Kidney Transplant Surgery in India
What are the kidneys?
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure (via maintaining salt and water balance). They serve the body as a natural filter of the blood, and remove wastes, which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormones including calcitriol, renin, and erythropoietin. Located at the rear of the abdominal cavity in retroperitoneum the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder.
The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body’s internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). Those acidic metabolism end products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system producing erythropoietin and calcitriol. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.
What are the diseases of the kidney?
Kidney disease results from damage to the nephrons, which are the tiny structures inside your kidneys that filter blood. Kidney disease is a silent killer. Signs and symptoms occur late in kidneys disease. Screening tests are vital, especially if you are at high risk. The progression of kidneys disease can be slowed or stopped if detected earlier.
What is chronic kidney disease?
Chronic Kidney Disease (CKD) develops when the kidneys lose most of their ability to remove waste and maintain fluid and chemical balances in the body. CKD can progress quickly or take many years to develop. CKD has five stages based on the severity of Kidney Disease found in an individual and is described below. Chronic Kidney diseases can lead to end-stage renal disease (ESRD), a condition in which the kidneys fail to work and need dialysis. People with advanced chronic kidney failure termed currently as CKD stage V usually would need to receive dialysis or a kidney transplant.
Are you at risk for kidney disease?
- Do you have diabetes?
- Do you have high blood pressure?
- Do you have cardiovascular (heart) disease?
- Did your mother, father, sister, or brother have kidney failure?
If you answered, “yes” to any of these questions, you are at risk for kidney disease and need further testing.
What are some tips to follow before talking to your doctor?
- Write down any questions or concerns you have BEFORE you go to the doctor’s office. That way, if you get nervous, you can still remember what you wanted to talk about and make sure you and your doctor get to talk about all of your concerns.
- Write down the answers you get and ask more questions if you need to.
- Know as much as you can about your family’s medical history.
- Bring someone with you for support and to help you remember what you learn.
What are some questions to ask your doctor?
- Based on my medical and family history, am I at risk for kidney disease?
- Would lowering my blood pressure help reduce my risk of developing kidney disease?
- Do my blood and urine tests show signs of kidney disease?
- How can I prevent or control kidney disease?
What are the risk factors for chronic kidney disease?
The risk Factors Include:
- High Blood Pressure: High blood pressure, called hypertension, can damage the small blood vessels in the kidneys, preventing the kidneys from filtering wastes from the blood. Taking prescription drugs to control blood pressure helps protect the kidneys from damage.
- An Immediate Family Member with Kidney Failure: Some kidney diseases result from hereditary factors, and can run in families.
- A History of Glomerular Disease: The risk of chronic kidney disease increases for patients with Glomerular Disease. Glomerular Diseases damage the glomeruli, which are tiny bundles of blood vessels that filter blood in the kidneys.
What are the different causes of chronic kidney disease?
The most common causes of kidney disease include diabetes, high blood pressure, and hardening of the arteries (which damages the blood vessels in the kidney). Some kidney diseases are caused by an inflammation of the kidneys, called nephritis. This may be due to an infection or to an autoimmune reaction where the body’s immune or defense system attacks and damages the kidneys. Other kidney diseases, such as polycystic kidney disease are caused by problems with the shape or size of the kidneys (anatomic disorders), while other kidney diseases interfere with the inner workings of the kidneys (metabolic disorders). Most metabolic kidney disorders are rare, since they need to be inherited from both parents. Interstitial and Hereditary diseases are also not uncommon. Other common causes of kidney failure include certain medications that can be toxic to kidney tissue, and blockages of the system that drains the kidneys (which can occur with prostate problems).
What are the symptoms and complications of chronic kidney disease?
The symptoms of kidney disease depend on the type of kidney disease. If the disease is caused by a bacterial infection, the person will develop a high fever. Other signs of kidney disease include passing too much or too little urine, or passing blood or abnormal levels of chemicals in the urine.
Mild to moderate kidney disease often does not have any symptoms. However, in ERSD or uremia when the kidneys have completely and permanently failed, the toxins accumulate in a person’s blood and the symptoms include:
- Puffy eyes, hands, and feet (called edema)
- High blood pressure
- Shortness of breath
- Loss of appetite
- Nausea and vomiting
- A bad taste in the mouth or bad breath
- Weight loss
- Generalized, persistent itchy skin
- Muscle twitching or cramping
- A yellowish-brown tint to the skin
- Urine that is cloudy or tea-colored
Kidney disease usually does not cause pain, but in some cases pain may occur. A kidney stone in the ureter (a tube leading from the kidney to the bladder) can cause severe cramping pain that spreads from the lower back into the groin. The pain disappears once the stone has moved through the ureter.
