Transplant - kidney

Alternative names
Renal transplant; Kidney transplant

Definition
A kidney transplant is a surgical procedure to implant a healthy kidney into a patient with Kidney failure.

Description

Kidney transplants are second only to corneal transplant as the most common transplant operation in the United States. There are over 9,000 kidney transplants performed each year.

Patients with chronic kidney disease can receive life-saving dialysis therapy until a donor becomes available. The donated kidney may be from:

     
  • Living related donor - genetically related to the recipient, like a parent, sibling, or offspring  
  • Living unrelated donor - like a friend or spouse  
  • Deceased donor - a recently deceased individual who has no known chronic kidney disease

The healthy kidney is transported in a cool saline solution that preserves the organ up to 48 hours. This gives time to perform blood and tissue donor-recipient matching tests, which are done before the operation.

PROCEDURE FOR A LIVING KIDNEY DONOR

While the patient is unconscious and pain-free (under general anesthesia), an incision is made in the side of the abdomen. The kidney is removed and the incision is closed. The traditional operation requires a long incision. However, improvements in technique use a short incision (mini-nephrectomy) or use laparoscopic techniques.

PROCEDURE FOR THE KIDNEY RECIPIENT

While the patient is unconscious and pain-free (under general anesthesia), an incision is made in the lower abdomen. The new kidney is stitched into place within the pelvis and the incision is closed.

Indications
A kidney transplant may be recommended for patients with Kidney failure caused by:

     
  • Severe, uncontrollable High blood pressure  
  • Infections  
  • Diabetes  
  • Glomerulonephritis

A kidney transplant alone may NOT be recommended for patients who have:

     
  • Heart, lung, or liver disease  
  • Other life-threatening diseases  
  • Certain infections, such as TB or osteomyelitis  
  • Difficulty taking medications several times each day for the rest of their lives

Risks
The risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

The risks for any surgery are:

     
  • Bleeding  
  • Infection

Additional risks include:

     
  • Infection due to the immunosuppressive medications that must be taken to prevent transplant rejections

Expectations after surgery

Kidney transplants generally offer the best outlook for patients with end-stage kidney disease. Most centers have patient and organ survivals of over 90% at one year, and more than 80% at three years. By 10 to 15 years, about 50% of transplanted kidneys are still functional. Kidneys from living related donors do better than from deceased donors.

However, this success is not without its costs. The patient’s immune system identifies the transplanted kidney as a foreign organ and tries to destroy it. This is called rejection. In order to avoid rejection, almost all kidney transplant recipients require life-long treatment with medications that suppress their immune response (immunosuppressive therapy).

This has several unwanted consequences. Because the immune system is suppressed, the patient has a higher risk of infection and cancer. This requires aggressive cancer screening.

The immunosuppressive medicines themselves have side effects, which may include High blood pressure and High Cholesterol, increased risk of Diabetes, and other problems.

The success of a kidney transplant depends in part on close followup and meticulous adherence to the medicine regimen.

Convalescence

For a living donor, the recovery period is 4-6 weeks. The patient should avoid heavy activity during this time. The sutures are removed after a week or so.

The kidney recipient is usually observed in the hospital for about a week. After that, he or she requires close followup in the transplant clinic and frequent monitoring of labwork.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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