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Transplant – Recipient

by Dr.P.N.Gupta

This information sheet summarises the information that the transplant surgeon gives you at the time of your renal transplant assessment. If there is anything that you do not understand do please ask him or one of your doctors.

Why do I need a kidney transplant?
  • Patients with chronic kidney failure (stage V – chronic kidney disease when kidney function is irreversibly decreased to less than 15 %) have three choices for treatment :
  • Hemodialysis
  • Continuous ambulatory peritoneal dialysis – CAPD
  • Kidney transplantation
  • Hemodialysis: Blood is passed through a dialysis machine and cleaned up in the same way as do the normal kidneys. It is done for 4 hrs three times a week.
  • CAPD peritoneal dialysis works by passing 2 liters of special fluid into the tummy. Some of the toxic chemicals in your blood pass into the fluid and, after 3-4 hours the fluid is drained out with toxins. The process is repeated 4 times in 24 hrs.
  • Kidney transplant: A kidney transplant is just another means of replacing a failed kidney. In addition to filtering the blood like dialysis, it has the advantage that it also provides its own erythropoeitin (epo) and controls phosphate.
  • Of the 3 modalities, kidney transplant provides the best outcome in terms of longevity, quality of life and the cost of treatment.
Is a transplant right for every body?
  • No, A transplant involves a major operation, and requires you to take drugs life long to stop your body rejecting it. For some people the operation and the side effects of the drugs are too dangerous, for example if you have bad heart disease or are very old or your expected life span is less than 5 years.
Where do kidneys come from?
  • The source of kidney is usually from a relative (e.g. a brother, sister or parent) or spouse (partner) who wants to donate a kidney and who has the right blood group and suitable kidney cell markers (the tissue type) as per the Indian law. However cadaver donors (donors who are brain dead) can be significant source of organs for donation as in the west.
Can I catch anything from my transplant?
  • All potential donors are carefully screened to make sure that you do not catch potentially infectious diseases such as hepatitis or AIDS.
Do I need to take any drugs after transplant?
  • Following your transplant you need to take drugs to stop your body rejecting the kidney. These drugs are called immunosuppressants. Because your body can reject the kidney at any time the drugs must be taken every day, although the doses can be reduced as you progress after the transplant. At the moment there are three main drugs, which we use.
  • Cyclosporin / Tacrolimusarethe most important drugs to stop rejection. It can itself cause some minor damage to the kidney, but this is out-weighed by the effect it has to stop your body destroying the kidney. It may also cause high blood pressure and increased facial hair growth. Lastly it can cause your gums to swell if your teeth aren’t in good condition so you should visit the dentist every 6 months.
  • Mycophenolate Mofetilhas fewer side effects but can cause diarrhoea and heartburn. In addition it can also cause reduction of blood cells from the bone marrow, therefore regular blood tests will be required with the use of this medicine.
  • Azathioprinehas few side-effects, apart from reducing the number of cells produced by the bone marrow, so you will have regular blood tests at the hospital.
  • Prednisolone(“steroids”) has some side effects as well. It can cause some swelling of the face and also increases your appetite so that patients will put on weight unless they try hard not to. Both cyclosporin / tacrolimus and prednisolone may produce diabetes in some patients and this may need tablets or injections to correct. This is however uncommon.
  • Although side effects may occur they are really a problem early on while the doses of the drugs are high, and are much less of a problem later on as the amount that you need to take is reduced.
  • Many new specific drug protocols & their pros and cons can be considered by your physician and discussed with you.
Where do you put the kidney?
  • The kidney will be placed in the upper part of groin and connected to the blood vessels that take blood to and from the leg. Your own kidneys will be left in place, although occasionally it is necessary to take out large kidneys in patients with polycystic disease, or take out kidneys, which are a source of infection.
How long does the operation take?
  • The operation takes about two and a half hours. You will usually be in the operating theatres for longer than this because it can take up to an hour to prepare you for your operation and give the anaesthetic, and another hour or so for you to recover afterwards before you are sent back to the ward.
How long will I be in hospital?
  • You will be in hospital for 7-9 days. Occasionally you may need to stay longer if a problem arises which needs treatment.
How often do I have to come back after my transplant?
  • In the first 4 weeks after the transplant you will need to come back at least twice a week so that we can keep a close eye on you. After that the visits are gradually spaced out so that during the first year you will be seen monthly, and later 4-6 times a year. This is because the chances of problems, such as rejection, occurring are highest in the first few months and less likely thereafter.
What is rejection and does it matter?
  • When you catch a cold it gets worse over the course of a few days. Shortly after that it goes away. It goes away because your body, or more specifically the immune system in your body, attacks the infection and gets rid of it. In the same way if we were to give you a kidney without any other treatment your immune system would attack and destroy the kidney. Giving you three three immunosuppressants described earlier stops your immune system attacking the kidney, but occasionally your body still succeeds in attacking it, a process that we call acute rejection.
  • Acute rejection is treated by giving you a high dose of steroids for 3-5 days, and occasionally you may need a second treatment with something stronger. Each episode of rejection may damage the kidney a little bit if we do not treat it soon enough. Because rejection is more likely to occur soon after transplantation we like to see our patients very frequently for first 3 months and then every month for one year.
Will I be involved in trials?
  • From time to time the Transplant Unit may try out new treatments or drugs, which may possibly be helpful to you because they may offer less side effects or better kidney function. You may be invited to take part in such a trial. If you are invited please remember that you do not have to take part, and that if you decide not to participate then you will have the standard treatment, which will not be affected in any way by your decision. Please feel free to discuss this with the transplant team at any time.
How successful is kidney transplant?
  • Kidney transplant is the best form of treatment for patients with kidney failure. Currently the success rates are more than 95 % at 1 year and 85-90 % at 5 years.
What are the risks from having a transplant?
  • There is the risk from having the operation, particularly if you have heart problems or lung problems.
  • There are risks due to having immunosuppression. Because immunosuppression suppresses your body’s ability to fight infection you are more prone to infection, including some infections, which you won’t have heard of because they only affect immunosuppressed patients. Some of these infections can be life threatening. This risk is high early after the transplant operation, but becomes less of a problem after a year as the amount of treatment you require gets less. The risk is also higher in the elderly patient who may not be strong enough to fight serious infections.
  • Lastly transplantation puts you at risk of certain sorts of cancer, in particular skin cancer and cancer of the lymph glands. The risk of skin cancer is higher if your skin has been exposed to the sun a lot. Although cancers can be frightening, transplantation is often a better alternative than dialysis, which may also cause life-threatening problems such as arterial disease.
  • It is the opinion of most experts that the small risks of cancer are much less important than the longer life and better life quality that can be achieved with a kidney transplant.
What can be done to prevent these complications?
  • The following can be helpful
    • Regular monitoring and visits to the treating physician & optimizing drug therapy.
    • Healthy life style
    • Face mask is not necessary – does not reduce the risk of infections.
    • Normal activities should build general well being.

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