Kidney disease can lead to both acute and chronic kidney failure, both of which can be life threatening. Acute kidney failure happens suddenly within hours to days, whereas chronic kidney failure happens gradually over a period of months to years. Acute kidney failure can often be reversed if the underlying disease is treated. In both conditions, the kidneys shut down and can no longer filter wastes or excess water out of the blood. As a result, poisons start to build up in the blood and cause various complications that can affect various body systems. Chronic kidney failure eventually reaches an end stage. This condition occurs when the kidney is working at less than 10% of full capacity. At this stage, the person will need dialysis or a kidney transplant to be able to go on living.
How is kidney disease diagnosed?
Unless the kidneys are swollen or there’s a tumour, your doctor can’t usually check for disease by feeling the kidneys. Instead, your doctor might test the urine and blood, take a scan of the kidneys, and test samples of kidney tissue. A routine urine test, called a urinalysis, checks for protein, sugar, blood, and ketones (created when the body breaks down fat). The urine is tested with a dipstick, which is a thin piece of plastic covered with chemicals that react when they touch substances in the urine. Your doctor will also check for red and white blood cells in the urine during a urinalysis (the urine is examined using a microscope). Depending on the suspected cause of the kidney problem, other tests may also be done.
Is there a test for kidney disease?
Since kidney disease sometimes has no symptoms, doctors may first detect the condition through routine blood and urine tests. Three simple tests to screen for kidney disease: a blood pressure measurement, checking for extra protein in your blood or urine, and measuring how well your kidneys are filtering wastes from your blood (Glomerular Filtration Rate or GFR).
Blood Pressure Test : High blood pressure (HBP), also known as Hypertension, can lead to kidney disease. It can also be a sign that your kidneys are already impaired. The only way to check blood pressure is to have a health professional measure with a blood pressure cuff. The result is expressed as two numbers. The top number, (called the systolic pressure) represents the pressure as the heart beats. The bottom number, (called the diastolic pressure) shows the pressure when the heart is resting. Your blood pressure is considered normal if it stays below 120/80 (expressed as “120 over 80”).
Checking for Extra Protein in the Blood or Urine: Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, small amounts of albumin leak into the urine, a condition known as microalbuminuria. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. Doctor’s test for protein using a dipstick in a small sample of urine, which that can be taken in the doctor’s clinic. The color of the dipstick indicates whether or not there is protein the urine.
Creatinine: A more sensitive test for protein or albumin in the urine involves testing a blood sample for the amount of protein and a waste product called creatinine. Creatinine is a waste created every time you use your muscles. When the kidneys aren’t working well, the level of creatinine in your blood goes up. This test is used to detect kidney disease in people at high risk, especially those with diabetes.
How is kidney function measured?
The Glomerular Filtration Rate (GFR) is used to measure how well kidneys filter waste from the blood. This test is also known as “measuring the Glomerular Filtration Rate”. The GFR is a measure or estimate of how well the kidneys filter wastes from the blood. GFR is been estimated from a routine measurement of creatinine in your blood. By comparing GFR tests done at different times, a doctor knows whether kidney function is getting better or worse.
The GFR when estimated from the creatinine value in the laboratory is called the estimated GFR or eGFR.
What is kidney failure?
Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease); a number of other diseases or health problems may cause either form of renal failure to occur.
Renal failure is described as a decrease in the glomerular filtration rate. Biochemically, renal failure is typically detected by an elevated serum creatinine level. Problems frequently encountered in kidney malfunction include abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) anemia as well as delayed healing in broken bones. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may occur. Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease.
What is Acute Kidney Injury?
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 ml per day in adults, less than 0.5 ml/kg/h in children or less than 1 ml/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal intrinsic renal and post renal.
How is Acute Kidney Injury treated?
In an individual with acute kidney injury and temporary shut down of kidney function the nephrologist will be able to usually identify an underlying cause and remove the underlying cause. Dialysis may be necessary to bridge the time gap required for treating these fundamental causes while the kidney recovery process occurs.
What is chronic kidney disease?
CKD as already described above can develop slowly and, initially, show few symptoms. CKD can be the long-term consequence of irreversible acute disease or part of a slow progressive destruction of the nephrons causing disease progression.
What are the stages of chronic kidney disease?
The severity of chronic kidney disease in divided into five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated.
What is acute on chronic kidney disease?
Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline renal function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if no prior baseline (i.e., past) blood work is available for comparison.
What is chronic kidney disease V or end stage kidney disease?
Stage 5 CKD is also called established chronic kidney disease and is synonymous with the now outdated terms end-stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF). There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires one of the forms of renal replacement therapy renal replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.
How is chronic kidney disease treated?
CKD cannot be cured; however, it can be managed. Taking certain steps during the early stages of the disease will help keep the kidneys healthy longer.
Those with diabetes need to monitor blood glucose closely to keep it under control, and should consult a doctor for the best treatment method. Control blood pressures to recommended target of <140/90. Both of this monitoring can be done at home.
Patients with reduced kidney function should control blood pressure and take an ACE inhibitor or an ARB. Many people will require two or more types of medication to keep the blood pressure below 130/80 mm Hg with frequent monitoring.
How does diabetes affect the body and kidneys?
Many damage small blood vessel in your body and affect your kidneys, eyes, skin, nerves, muscles, intestines and heart. High blood pressure and hardening of the arteries can develop, which can lead to heart disease.
High blood sugar makes the kidneys work harder and results in progressive damage to the small filtering units of the kidneys and leads to leakage of protein in the urine.
The WHO (World Health Organization) predicts that developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle-income countries.
Diabetics are also at increased risk of urinary tract infections due to high sugar content in the urine.
How can I prevent diabetes induced kidney problems?
- Carefully follow prescribed treatment to control blood sugar
- Control blood pressure to 130/80 mmHg
- Control cholesterol level with diet and medication if necessary
- Get urine checked for kidney function
- Treat urinary tract infections early
- Adopt a healthy diet that is high in fiber, low in fat, sodium and cholesterol
- Aim to achieve and maintain a healthy body weight
- Exercise 30 minutes a day, at least 3 times a week
- Quit smoking
How does high blood pressure damage the kidneys?
High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It’s a dangerous cycle.
High blood pressure is one of the leading causes of kidney failure, also called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or have regular blood-cleansing treatments called dialysis.
What are the signs and symptoms of high blood pressure?
Most people with high blood pressure have no symptoms. The only way to know whether a person’s blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, called the systolic pressure, represents the pressure when the heart is beating. The bottom number, called the diastolic pressure, shows the pressure when the heart is resting between beats. A person’s blood pressure is considered normal if it stays at or below 120/80, which is commonly stated as “120 over 80.” People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt lifestyle changes to lower their blood pressure and prevent heart and blood vessel diseases. A person whose systolic blood pressure is consistently 140 or higher or whose diastolic pressure is 90 or higher is considered to have high blood pressure and should talk with a doctor about the best ways to lower it.
What are the signs and symptoms of chronic kidney disease (CKD)?
Early kidney disease is a silent problem, like high blood pressure, and does not have any symptoms. People may have CKD but not know it because they do not feel sick. A person’s glomerular filtration rate (GFR) is a measure of how well the kidneys are filtering wastes from the blood. GFR is estimated from a routine measurement of creatinine in the blood. The result is called the estimated GFR (eGFR).
Creatinine is a waste product formed by the normal breakdown of muscle cells. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.
An eGFR with a value below 60 milliliters per minute (mL/min) suggests some kidney damage has occurred. The score means that a person’s kidneys are not working at full strength.
Another sign of CKD is proteinuria, or protein in the urine. Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of failing kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR.
How can kidney damage from high blood pressure be prevented?
It is recommended that people with CKD use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
How can blood pressure be controlled?
Five lifestyle changes help control blood pressure. People with prehypertension or high blood pressure should maintain their weight at a level close to normal.
Eat fresh fruits and vegetables, grains, and low-fat dairy foods.
Limit their daily salt, or sodium, intake to 2,000 milligrams. They should limit frozen foods and trips to fast food restaurants. They should read nutrition labels on packaged foods to learn how much sodium is in one serving. Keeping a sodium diary can help monitor sodium intake.
Get plenty of exercise-at least 30 minutes of moderate activity, such as walking, cycling, or swimming, most days of the week.
Avoid consuming too much alcohol. Men should have no more than two drinks-two 12-ounce servings of beer or two 5-ounce servings of wine or two 1.5-ounce servings of hard liquor-a day. Women should have no more than a single serving a day because differences in the way foods are broken down in the body make women more sensitive to the effects of alcohol.
Can medicines help control blood pressure?
