Organ Transplantation

How Is Kidney Transplant Done?

Kidneys for transplantation come from two different sources: A living donor or a deceased donor.

The Living Donor

Sometimes family members including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, a spouse or a close friend may wish to donate a kidney. Such a person is called a “living donor.” The donor must be in excellent health, well-informed about transplantation and be able to give informed consent. Any healthy person can donate a kidney safely.

Deceased Donor

A deceased donor kidney comes from a person who has suffered brain death. The Uniform Gift Act allows everyone the consent to organ donation for transplantation at the time of death and allows families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected.

Transplant Evaluation Process

Regardless of the type of kidney transplant – living donor or deceased donor – special blood tests are needed to find out what type of blood and tissue is present. These test results help to match a donor kidney to the recipient.

Blood Type Testing

The first test establishes the blood type. There are four blood types: A, B, AB, and O. Everyone fits into one of these inherited groups. The recipient and donor should have either the same blood type or compatible ones unless they are participating in a special program that allows donation across blood types. The list below shows compatible types:

• If the recipient’s blood type is A, the donor’s blood type must be A or O
• If the recipient’s blood type is B, the donor’s blood type must be B or O
• If the recipient’s blood type is O, the donor’s blood type must be O
• If the recipient’s blood type is AB, the donor’s blood type can be A, B, AB, or O

The AB blood type is the easiest to match because that individual accepts all other blood types.

Blood type O is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type O donors. For example, if a patient with blood type O received a kidney from a donor with blood type A, the body would recognize the donor kidney as foreign and destroy it.

Tissue Typing

The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. Antigens are markers found on many cells of the body that distinguishes each individual as unique. These markers are inherited from the parents. Both recipients and any potential donors have tissue typing performed during the evaluation process.
To receive a kidney where the recipient’s markers and the donor’s markers are all the same is a ‘perfect match’ kidney. Perfect matched transplants have the best chances of working for many years. The perfect match kidney transplants come from siblings.
Although, tissue typing is done despite partial or absent HLA match with some degree of ‘mismatch’ between the recipient and donor.

Crossmatch

Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Individuals may make antibodies each time there is an infection, with pregnancy, have a blood transfusion or undergo a kidney transplant. If there are antibodies to the donor’s kidney, the body may destroy the kidney. For this reason, when a donor’s kidney is available, a test called a crossmatch is done to ensure the recipient does not have pre-formed antibodies to the donor.
The crossmatch is done by mixing the recipient’s blood with cells from the donor. If the crossmatch is positive, it means that there are antibodies against the donor. The recipient should not receive this particular kidney unless a special treatment is done before transplantation to reduce the antibody levels. If the crossmatch is negative, it means the recipient does not have antibodies to the donor and that they are eligible to receive this kidney.
Crossmatches are performed several times during preparation for a living donor transplant and a final crossmatch is performed within 48 hours before this type of transplant.

Serology

Testing is also done for viruses such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus) to select the proper preventive medications after transplant. These viruses are checked in any potential donor to help prevent spreading disease to the recipient.

Transplant Surgery

The transplant surgery is performed under general anesthesia. The operation usually takes 2-4 hours. This type of operation is a heterotopic transplant, meaning the kidney is placed in a different location than the existing kidneys. (Liver and heart transplants are orthotopic transplants in which the diseased organ is removed and the transplanted organ is placed in the same location.) The kidney transplant is placed in the front (anterior) part of the lower abdomen, in the pelvis.

The original kidneys are not usually removed unless they are causing severe problems such as uncontrollable high blood pressure, frequent kidney infections or are greatly enlarged. The artery that carries blood to the kidney and the vein that carries blood away is surgically connected to the artery and vein already existing in the pelvis of the recipient. The ureter or tube that carries urine from the kidney is connected to the bladder. Recovery in the hospital is usually 3-7 days.

Complications can occur with any surgery. The following complications do not occur often but can include:

• Bleeding, infection or wound healing problems.
• Difficulty with blood circulation to the kidney or problem with flow of urine from the kidney.

These complications may require another operation to correct them.

How Long Can A Transplanted Organ Last?

Transplanted organs don’t last forever.

While transplanting a healthy organ to replace a diseased or failed organ can prolong life, transplants have limits. A transplanted pancreas keeps working for five years in only 57 percent of patients, meaning nearly half of the patients will need a second transplant. A transplanted liver will function for five years or more in 70 percent of recipients and even longer if the organ came from a living donor. After a heart transplant, the five-year survival rate for the organ is about 76 percent. However, a transplanted lung continues to work for five years or more in only about 52 percent of patients, according to the Scientific Registry of Transplant Recipients.

What Are The Do’s & Don’ts After Kidney Transplant?

Do’s for a kidney transplant patient:-

1- Enjoy your new freedom
2- Take your medications regularly – Failure to do so may cause rejection and loss of kidney.
3- Have a complete list of your tablets ready and up-to-date.
4- A folder with copies of all letters who you may have seen as well as copies of laboratory values will help a lot.
5- When you have blood test to check the levels of the immunosuppressive drugs, make sure the blood is taken before the morning dose.
6- If you forget/miss the dose of your medicine seek advice.
7- Attend your clinic appointments. Your transplant function should be checked on a regular basis. Ask your doctor about the intervals.
8- If you feel unwell or you think something is wrong, seek advice as soon as possible. Inform your doctor.

Don’ts For The Kidney Transplant Patient:-

1- Do not stop your medication.
2- Your immune system is impaired by the immunosuppressive medication. Do not ignore the signs of infection. A fever, cough, urinary symptoms or abdominal pain should be informed to the doctor straightaway.
3- Do not take any other medication (this includes over the counter drugs) unless advice from the kidney/transplant doctor is taken.
4- Do not make mistakes with your immunosuppression. If uncertain about the dose, ask for advice.
5- Do not change the schedule of your immunosuppression.
6- Avoid the company of people with infections (eg., people with runny nose or cough), particularly early after transplantation.
7- It is important that you do not miss appointments. Even if you feel well, it is important to attend the clinic because it is very rare that you get symptoms with transplant rejections. Similarly, it is just as important to attend the clinic if you are unwell.
8- Do not ignore advice from the transplant team. If they strongly advise investigations, they have good reasons.
9- Do not smoke.
10- Do not go on a holiday without appropriate precautions.