Kidney Transplantation

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A person with permanent kidney failure (end stage renal disease, ESRD) needs renal replacement theray (RRT) to remove waste from their body. This could be achieved by hemodialysis, peritoneal dialysis or kidney (renal) transplantation (KTP). KTP is the solid organ transplant where a kidney from healthy donor is removed and transplanted into a patient with ESRD. Kidney transplantation is the best treatment option that allows him to live much like a normal person.

Kidney Transplantation is typically classified as

Deceased-Donor (formerly known as cadaveric) where organ from brain dead individual is utilized.
Living-donor transplantation organ from related (living-related) or non-related (living-unrelated) donor depending on whether a biological relationship exists between the donor and recipient is used.

Generally most patients with ESRD can undergo KTP but some people with kidney failure specially patient in older age and severe heart or vascular disease may be unfit to undergo kidney transplantation and are treated with long term dialysis. The conditions that prevent a person from being eligible for kidney transplantation include:

Active or recently treated cancer.
Active infection.
A chronic illness that could lead to death within a few years.
Dementia/Poorly controlled mental illness.
Severe obesity (a body mass index greater than 40).
Current drug or alcohol abuse.

A successful transplant takes a coordinated effort from the health care team which includes nephrologist, transplant surgeon, transplant coordinator, and dietitian. But the most important members are the patient and his family. By learning about the treatment, one can work along with the health care team to give the best possible results and the patient can lead a full, active life.

The Transplant Process

The transplantation process begins when the patient understands that his kidneys are failing and now he must start to consider the treatment options like maintainence dialysis or kidney transplantation. The healthcare team thoroughly evaluates the patient and then tells about his fitness for successful transplantation.

Medical Evaluation at a Transplant Centre

The patient medical evaluation is done to access fitness for undergoing transplantation. A detailed workup for transplantation is started. The patient blood is tested for blood type and other matching factors to determine whether the body will accept an available kidney. The medical and surgical team evaluate to see whether the patient is healthy enough to undergo the surgery. Cancer, a serious infection, or significant cardiovascular disease would make transplantation unlikely to succeed. At each step of evaluation the team want to make sure that the patient can understand the process and follow the schedule for taking medicines.

Kidney Recipient Evaluation

Suitability for kidney transplantation is basically depends on two factors:

Blood group The recipient blood group (A, B, AB, or O) must be compatible with the donor's blood group.
HLA factors HLA stands for human leukocyte antigen, a genetic marker located on the surface of white blood cells. Every individual inherit a set of three antigens from the mother and three from the father. A higher number of matching antigens increases the chance for the transplanted new kidney to last for a long time.
If one is selected on the basis of the first two factors, a third is evaluated: Antibodies (Cross match) A person immune system may produce antibodies that act specifically against antigen in the donor's tissues. To see whether this is the case, a small sample of recipient blood is mixed with a small sample of the donor's blood in a tube. If no reaction occurs, this is described as negative cross-match. This suggests that one will be able to accept the particular donor kidney.

Kidney Transplantation

Kidney Transplantation is typically classified as

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