Many people need medicine to control high blood pressure. Several effective blood pressure medicines are available. The most common types of blood pressure medicines doctors prescribe are diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and calcium channel blockers. Two of these medicines, the ACE inhibitors and ARBs, have an added protective effect on the kidneys. Studies have shown that ACE inhibitors and ARBs reduce proteinuria and slow the progression of kidney damage. Diuretics, also known as “water pills,” help a person urinate and get rid of excess fluid in the body. A combination of two or more blood pressure medicines may be needed to keep blood pressure below 130/80. When the blood pressure continues to be uncontrolled despite four medications including a water pill it is termed as resistant hypertension.
Who is at risk for kidney failure related to high blood pressure?
Everyone has some risk of developing kidney failure from high blood pressure. However, some ethnic groups are more likely to have high blood pressure and its related kidney problems—even when their blood pressure is only mildly elevated.
People with diabetes also have a greater risk of developing kidney failure. Early management of high blood pressure is especially important for people with diabetes. An ACE inhibitor is the most effective drug at slowing the progression of kidney disease although their effect in lowering blood pressure maybe variable.
Can diabetes and high blood pressure be cured?
Diabetes and high blood pressure are serious diseases and a person having a combination of these diseases should be more careful about his health and lifestyle than most people to prevent complications that can occur due to both of the diseases.
Diabetes occurs when the body is either not able to make insulin or use insulin correctly. Insulin is the hormone that promotes the transfer of glucose from blood into cells where it is used for energy. Due to the lack or incorrect use of insulin, too much sugar stays in the blood. The abnormally increased amount of sugar in the blood can damage different parts of the body, including the heart, blood vessels, eyes, nerves and kidneys. As a result, diabetes can cause complications, or damage to other body functions.
Where blood sugar is high this is associated with increased oxidation damage to blood vessels causing atherosclerosis. Atherosclerosis, which can lead to high blood pressure, is more common in diabetics. This atherosclerotic damage in itself and the healing of the damage with the formation of scar tissue causes artery hardening. Scar locations in blood vessels are also be a site for the formation of artheromatic plaques, which narrow blood vessels further. Narrowing and hardening of blood vessels is thought to cause the high blood pressure.
There are other probable reasons why diabetes and high blood pressure are linked. Most Type 2 diabetes patients have additional risk factors that are commonly associated with later high blood pressure. These factors include truncal obesity, a sedentary lifestyle, elevated triglyceride and LDL cholesterol and a lowered HDL cholesterol level. These factors further increase the risk to diabetic patients of heart disease or stroke. Based on statistics, it is estimated that more than 65% of diabetes patients die from heart disease or stroke.
A great number of people who become diabetic are overweight. In fact being overweight is one of the major conditions putting a person at risk of becoming diabetic. However, being overweight is also one of the major indicators of later high blood pressure. High blood pressure can also worsen complications that occur in diabetes such as kidney damage or retinopathy.
The good new is that both diabetes and high blood pressure can be treated and managed. Although diabetes cannot be cured, proper medication, and healthy living can bring blood sugar down to manageable levels allowing the patient to live a fairly normal life. In addition, blood pressure can be lowered to normal levels by employing the same methods of healthy living and proper nutrition used to treat diabetes. This is why in most cases the overall non-drug management of both high blood pressure and diabetes is the same. If life style changes cannot control blood pressure do not hesitate to initiate medications to prevent the long term complications that can occur.
If you already have diabetes, make sure you check your blood pressure regularly at home. Have regular medical checkups to check your glycosylated hemoglobin and lipid profile. Take your medications regularly. Follow a strict healthy diet, which should be either prescribed, by your doctor or a nutritionist who is aware of your condition. In most cases, your doctor may also prescribe a regular exercise regimen, which you should also follow.
In summary, eat right and healthily, exercise regularly, keep your diabetes and high blood pressure in check and have a positive attitude in life. These will go a long way to keeping both conditions under control.
What symptoms are seen once your kidneys fail?
- Swollen legs, ankles or feet
- Puffy eyes
- Weight gain due fluid retention
What is renal replacement therapy?
Renal replacement therapy is a term used to encompass life-supporting treatments for renal failure and includes:
- Peritoneal dialysis
- Renal transplantation
These treatments do not cure chronic kidney disease but perform some of functions of the normal kidney and are hence termed as replacement therapies. Early dialysis in acute renal failure may have favorable outcomes and bring resolution of renal failure since it is usually a temporary setback in acute kidney injury.
What is the best form of renal replacement therapy?
Transplant is the best form of renal replacement therapy as it gives better quality and quantity of life as compared to any form of dialysis.
What is dialysis?
