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Transplant Procedure

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  • You will be admitted to the hospital 48 hours before transplant.
  • A nephrologist, transplant surgeon, anesthesiologist will assess your fitness.
  • Lymphocyte crossmatch test to check if there are no preformed antibodies in recipient towards donor cells are rechecked and confirmed again.
  • If you are found to be fit in this final assessment and repeat crossmatch is negative, and there is no evidence of active infection, you will be started on immunosuppressive medications- which will prevent kidney rejection.
  • You will be given a hemodialysis session 24 hours prior to operation so that creatinine, electrolytes, and water status is optimal and safe for anesthesia and surgery. CBC, electrolytes, PT, PTT Xray chest will be re-done to check for same.
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Operation procedure

Surgical-technique

Surgical technique:
If you have got living donor, the nephrectomy (removal of kidney) is performed via laparoscopy technique. The left kidney is usually preferred. Once the kidney is removed, it will be flushed with preservative fluid as soon as possible, and the kidney will be cooled and kept on ice. If its deceased donor is surgically removed with other organs and transferred to the respective hospital in perfusion fluid and ice, the kidney will be examined, all clots and blood removed renal artery and vein prepared to be joined in the recipient.

Recipient-procedures

Recipient procedures
 kidneys are usually kept in the right iliac fossa. Donor kidneys artery is joined to recipients external/internal iliac artery. Donor’s vein is joined to recipient external iliac vein. Once joining is over recipient s blood will flow through the transplanted kidney, and filtration starts immediately in almost 95% of live donors and 60% of deceased donors. Once the kidney blood supply starts, the ureter is implanted into the bladder through an opening created and sutured. Usually, a ureteric tube (stent) is kept in the ureter to the bladder, which is removed after 4 weeks. Both donor and recipient surgeries are done under general anesthesia. Native recipient kidneys are not usually removed unless they have stones, infection, or are too big for a new kidney to accommodate.

After both donor and recipient are out of anesthesia and can breathe on their own, ventilators are removed, and recipient and donor are shifted to ICU. Both monitored in ICU for fluid balance, urine output, BP, respiration every hourly. The recipient will be continued immunosuppressive drugs.

The donor will be shifted towards in 2 days and discharged on 4-5 days. The recipient will have an ICU stay of 4 days and a subsequent ward stay of 6-7 days. The urine catheter will be removed on days 3-5. Drain tube from a surgical site that is in place to drain all the fluid or blood accumulating in the surgical site will be removed when drained fluid stops draining. Daily both will be monitored for CBC, renal functions, blood sugars in ICU and wards Will be educated on care, precautions, medication doses, diet to be followed, and follow up visits schedule and monitoring.

Complications after kidney transplant:

Rejection

Rejection:
 When the recipient's blood flows through the donor’s kidney, the defence cells of the recipients' blood recognize new kidneys as foreign cells and try to fight with them to remove them. This process will cause rejection and lead to a decline in the function of the kidney. We give drugs that will depress the immune system of the recipient so that it will not fight/ reject the new donor kidney; these medications are called immunosuppressives. Fortunately, because of the availability of potent drugs rejection rate is less than 10% and 90% of rejections are reversible. Rejection will be suspected when there is a decrease in urine output, increasing creatinine, fever, or tenderness over the kidney. Diagnosis of the rejection is proved by biopsy of transplant kidney. As you are on immunosuppressive drugs your defence power is less, and you will be prone to infections. you will be given drugs to prevent infection(prophylaxis). You should take precautions to prevent infections, like wearing a mask, hand washing. If you get fever, breathlessness, contact your transplant team immediately. Early detection of infection and treatment is important. Complete all your vaccination two weeks prior to transplant. Other early complications include a clot in the renal artery, vein, leakage of urine around the kidney, but due to improvement in surgical techniques, these complications are rare now to the tune of 3-5%.

