Table of contents:
- Kidney Transplant Types
- Indications for Kidney Transplant
- Kidney Transplant Alert
- Before Kidney Transplant
- Kidney Transplant Procedure
- After Kidney Transplant
- Kidney Transplant Complications
Kidney transplant or kidney transplant is a surgical procedure to replace kidney organs that have been damaged by end-stage chronic kidney failure. The transplanted kidney can come from a living or deceased donor
Kidneys are very important organs for the body. This pair of organs has the function of filtering and removing waste substances, fluids, minerals, and toxins in the body through urine.
When kidney function declines, such as in kidney failure, substances that should be removed will accumulate in the body, so that it can cause he alth problems. That's why someone whose kidneys are no longer able to function properly needs to get therapy that can replace kidney function.
In the early stages of kidney failure, kidney function may still be helped with dialysis and continuous ambulatory peritoneal dialysis (CAPD). However, if kidney function has severely decreased, neither dialysis nor CAPD can bear all the work of the kidneys.
So, to treat kidneys whose function has greatly decreased due to end-stage chronic kidney failure, kidney transplantation is believed to be better in prolonging life and improving the quality of life of patients.
Kidney Transplant Types
Based on the donor category, kidney transplants are divided into two types, namely:
- Living-donor kidney transplant, which is a transplant of one kidney from a living donor
- Deceased-donor kidney transplant, which is a kidney transplant from a recently deceased donor, with the permission of the family or the wish of the donor while he was still alive
In Indonesia, new kidney transplants are performed from living donors.
Indications for Kidney Transplant
As mentioned above, kidney transplantation is performed on patients diagnosed with end-stage chronic kidney failure, a condition when kidney function has severely decreased and toxins have accumulated in the body.
The following are signs that kidney function has decreased significantly:
- Accumulation of fluid in the body, such as in the arms, legs, and lungs, which causes swelling of the body parts, shortness of breath, and decreased urine production
- Nausea and vomiting
- Appetite decreased
- Pale and dry skin
- Easy to feel tired
- Easy to bruise
- Muscle, joint or bone pain
- Daze to a loss of consciousness
The following conditions can increase a person's risk of developing chronic kidney failure:
- Diabetes type 1 or type 2
- High blood pressure or hypertension
- Hemolytic Uremic Syndrome
- Sickle cell anemia
- uric acid disease
- Rheumatoid arthritis
- Several types of cancer, such as lymphoma, multiple myeloma, and renal cell carcinoma
- HIV infection
- Disorders with the flow of urine, for example due to urinary tract stones
- Polycystic kidney disease
Kidney Transplant Alert
To undergo a kidney transplant, the patient must be in a fairly he althy condition, so the chances of recovery are high. Therefore, end-stage chronic kidney failure patients with the following conditions are generally not allowed to undergo kidney transplantation:
- Bacteria or viral infections that are not handled properly, such as tuberculosis (TB) that spreads
- severe cardiovascular disease, such as heart failure
- Cancer that has spread
- Chronic hepatitis and liver cirrhosis
- Severe mental disorder or psychosis
In addition, conditions that can weaken the body, such as smoking, excessive alcohol consumption, or substance abuse, will increase the risk of kidney transplant failure.So, patients with this condition may not be given priority to get donor organs.
The age of the donor and recipient is also an aspect to be considered, because with increasing age, the risk of complications and transplant failure increases. In addition, the compatibility of the kidneys, blood types, and body tissues of the recipient and donor must also be ensured.
Before Kidney Transplant
Before undergoing a kidney transplant, the doctor will evaluate by asking the patient several questions regarding the history of the disease that has been suffered, the drugs used, and the history of allergies to anesthetics and immunosuppressant drugs.
The doctor will also carry out a general examination, starting from a physical examination, blood tests, scans, such as X-rays, CT scans, or MRIs, to psychological examinations to ensure the patient's physical and mental readiness. This process may take several days.