Dialysis (from Greek “dialusis”, meaning dissolution, “dia”, meaning through, and “lysis”, meaning loosening) is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement of the lost kidney function in presence of renal failure. Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure) or for those with progressive but chronically worsening chronic kidney disease – stage 5 (previously chronic renal failure or end-stage kidney disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a “holding measure” or a bridge until a renal transplant can be performed, or sometimes as the only supportive measure called maintenance dialysis in those who are unfit or do not opt for a kidney transplant. Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. But dialysis treatments are the only options currently and replace some of the lost functions through diffusion (waste removal) and ultrafilteration (fluid removal).
What is a kidney transplant?
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end stage renal disease or CKD stage V. 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.
How will a kidney transplant change my life?
There are many advantages to transplantation, including freedom from dialysis as well as diet and fluid restriction. Most important, however, is the quality of life almost everyone enjoys after transplantation. Patients are able to perform most, if not all, of the activities they were able to perform before the onset of kidney disease: work, exercise, recreational activities, etc.
Almost everyone feels that they have a better quality of life after the transplant. For those who receive a close match, up to 90% are still alive after 1 year, and more than 70% are alive after 5 years. In order to avoid rejection, almost all kidney transplant recipients must take medicines that suppress their immune response for the rest of their life. This is called immunosuppressive therapy. Although the treatment helps prevent organ rejection, it also puts patients at a higher risk for infection and cancer. If you take this medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol and increase the risk for diabetes. A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed.
What is HLA matching?
When two people share the same Human Leukocyte Antigens ( HLA), they are said to be a “match”, that is, their tissues are immunologically compatible with each other. HLA are proteins that are located on the surface of the white blood cells and other tissues in the body.
There are three general groups of HLA; they are HLA-A, HLA-B and HLA-DR. There are many different specific HLA proteins within each of these three groups. (For example, there are 59 different HLA-A proteins, 118 different HLA-B and 124 different HLA-DR!) Each of these HLA has a different numerical designation, for example, you may have HLA-A1, and while some one else might have HLA-A2. The A,B and DR are the important antigens for renal transplantation. However, the major impact comes from the DR and B antigens, with little additional effect from the A antigens. Each antigen also appears to exert its effect at different times post-transplant, with the maximal effect of DR and B mismatching occurring within the first six months and two years post-transplant, respectively.
What if I do not have HLA matched donor?
Those who receive a kidney from a living related donor do better than those who receive a kidney from a donor who has died. (If you donate a kidney, you can usually live safely without complications with your one remaining kidney). However, the immunosuppressive medications of today negate any major outcome differences in today’s era of kidney transplantation between living related and living unrelated donor renal transplants.
Who can become my donor?
Basic criteria for donating includes:
- Minimum age of 18 years old
-Approximate maximum age of 60 years old
- Good general health (no history of diabetes, high blood pressure, or hepatitis)
- No history of kidney disease
-No major weight problems
-Willing and interested in donating
- Blood typing –There are four different blood types. They are A, B, AB, and 0. Every person has one of these blood types. The donor’s blood type does not have to be the same as the recipient’s blood type, but it has to be compatible. It does not matter if the donor’s blood type is Rh (+) or (-).
What medical reports do I need to send to get doctor’s opinion and cost of treatment?
Please fill in and send in the kidney transplant evaluation form to get the opinion of our nephrologists and cost of treatment.
Is kidney transplantation a risky or experimental treatment?
Surgery is always serious. Transplant surgery is no different. Kidney transplantation is today a very well established form of renal replacement therapy. As in any surgical procedure, however minor, a minimum degree of pre-operative risk does exist which is acceptable. However, the success rate for a transplant where the donor is a relative is 98 percent while a transplant from a deceased donor is 85 percent. In both cases, chances for a successful procedure are quite high.
Are there different types of kidney transplants?
Although deceased donor kidney transplants are successful in most cases, there are still several reasons why a transplant from a living donor is preferred. In general, a relative’s kidney will match the recipient more closely than that of a deceased donor. This similarity results in fewer cases of rejection, lower doses of necessary medication, and a greater long-term success rate for the recipient. Secondly, the recipient of a living donor kidney is less likely to need temporary dialysis after the transplant. This is because the kidney has not been stored for several hours like a deceased donor kidney. The living donor kidney usually begins to work immediately. Finally, the wait for a deceased donor kidney can be very long. Many patients wait four or more years for a kidney to become available. With a living donor, the transplant surgery can be scheduled at a time that is convenient for both the recipient and the donor.
