Sunday, 27 January 2008

A little about kidney transplants....

Over 1,500 kidney transplants are performed in the UK every year and many more could be performed if more kidneys were available. The first kidney transplant operations were performed in the 1950s. The operation itself is straightforward, and the success rate for kidney transplants is excellent and higher than for other kinds of organ transplants.

Tests before the operation….

Someone who is called into the hospital for a transplant is not guaranteed to receive it. Before the operation can go ahead, it is necessary to check that you are well enough to have the operation and will not reject the transplanted kidney.

o Physical examination - even if you have so much as a cold the operation could not go ahead due to risks and you may be sent home.

o Cross-match - the cross-match is a blood test that checks there are no antibodies (substances that normally help the body to fight infection) that would react with the donor kidney. High levels of such antibodies in the blood mean that the new kidney is likely to be rejected as soon as it is put in, even if it seems a good match.

The operation….

An operation to transplant a kidney requires a general anesthetic and lasts about two to three hours. The recipient’s own kidneys are usually left in place. The transplant kidney is placed lower down in the abdomen, just above the groin.

When the patient wakes up they will have lots of tubes coming out of them. These will include:

  • a urinary catheter (a tube into the bladder)
  • a central venous pressure (CVP) line. This is a tube which goes into a large vein under the collarbone or in the side of the neck, and measures the pressure of blood inside the heart
  • an intravenous drip in the arm (to give the patient fluid and drugs if necessary); and, probably
  • one or more surgical drains coming out of the abdomen (to drain off any fluid that gathers around the kidney after the operation).

In about one third of kidney transplants, the kidney does not produce any urine in the first few days after the transplant. This does not mean that the transplant will never work. If the transplant does not work at the start, dialysis will be required and the patient will need to play a waiting game until the kidney starts working.

Click here to see an animation of how a transplant takes place ...

The future after a kidney transplant…

The stay in hospital is usually about two weeks. After leaving hospital, clinic visits are very frequent for months - initially two or three times per week.

The transplanted kidney provides enough kidney function and after a successful transplant, there is no need for dialysis, provided the transplant continues to work well. A ‘good’ transplant provides about 50% of the function of two normal kidneys (compared with only about 5% from either type of dialysis). However, it is not a complete cure for all the problems of kidney failure. This is because it is necessary to take drugs to keep the transplant working, and these have side effects.

Patients who have a successful transplant should feel better and have more energy. There may still be a need to watch your diet to protect the kidney (but not half as much restriction as there is on dialysis).

If a transplant fails, you can go back to dialysis or have another transplant. Even a successful transplant may not last forever. You have to take a range of medication daily to prevent rejection (the process in which the body’s immune system recognises a transplanted kidney as "foreign" and tries to remove it) of the new kidney. These are called immuno-suppressants they are drugs that are used to make the immune system less effective, so that a transplanted kidney will not be rejected these are taken for the rest of your life.

Hopefully the call will come soon... and this will be a reality!

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