(Kidney Transplant, Renal Transplant)
A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. The kidney may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the remaining kidney.
A person receiving a transplant usually receives only one kidney, but, in rare situations, he or she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The kidneys and urinary system keep chemicals, such as potassium and sodium, and water in balance, and remove a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. Kidneys also regulate fluid and acid-based balance in the body.
Two kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. Their function is to:
The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.
Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
A kidney transplant may be recommended for persons with end stage renal disease (ESRD), a permanent condition of kidney failure that often requires dialysis (a process used to remove wastes and other substances from the blood). Some conditions of the kidneys that may result in ESRD include, but are not limited to, the following:
Other conditions, such as congenital defects of the kidneys, may result in the need for a kidney transplant.
There may be other reasons for your doctor to recommend a kidney transplant.
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
The new kidney may be rejected. Rejection is a normal reaction of the body to a foreign object or tissue. When a new kidney is transplanted into a recipient's body, the immune system reacts to what it perceives as a threat and attacks the new organ, not realizing that the transplanted kidney is beneficial. To allow the transplanted organ to survive in a new body, medications must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object.
The medications used to prevent or treat rejection have side effects. The exact side effects will depend on the specific medications that are taken.
Contraindications for kidney transplantation include, but are not limited to, the following:
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
In order to receive a kidney from an organ donor who has died (cadaver), a recipient must be placed on a waiting list of the United Network for Organ Sharing (UNOS). Extensive testing must be done before an individual can be placed on the transplant list.
Because of the wide range of information necessary to determine eligibility for transplant, the evaluation process is carried out by a transplant team. The team includes a transplant surgeon, a transplant nephrologist (doctor specializing in the treatment of the kidneys), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Additional team members may include a dietician, a chaplain, and/or an anesthesiologist.
Components of the transplant evaluation process include, but are not limited to, the following:
The transplant team will consider all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for kidney transplantation.
Once you have been accepted as a transplant candidate, you will be placed on the UNOS list. When a donor organ becomes available, you will be notified and told to come to the hospital immediately.
If you are to receive a kidney from a living family member (living-related transplant), the transplant may be performed at a planned time. The potential donor must have a compatible blood type and be in good health. A psychological test will be conducted to ensure the donor is comfortable with the decision.
The following steps will precede the transplant:
Kidney transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a kidney transplant follows this process:
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room. Kidney transplantation usually requires an in-hospital stay of several days.
A kidney from a living donor may begin to make urine immediately, but urine production in a cadaver kidney may take longer. Until urine output is sufficient, dialysis may be required.
You will have a catheter in your bladder to drain your urine. The amount of urine will be carefully measured to evaluate the new kidney's function.
You will receive IV fluids until you are able to take in adequate food and fluids.
Your immunosuppression (antirejection) medications will be closely monitored to make sure you are receiving the optimum dose and the best combination of medications.
Blood samples will be taken frequently to monitor the status of the new kidney, as well as other body functions, such as the liver, lungs, and blood system.
Your diet will be gradually advanced from liquids to more solid foods as tolerated. Your liquid intake may be restricted until the new kidney is fully functional.
You may begin physical activity by the day after the procedure. You should get out of bed and move around several times a day.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
You should not drive until your doctor tells you to. You should avoid any activity or position that causes pressure to be placed on the new kidney. Other activity restrictions may apply.
Notify your doctor to report any of the following:
Fever and tenderness over the kidney are some of the most common symptoms of rejection. An elevation of your blood creatinine level (blood test to measure kidney function) and/or blood pressure (monitored by your doctor) may also indicate rejection. The symptoms of rejection may resemble other medical conditions or problems. Consult your transplant team with any concerns you have. Frequent visits to and contact with the transplant team are essential.
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
To allow the transplanted kidney to survive in a new body, you will be given medications for the rest of your life to fight rejection. Each person may react differently to medications, and each transplant team has preferences for different medications. The antirejection medications most commonly used singlely, or in combination,include:
New antirejection medications are continually being developed and approved. Doctors tailor medication regimes to meet the needs of each individual patient.
Usually several antirejection medications are given initially. The doses of these medications may change frequently, depending on your response. Because antirejection medications affect the immune system, persons who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making you very susceptible to infection.
Some of the infections you will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses. You should avoid contact with crowds and anyone who has an infection for the first few months after your surgery.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.
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