What happens in the immediate postoperative period?
The transplant surgery takes about three hours. The donor kidney will be placed in the lower abdomen and its blood vessels connected to arteries and veins in the recipient’s body. When this is complete, blood will be allowed to flow through the kidney again. The final step is connecting the ureter from the donor kidney to the bladder. In most cases, the kidney will soon start producing urine.
Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3–5 days to reach normal functioning levels, while cadaveric donations stretch that interval to 7–15 days. Hospital stay is typically for 4–7 days. If complications arise, additional medications (diuretics) may be administered to help the kidney produce urine.
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 (calcineurin), mycophenolate and Prenisolone. Some patients may instead take cyclosporine (calcineurin), sirolimus or azathiaprine. Calcineurins, 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.
What is a living related donor program?
Types of living donor organ transplants possible in a program:
• Kidney (entire organ)
• Liver (segment)
• Lung (lobe)
• Intestine (portion)
• Pancreas (portion)
What are the possible relationships with transplant candidate in a living donor program?
Biologically related donors are blood relatives, such as parents, brothers/sisters, and adult children.
Unrelated donors can include people who have some type of social connection with a transplant candidate, such as a spouse or significant other, a friend, or a coworker.
Non-directed or altruistic donation:
These individuals donate to an anonymous candidate on the waiting list.
Some of these donors may eventually meet the transplant candidates, but only if both parties agree.
Living donors should be in good overall physical and mental health and free from uncontrolled high blood pressure, diabetes, cancer, HIV, hepatitis, and organ diseases (such as those related to the kidney, heart, liver, lung, intestine and pancreas).
Most living donors are older than 18 years of age and compatible with the intended transplant candidate. Since some donor health conditions can prevent the donation and transplant from being successful, it is important that you share all information about your physical and mental health.
You must be fully informed of the risks involved and complete a full medical and psychosocial evaluation. Your decision to serve as a donor should be completely voluntary and free of pressure or guilt. A living donor cannot be paid for the donation because it is illegal under the Indian Human Organ Transplant Act.
Does the donor have to observe any restrictions after surgery?
Except during the immediate postoperative period, when the donor should not climb stairs or lift weights as in any other abdominal surgery he or she can perform all the activities performed prior to donation. Kidney donors are advised to avoid or at least minimize use of medications that can be toxic to kidneys. A common example is the NSAID medications like Advil or ibuprofen, which is the main ingredient in pain relievers. It is also important that the donor should follow-up with the nephrologist at least once a year for life.
Are there any long-term ill – effects on the donor?
Frankly, there is inadequate medical research on the long-term consequences of living donation, and some of the research available is limited in scope (e.g., one transplant center) or does not follow statistically rigorous procedures (e.g., inadequate sampling). The research currently available has shown there are few, if any, long-term effects on a living kidney donor. Mortality rates look to be the same or better than the general population. Some studies have revealed slightly higher incidence of high blood pressure and elevated levels of protein in the urine. There is also a possibility (0.1% to 1.1%) that a living kidney donor will develop End Stage Renal Disease and need a kidney transplant.
Can kidney donation impact my future pregnancies?
Whether it is organ donor or recipient the sex life is not affected. The female donor can bear children. Research has demonstrated that the donor nephrectomy is not detrimental to the prenatal course or outcome of future pregnancies. The presence of a solitary kidney does not appear to pose a significant risk during the course of a normal pregnancy.
After kidney donation how much physical exercise should I do?
If your kidney was removed laparoscopically, you shouldn’t lift anything heavier than 15 pounds for three weeks following surgery. If your kidney was removed through an open flank incision, you shouldn’t lift anything heavier that 15 pounds for 5 weeks. You should get exercise, though. Start with a little walking, first around the house and then, weather permitting, outside. Go a little farther each day. You can do some stretching exercises or low impact aerobics. This will help your muscles stay flexible. Start with five or ten minutes of gentle stretching, after a few days you may increase to light exercise and then gradually increase to full exercise after 4 weeks (laparoscopy) or 8 weeks (open). Each person’s body is different, so it isn’t possible to tell you exactly how much exercise you should be doing, but you should get some exercise. It will help you heal and it will make you feel better. Listen to your body and don’t over do it. You’ll know the next morning if you’ve done too much.
After kidney donation should I be on a special diet?
You don’t need a special diet after kidney donation like everyone; you should eat a healthy diet with lots of fruits and vegetables and avoid too much fat and protein. You may drink alcohol, but do so moderately.
After kidney donation how long will I have pain?
