Q. What is a kidney transplant?
Q. Who is a candidate for a kidney transplant?
Q. Where do kidneys for transplantation come from?
Q. Can an unrelated living person donate a kidney?
Q. What are the chances my transplanted kidney will work?
Q. What happens if my new kidney fails?
Q. What are the chances that I will die as a result of receiving a kidney transplant?
Q. What are some of the factors which would increase the risk of transplantation?
Q. Will my own kidneys be removed?
Q. How is rejection prevented?
Q. How long will I have to take these drugs?
Q. Do these immunosuppressive drugs have side effects?
Q. What is a kidney transplant?
A kidney transplant is a surgical procedure in which a healthy kidney from one person is placed into another whose kidneys have stopped working.
Q. Who is a candidate for a kidney transplant?
Any patient whose kidneys have permanently stopped working is a potential candidate for a kidney transplant. However, many factors must be considered in choosing between transplantation and chronic dialysis for a given individual. Among these factors are age, other medical problems, and personal considerations of work and lifestyle. You should discuss the options with your doctor and attempt to obtain as much information as possible in reaching your decision.
Q. Where do kidneys for transplantation come from?
There are three sources of kidneys for transplantation: living related, living unrelated, and cadaver donors. Living donors are usually members of the recipient’s immediate family, such as siblings, parents or children. Only such close relatives are likely to have an acceptable tissue match, although recent data suggests that success with living unrelated kidneys is closer to that of related grafts than that of cadavers. This may be due to better state of the donor and less storage time. Cadaver donor kidneys are removed from victims of brain death, usually the result of an accident or a stroke.
Q. Can an unrelated living person donate a kidney?
As the results seem better, and the supply of cadaver kidneys remains low, living unrelated kidneys are being considered increasingly. Spouses are the usual donors, although rarely, friends can be used if extensively screened.
Q. What are the chances my transplanted kidney will work?
The success rate following transplantation depends upon the closeness of the tissue match between donor and recipient. A kidney from a brother or sister with a “complete” match has a 95% chance of working at the end of one year. A kidney from a parent, child, or “half-matched” sibling has an 85% chance of working for at least one year. Finally, a cadaver donor kidney has an 80% change of working at least one year.
All of these statistics assume this is your first transplant, and that you will be taking the anti-rejection drugs. If you are having a repeat transplant, the success rate will be 10%-15% less.
These kidneys are not immortal, however, with 50% of cadaver kidneys declining over 6 – 10 years, a rate faster than the relatively stable success of related kidneys.
Q. What happens if my new kidney fails?
If the transplant fails, patients return to dialysis as before. The transplant will be removed only if it is causing symptoms, such as fever or pain. This is often necessary if the kidney fails soon after transplant, but rarely if it fails after several months. You may be able to have another transplant later, if you desire.
Q. What are the chances that I will die as a result of receiving a kidney transplant?
One of the major achievements in the field of transplantation in the last ten years has been a major reduction in the risk of death. Currently, the risk of death in the first year after a kidney transplant is about 3 – 5%, occurring primarily in high risk patients, particularly those over 60 – 65 and, to a less extent, those with juvenile diabetes. This includes death from any cause, whether or not related to the transplant. This risk is not significantly different from that sustained during a year of dialysis. During your transplant evaluation, any risk factors you may have that will increase your risk for transplantation will be identified and discussed with you.
Q. What are some of the factors which would increase the risk of transplantation?
Advanced age is a significant risk factor. Generally, patients over the age of 60 have done less well than younger patients. Significant heart disease, particularly a history of angina or prior heart attacks, will also increase the risk.
Because of the high incidence of heart disease in diabetic patients, all diabetics must undergo an exercise stress test before being accepted for transplantation. Chronic lung disease increases the risk of pneumonia after transplantation.
Smoking will also increase this risk, and all potential transplant patients are urged not to smoke. Patients who are significantly overweight are more likely to have complications in any surgical procedure, and should attempt to reduce before transplantation. A history of other systemic diseases such as cancer or hepatitis may also affect the risk; indeed, many patients with a history of cancer or abnormal liver enzymes secondary to hepatitis may not be accepted for transplantation. All of these factors vary in importance in different individuals, and should be discussed with your doctor, as well as with the transplant surgeon when you have your transplant evaluation.
Q. Will my own kidneys be removed?
It is rarely necessary to remove your own kidneys prior to transplantation. This may be required if you have severe high blood pressure uncontrollable by medication and dialysis, or if your kidneys are chronically infected. However, whenever possible, your own kidneys will be left alone. Even if not functioning normally, they continue to make erythropoietin, a hormone your body requires to make red blood cells, and they may make some urine. This is particularly important if your transplant should fail.