Long term complications:
  • Obesity
  • Infection
  • Heart attack
  • Stroke
  • Side effects of steroids: osteoporosis, cataract
  • Chronic rejection leads to total failure of transplant kidneys.
  • Very rarely, kidney transplant patients can get cancers as a complication of immunosuppressive therapy.

Life after kidney transplant

A kidney transplant can remarkably improve the quality of life of the patients. However, there are certain practices and measures that you need to follow to live everyday life.

Regular-follow-ups

Regular follow-ups
You may have to do frequent follow up with your nephrologist for the initial few months after the transplant. They will keep a check on the body's response to transplant and any complications which may arise. It is critical to comply with the doctor's advice and does not miss the appointments.

Immunosuppressants

Immunosuppressants:
As our body have a tendency to reject the foreign object and organ. You may have to take immunosuppressant medicines to avoid the possibility of rejection of the organ.

Hygiene-and-lifestyle

Hygiene and lifestyle:
Staying active and practising good hygiene is an excellent contributory factor for recovery. Live a healthy lifestyle by engaging in any form of physical activity, eating a balanced diet, avoiding smoking, alcohol, etc.

Living well with kidney transplant:

Living healthy after a kidney transplant may require various modifications in your daily lifestyle and to avoid complications. Therefore, it is recommended that you:

Eat-a-healthy-diet

Eat a healthy diet:
Prefer eating food that includes fresh fruits, vegetables, whole grains, etc. This will keep you fit and healthy.

Stop-smoking

Stop smoking:
Smoking has been linked with a high risk of cancer and various other health problems. It is important to quit smoking.

Lose-weight

Lose weight:
Being overweight or obese increase the risk of cancer and various other health problems. Indulge in some form of physical activity like regular exercising, yoga, etc., to ensure you stay fit and healthy.

Listen-to-your-doctor

Listen to your doctor:
Follow your doctor's advice and instruction diligently as it will not only help you to prevent infection but also help it recover soon.

Success rate and life expectancy after kidney transplant:

Because of progress in surgical technique, new potent immunosuppressive drugs, overall care survival after kidney transplant has improved

Living donor kidney survival:

  • 1 year – 97%
  • 5 year: 88%
  • 10 year 80%

Deceased donor kidney:

  • 1 year – 97%
  • 5 years: 80%
  • 10 years: 72%

Causes of death

  • Cardiovascular disease (heart attack/stroke) - 42-47%
  • Infection- 15-18%
  • Cancers- 9-15%
  • Unknown- 23-31%

Choosing ideal kidney transplant centre:

It is essential to learn about different transplant hospitals and centers before finalizing the one. Here are a few things to keep in mind while choosing a transplant hospital/center:

  • Consult more than one doctor, talk to patients who have undergone kidney transplants in the hospital, and know about their experience.
  • Whether the center/hospital has expertise in living or deceased donor transplants.
  • The reputation of the hospital/center and its mortality rate for kidney transplant patients.
  • If the hospital/center is covered under your insurance policy.
  • Total experience the hospital/center hold in dealing with kidney transplant cases.

Cost analysis of Kidney Transplant

Living with a disease that badly affects your life is an extremely painful experience for the patient and his family. Patients who opt for dialysis may need to spend around Rs. 25000 per month on 7-10 sessions. Getting a kidney transplant can undoubtedly improve the quality of life of the patient. The average cost of Kidney transplants in India varies between 7-10 lakh approximately. It is important to check with your insurance company whether the transplant cost is covered in your plan. Various factors that will affect the cost are:

  • Hospital infrastructure and location
  • Organ and transport charges
  • Length of stay in hospital
  • The expertise of surgeons, their team, and use of advanced technology
  • Any health complications
  • Recovery and rehabilitation
  • Post-transplant medications

A patient who travels from home to hospitals for transplant also needs to keep the cost of staying near the new city's hospital. The cost of staying also adds up over the course of a few months.

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