Because each person responds in a unique way to surgery and pain, it is impossible to tell you how long you will need pain medication. Most kidney donors need pain medication for a few weeks after surgery. No medication can take away all of the pain, but it should take the edge off of the pain so that you can do what you need to do. The pain will gradually decrease, but you may notice pulling, soreness and some spasms in the muscles of your back for a few months after surgery. This is part of the normal healing process.
After kidney donation what about sex?
You should wait at least two to three weeks after your surgery. You may want to try non-intercourse sexual activities for a while. Listen to your body and don’t over do it.
After kidney donation does my incision need special care?
Although you will be ready to return to your full activities within a few weeks of your surgery, your incision will still be healing for about three months. During this time, new skin cells are growing and old cells are being removed. This process will leave a visible line on your skin. This line will be more noticeable if you expose it to sun during the first year following your surgery. You can swim and do other activities in the sun, but you should wear a shirt or cover-up and/or use sun block to keep the sun off of the incision. It may be helpful to apply vitamin E cream to the incision line once a day, but you should not do this for three weeks after your surgery.
After kidney donation when can I drive a car?
You should not drive a car while you are taking pain medication. Wait at least 3 weeks before you drive, but you may need to wait longer as pain and soreness that you will feel, may make you less able to drive safely.
After kidney donation when can I go back to work?
Depending on the type of work you do, you may return to work as early as three weeks (if your kidney was removed laparoscopically) or six weeks after your surgery (open flank). If your work requires you to lift heavy weights (over 25 pounds) you should plan to lift only lighter weights at first and then gradually increase your lifting over four to six weeks. If you need a letter for your employer about this please let us know and we can provide one.
After kidney donation surgery Is there anything to watch out for?
You will notice several changes after your surgery. You will have pain in the area of your incision. This will gradually go away, but you may feel some pulling, cramping or tightness in the incision area for several weeks after the surgery. Don’t be afraid to use the pain medication you were given. If you notice that you are running out of the medication and need more, call the kidney transplant nurse coordinators.
You will probably feel a little weaker and more sore a day or two after you leave the hospital. This is normal. Most kidney donors find themselves wanting to be up and around once they get home. You should gradually increase your activity, but don’t over do it. Listen to your body. If you are feeling more pain, take more time to rest and cut down a little on your walking or exercise.
Even though you are gradually feeling better, don’t be surprised if you feel as if you don’t have enough energy. It may take up to three to four months after kidney surgery to feel completely back to normal.
You may have strange sensations around your incision. You might notice burning, numbness or just very faint sensation.
This is caused by the incision and it is normal. It will go away as the nerves grow back together. This could take several months. If you have bothersome sensations or pain, which don’t improve, call the transplant coordinator on call.
If you have fevers, nausea or vomiting, shortness of breath, a sudden increase in pain or anything else that seems out of the ordinary, please call the transplant coordinator .
Are there any diet restrictions after transplant?
Kidney transplant recipients are discouraged from consuming grapefruit, pomegranate and green tea products. These food products are known to interact with the post transplant immunosuppressive medications, thereby lowering their levels specifically tacrolimus, cyclosporine and sirolimus; the blood levels of these drugs may be lowered, potentially leading to a rejection episode. Acute rejection can occur in about 10–25% of people after transplant during the first 60 days. Rejection does not necessarily mean loss of the organ, but it may necessitate additional treatment and medication adjustments.
What do I do if I do not have a related donor?
Since medications to prevent rejection are so effective, that donors do not need to be genetically similar to their recipient. Although living unrelated altruistic donation is an option, most donated kidneys come from deceased donors all over the world; however, the utilization of living donors is on the rise in developed nations. This varies by country: for example, only 3% of kidneys transplanted during 2006 in Spain came from living donors the rest being from cadaver donors.
How much money do I have to pay the donor?
In the developing world some people sell their organs. Such people are often in grave poverty or are exploited by middlemen. People traveling to make use of such kidneys, sometimes known as “transplant tourists,” are not looked upon favorably. These patients may have increased complications owing to poor infection control and lower medical and surgical standards. Although legalization of organ trade and appropriate legislation in these nations could prevent such tourism, it is not an answer to a deficit in donors. The Indian Human Organ Transplant act currently does not support the sale of organs.
Do my old kidneys have to be removed?
Diseased kidneys are normally not removed as they shrink to small functionless scar tissue over time. Removal of a diseased kidney is performed only if it is responsible for uncontrolled high blood pressures requiring more than 4 or 5 drugs in full doses, is part of a severe life threatening infection called pyelonephritis, contributing to severe uncontrolled pain or bleeding, a malignancy is suspected in the diseased kidney or the kidney is too large as in a polycystic kidney to provide place for the new transplant kidney.
