FAQ’s – KIDNEY TRANSPLANTATION
- When does a person require kidney transplant? Damage to the kidneys may result in its inability to remove toxic waste products and extra fluid from the body, regulate blood pressure, maintain a proper balance of fluid and salts such as potassium, calcium and phosphorous. Hence, persons whose kidney totally stops functioning (i.e. permanent kidney failure) require a kidney transplant. Kidney transplantation is a process of replacing the non-functioning kidney with a kidney obtained from living or deceased (dead) donor.
- Is kidney transplant suitable for everyone? Although most of the patients with kidney failure can be considered for kidney transplantation it may not be recommended in a few. Kidney transplant involves a major operation and requires a person to take immunosuppressant drugs (to prevent rejection of new kidney). For some people the operation and the side effects of the drugs may be too dangerous. These include very old people and patient having severe or uncorrectable heart disease or lung disease, serious infection (such as hepatitis, tuberculosis, HIV), cancer, and problem of drug/alcohol abuse. Hence, it is essential to get an assessment of the overall health status of a person before considering them for kidney transplant.
- Can I receive any kidney? No, before implanting a donor kidney it is imperative to undergo some special blood tests such as blood group typing, HLA typing, Cross matching and panel reactive antibody test. These tests enable your doctor to determine whether the donor kidney is suitable for you or not.
- Will my own kidneys be removed? In case you are suffering from severe high blood pressure uncontrollable by medications and dialysis or if the kidneys are chronically infected then your kidneys may be removed. Otherwise they will be left in place.
- How long will I be in the hospital? The length of your stay in the hospital will depend upon your condition. Usually one has to remain in the hospital for 1-2 weeks after the transplant opaeration. If everything is fine the patient is encouraged to move out of the bed on the day following surgery and may resume eating solid food within 2-3 days. However, if your kidney does not work right away or if there are chances of rejection then your hospital stay may be prolonged.
- Will my new kidneys work right away? If the kidney is obtained from a deceased donor there are chances that it may not start functioning right away. During the process of removing the kidney, storing it and placing it in the recipient some degree of damage may occur in the kidney. This is called acute tubular necrosis (ATN). This damage is reversible and it may take three or more weeks for the kidney to start making urine. Till then the patient is kept on dialysis. ATN can also occur in living related donor transplantation, but it is much less common.
- What is rejection? Normally our body’s defense mechanism or the immune system protects us against any foreign body such as viruses, bacteria etc. So when a kidney from the other person is transplanted, your body may recognize it as a foreign invader and hence attack it to get rid of it. This is called as rejection. Hence, to prevent your body from rejecting the new kidney you will be kept on immunosuppressant drugs (which suppress the natural immune response) for the rest of your life.
Rejection is most likely to occur in first three months after the transplant. However it may occur many years later for many reasons especially if you do not follow the medication schedule prescribed by your doctor. Most rejection episodes can be treated with medications.
- What are the signs and symptoms of kidney rejection? Fever (100o F or more), weight gain (more than 2 lbs or 1 kg in a day), pain in the kidney region, decreased urine output may be the warning signs of kidney rejection. Hence, immediately consult your transplant team if you observe any of these symptoms/signs after kidney transplant.
- Do I need to take any medications after transplant? Following kidney transplantation you will be put on immunosuppressant drugs, which suppress your immune system and hence prevent your body from rejecting the new kidney. Because the body never accepts the new kidney as part of itself, rejection can occur anytime. Therefore you will need to take these medications for the rest of your life. However, it may be possible to reduce the dosage of medications gradually over time. The three main immunosuppressants in use are Cyclosporin, Azathioprine and Prednisolone
- Do these medications cause any side effect?Although side effects may occur they are usually a problem only in the beginning when the doses of the medications are high. Once the body gets used to the drugs and the dosage is decreased the side effects will lessen. The common side effects include excessive hair growth or hair loss, weight gain high blood pressure, skin problems such as acne.
- How frequently do I have to come back after kidney transplant? Because the chances of rejection of kidney are more in the earlier months you will have to come to the hospital more frequently. In the first weeks after the transplant you will need to come back at least twice a week so that your transplant team can monitor the status of the kidney. Thereafter, the visits are gradually spaced out so that by the end of the first year you will be seen monthly, and later at least once in a year.
- Will I be able to resume my job soon after kidney transplant? Depending on your response to kidney transplant, development of any complications and the kind of work you do, your transplant team will encourage you to return to work as soon as possible after transplant. Most people are able to resume their previous employment by 8-12 weeks unless they do manual labor or develop some complications. Before joining your work it is advisable to consult your doctor and get a thorough check-up done.
- Do I need to undergo any screening tests after kidney transplantation? The use of immunosuppressant drugs decreases your immunity thereby increasing your risk of having infection, cancer or other diseases. Hence, you will need to undergo the following:
- Post transplant diabetes is common hence get your blood sugar checked at frequent intervals.
- Visit your dentist every six months for a check-up to avoid infections and/or cavities.
- Get a bone density test done annually.
- Women should get a pelvic examination and pap smear done annually to rule out cancer of cervix. Women above the age of 40 should have an annual mammogram done for breast cancer.
- Men over the age of 45 (having family history of prostate cancer) or 50 years should get Prostate specific antigen (PSA) done annually.
- All people over 50 years should get them screened for colon-rectal cancer including rectal examination every 2 years.
- Meet your dermatologist if you observe any unusual skin changes to rule out skin cancer.
Are there any health risks to the donor? You may carry the usual risks related to surgery. These include the risk of bleeding, wound infection, and anesthetic side effects. A pre-assessment of the donor’s health status is done to identify any special factors that would place a donor at increased risk. It is important to know that donating a kidney does not change your life expectancy or increase your chances of kidney failure. In fact, you can lead a normal and healthy life even with a single kidney