a donor whose blood group matches or is compatible is preferable.
Tissue typing. The next step is a tissue typing test called human leukocyte antigen (HLA) typing. A good match means it’s less likely that the body will reject the organ.
Crossmatch. The test determines whether antibodies in your blood will react against specific antigens in the donor’s blood. A negative crossmatch means they are compatible, and your body isn’t as likely to reject the donor’s kidney.
There are other investigations, including CT angiography and GFR calculation for living donors, echocardiography for both donors and recipients and a few others to check whether donor and recipient can sustain after the operation.
Can a kidney transplant be performed before starting dialysis?
Yes, some people get their renal transplant before needing to go on dialysis. This is called Pre-emptive kidney transplant and has shown better survival benefits compared to dialysis patients.
If a family member is ready for kidney donation, but the donor is incompatible. What are the solutions?
Suppose someone has a willing kidney donor whose organ isn’t compatible with or doesn’t match well for other reasons. Rather than donating a kidney directly to his relative, that donor may give a kidney to someone who may be a better match. Then, his recipient receives a compatible kidney from that recipient’s donor. This is called a paired donation.
What kind of surgery is it? After how much time can one go for the work?
Kidney transplants are performed with general anesthesia. The blood vessels and ureters of the new kidney are attached to the recipient. Kidney transplant recipients can return to work and other normal activities within eight weeks after transplant. There is a need to have blood tests several times a week and medication adjustments in the weeks following the transplant. So, one may need to make arrangements to stay near the transplant center.
For how long is there a need for the medications? Is there any dietary restriction?
Mostly, medications are needed for life long. It is important to take all medicines as the doctor prescribes. One may reject a new kidney if he/she skips medications, even for a short period of time. After a kidney transplant, there are fewer dietary restrictions compared to patients with CKD and dialysis-dependent patients.
In what kind of kidney patients’ transplants are not prescribed?
Patients with advanced age, severe heart disease, recently treated cancer, or poor mental health are usually denied renal transplants.
Who are the members of the renal transplant team.?
A transplant team includes a nephrologist, transplant surgeon, anaesthetist, transplant coordinator, nursing officers, pharmacist, dietitian, and social worker. This team will take care of all the patient’s related issues with patients and family members. Along with them, all hospital staff, from administrative to supporting staff, are directly/indirectly involved in their care.
What is the status of a kidney transplant from a pig to a human?
There is a significant disparity between the demand and supply of kidney transplants. Research is going on for the transplant of kidneys from animals like a pig to humans called xenotransplant, but this is still in the initial phases and requires more valid studies.
(The author is Assistant Professor Department of Nephrology)