What anesthesia will I be given for transplant?
Kidney transplants are done with the most advanced techniques. A transplant takes about 4-5 hours under general anesthetic or epidural anesthesia. An incision is made on the lower right or left side of the abdomen for the kidney transplant. The new kidney is attached directly to the bladder and blood vessels.
When can I go home after the transplant?
You should be out of bed by the next day and eating shortly thereafter. Medication to control organ rejection will be given to you. Within days, you will be walking and stretching. You will leave hospital usually in a week’s time.
When can I resume normal activities after transplant?
Once discharged, as you get stronger, you’ll be able to exercise even more. After several months, you’ll feel good enough to return to all your normal activities with renewed vigor.
Are there any diet restrictions after transplant?
Kidney transplant recipients are discouraged from consuming grapefruit, pomegranate and green tea products. These food products are known to interact with the post transplant medications, specifically tacrolimus, cyclosporine and sirolimus; the blood levels of these drugs may be lowered, potentially leading to a rejection episode. Acute rejection occurs in 10–25% of people after transplant during the first 60 days. Rejection does not necessarily mean loss of the organ, but it may necessitate additional treatment and medication adjustments
How many days do the kidney donor need to stay in the hospital?
The donor would need to stay in the hospital for between 3-5 days following a routine donor nephrectomy surgery.
How many days do the kidney transplant recipient need to stay in the hospital?
The renal transplant recipient would need to stay in the hospital for approximately 7 days following a routine transplant surgery.
What are the numbers of days of stay in India after surgery for follow-up for both donor and the recipient?
The donor could leave the country in 2 weeks time if certified by the surgical team. The recipient would ideally be needed to stay for at least a month. However if adequate follow-up with a trained nephrologist is available back in his or her home country they may go back earlier based on their fitness.
What are the legal documents that I need to produce when I come to India?
- Address of proof for the donor and the recipient
- Identity Proof of the donor and the recipient
- Age Proof for the Donor and the Recipient
- Marriage Certificate (if the donor is a spouse)
- Proof of Income for donor and the recipient
- Passport size photographs of the donor and the recipient
- Police Verification Report from country of citizenship
- Affidavit (Consent Letter) from the Donor saying that the donation is out of love and affection and is not sold and he is donating with his free will.
- Affidavit (Consent Letter) from the family members saying that the donor is donating the kidney out of his free will and out of love and affection and that the recipient has not paid for donation and neither has been forced to make the said donation
- Affidavit (Consent Letter) from the Recipient saying that the donation is out of love and affection and has not forced or paid the donor for donation
- Letter from the Ministry of Health addressed to their Local Embassy in India giving details of the patient/donor/treatment/relationship and requesting them to issue NOC for the kidney transplant at Narayana Hrudayalaya Hospitals, in Bangalore.
- Medical Visa
- Family Tree drawn on a white paper
- Family pictures showing donor and the recipient both together
Standard Process for Kidney Transplant in India for a Foreign Patient
PART I (This may take a period of 25 – 35 days)
- Patient/Donor arrives at the airport.
- They are picked up from the airport and accommodated in a guesthouse.
- Next day they have consultation with the doctor.
- All the documents are reviewed and checked and the medical investigations are carried out on the donor and the recipient
- Once the donor and the recipient are found medically fit for the transplant the legal documents are sent to the Embassy of the patient in Delhi for granting the NOC.
- On receipt of the NOC the Internal Transplant Committee reviews the case and gives green signal for the transplant.
- An appointment is booked with the Ethics Committee for the Interview with the patient/donor.
- The donor/patient are interviewed by the Ethics Committee and if found suitable for transplant the NOC is issued by the Ethics Committee
- After obtaining the NOC from the Ethics committee the patient and the donor is admitted in the hospital for the transplant.
- After the successful completion of the Transplant the donor may get discharged in 7-days and stay in the nearby hotel.
- The recipient needs to stay 3-4-weeks for the observation and follow-up (as advised by the doctor)
- Post discharge the recipient may need to stay in a nearby place for the follow-up for a period of 7-days (as advised by the doctor)
- The time taken for getting the NOC from the Ethics committee may be around 25-35 days.
- The patient should send the HLA Type Match test results of the donor and himself to confirm the donor.
- Donor has to be either
- Sibling (Brother or Sister)
- Spouse (Wife or Husband)