Patients also have to do some tests to ensure compatibility with the donor kidney. This aims to suppress the potential rejection of the body against the new kidney organ. Some of these tests are:
Check blood group
The first step is to check the patient's blood group. The goal is to find out whether the blood types of the patient and the donor match.
If the blood type matches, a tissue check is performed to determine the compatibility of the donor and patient tissues. This test is performed by examining human leukocyte antigen (HLA), where the donor's gene will be compared with the gene of the patient or recipient.
Blood compatibility test (crossmatch)
In this last test, a sample of donor blood and a patient's blood sample will be taken and then mixed in the laboratory to check for a reaction. If there is no reaction, the donor and patient's blood is considered compatible and the risk of organ rejection by the body is low.
In patients who have not received a kidney donor, the doctor will advise the patient to do the following things to get a potential kidney donor:
- Living a diet that has been adapted to he alth conditions
- No smoking
- Don't drink alcohol
- Exercise regularly
- Consuming drugs that have been prescribed by the doctor
- Consult a doctor regularly
If the donor and recipient are ready and a date has been set for kidney transplant surgery, both the donor and recipient will be asked to fast for 8 hours before the kidney transplant procedure is performed.
Kidney Transplant Procedure
Kidney transplant procedure is performed at the same time as surgery to remove a kidney from a donor. The following are the steps that doctors do in the kidney transplant procedure:
- Patients will be asked to change into hospital clothes.
- After changing clothes, the patient will be asked to lie on the bed in a supine position.
- The doctor will give an injection of general anesthesia (general anesthesia), so that the patient will not feel anything during the procedure.
- The doctor will make an incision in the lower abdomen.
- After the kidney is removed from the donor, the doctor will attach the kidney to the patient's body without removing the patient's old kidney, unless there is an infection or previous pain complaint.
- The doctor will connect the blood vessels in the new kidney to the blood vessels in the stomach, so that the new kidney gets a blood supply and can function normally.
- The doctor will connect the urinary tract (ureter) from the new kidney to the bladder. The doctor may also place a stent (a special small tube) in the new ureter to allow urine flow for 6–12 weeks after the transplant.
- When the kidney is fully attached, the doctor will close the incision in the abdomen with stitches.
Overall, a kidney transplant procedure generally takes approximately 3 hours. During surgery, the patient's blood pressure, heart rate and blood oxygen levels will be continuously monitored.
After Kidney Transplant
After the effect of anesthesia (total anesthesia) begins to decrease, the patient will feel pain at the incision site. The doctor will give pain medication to relieve it.
After undergoing a kidney transplant, the patient needs to be hospitalized for at least 1 week so that the doctor can observe and ensure that there are no effects or complications.
After being discharged, the patient will be asked to rest at home for at least 6 weeks and avoid strenuous physical activity or lifting heavy objects before the doctor allows.
In general, the new kidney organ will immediately work according to its function. However, sometimes it takes several days or several weeks, so the patient still needs to undergo dialysis until the new kidney works normally.
To suppress the potential for rejection of donor kidney organs, patients will be given immunosuppressant drugs, such as ciclosporin, tacrolimus, corticosteroids, or mycophenolate mofetil.
Immunosuppressants are drugs that can suppress the immune system, so that the immune system does not attack the donor's kidney organs which it perceives as foreign objects.
Besides giving immunosuppressants, doctors can also give antibiotics, antivirals, or antifungals to prevent infection due to a suppressed immune system.
To expedite the recovery process, patients are required to carry out regular check-ups and take medicines prescribed by doctors.
Kidney Transplant Complications
The following are complications that can occur as a result of undergoing a kidney transplant:
- The body's rejection of the new kidney, so that the kidneys fail to function
- Blood clot
- The passage of urine from the new kidney to the bladder is leaking or obstructed
- Heart attack
In addition to complications from the procedure, kidney transplant patients may also experience the side effects of immunosuppressant drugs, such as:
- Gain weight
- bone loss (osteoporosis)
- High blood cholesterol level
- Easy to get infected