The body has a normal defense mechanism, called the immune system, which protects it from foreign substances, such as bacteria and viruses. The body sees a kidney transplant as foreign and attacks it to get rid of it. This process is called rejection, and is a normal response of the body’s immune system. Even though rejection may be prevented by medication, the possibility of rejection never goes away. The body will not adapt to the kidney, nor will the kidney change to accommodate the body, although after the first 3 – 6 months, rejection is less of a problem.
Q. How is rejection prevented?
To prevent rejection patients are given drugs, called immunosuppressive medications. These drugs work by lowering the body’s immune response, making it incapable of destroying the kidney. There are now several immunosuppressive medications available, giving transplant physicians new flexibility in treating recipients. Most patients will receive a combination of drugs. The newest of these medications is called cyclosporine, a highly effective drug which has considerably improved the results of transplants of all sorts.
Cyclosporine works by interfering with the ability of your lymphocytes to cooperate normally in attacking the transplant. It is now given in pill form in combination with prednisone, a steroid medication with anti-inflammatory properties. The combination of cyclosporine, Imuran (an older drug), and prednisone, all in low doses, is used currently for all recipients of unrelated kidney transplants, and for all living related donor transplants that are not perfectly matched.
The additional immunosuppressive drug mentioned above is azathioprine or Imuran. Occasionally, patients are switched from cyclosporine to Imuran several months after transplant to avoid some potential side effects of long term cyclosporine administration. Your doctor will advise you if this is necessary.
Q. How long will I have to take these drugs?
It will be necessary for you to take some immunosuppressive medication for as long as you have the transplant. Because the body never accepts the kidney as part of itself, rejection can occur even years later, particularly if you stop your medicines. However, it will be possible to reduce the dosage of medications gradually over time, as the risk of rejection lessens with time.
Q. Do these immunosuppressive drugs have side effects?
All currently available immunosuppressive medications have side effects. Some of these are common to all such drugs, and some are particular for the individual drug. The most important side effect these drugs have in common is that by reducing the body’s immune defenses, they may actually increase the risk of infection. Because they depress the body’s immune system in a non-specific way, the body is less able to fight off some kinds of infection. This does not mean that you will be ill frequently, but rather that there are some kinds of infection only contracted by patients taking these or similar drugs. Most of these infections are treatable, if detected early enough. Therefore, it is very important that you report any symptoms such as fever or a cough to your doctor without delay. Despite the risk, these infections are not common; only about 15% of transplant recipients ever have any significant infection.
Cyclosporine has a number of special side effects, of which the most important is kidney toxicity. Sometimes cyclosporine will cause your creatinine to rise, even in the absence of any other problem. Usually this improves with a reduction in the dose. Serial cyclosporine blood levels are currently available to help decide the best dose for an individual patient. Other side effects rarely caused by cyclosporine include mild hand tremors, hair growth, and inflammation of the gums. These generally improve if the dose is lowered.
Side effects secondary to prednisone occur much less commonly now than they did years ago, because so much lower doses are used. The most common side effect now rarely seen is a tendency to gain weight and develop a fat face. Other possible effects include fluid retention, stomach irritation or ulceration, thinning of the hair, acne, mood swings, bone disease, and delayed wound healing. Sugar control will be more difficult for diabetics, and an occasional borderline diabetic may require insulin for the first time. Many of these side effects improve as the prednisone dose is lowered over the first year and, in general, are infrequently seen.
Tissue typing is a series of laboratory blood tests which compare the genetic makeup, the natural differences and similarities between the recipient and donor. These tests cannot compare all genetic differences, but look at those which have been found to be important for the success of a transplant.
HLA (human lymphocyte antigen) typing examines a set of six antigens, three of which are inherited from each parent. Four of these are the A and B antigens which have been known for a long time; two are the Dr (region) antigens which have been more recently discovered. Cadaver donor kidneys may be matched for from 0 to 6 of these antigens. Living related donor kidneys are generally matched for three or six of these antigens, because they are inherited in groups of three. Individuals are classified as high or low responders.
Nephrologist
Dr. Rajeev Bhatia M.D. D.N.B
Mob : +91 - 98155 08161
Email : rajivkbhatia@rediffmail.com
Patel Hospital Pvt. Ltd
Civil Lines, Jalandhar, Pb
Help line : +91-181-3041000
Email : care@patelhospital.com
