Kidney Transplant
Kidney Transplant Treatments in India has become very common treatment procedure available in most of the corporate hospitals. India has the best kidney transplant surgery hospitals across all the metros. The cost of the kidney transplant surgery is also very competitive compared to other countries, that attracts medical travelers to India.
Kidney or Renal Transplantation is the transplant of the kidney into a patient who is suffering with the renal diseases. The transplantation is the choice given for the last stage of the renal disease only. Now a day’s people are more aware about the renal transplantation and they know the value of the surgery so that instead of going for the prolonged dialysis the renal transplantation is the best option.
The donors for the transplantation can be classified as two types. Living related donor and the Cadaveric donors. The living related donors are called as the first degree relatives like spouse, brother, sister, parents and children. If all the parameters are checked they are eligible as donors. The cadaveric donors are very difficult and it is mostly followed by the registration only.
Indications:
The common indication for the renal transplantation is ESRD which is called as End Stage Renal Disease. There are certain diseases which may lead to this End Stage Renal Disease which are malignant hypertension, infections, Diabetes and glomerulosclerosis. There are also certain genetic causes which are polycystic kidney, inborn errors of metabolism and some autoimmune conditions.
Donors:
The donors may be from the living donors or the cadaveric donor. Most donated kidneys come from the cadavers but it may vary from case to case and also with the countries.
Living Donors:
The potential live donors are carefully evaluated both medically and psychologically. The medical evaluation is to confirm whether the donor is free from illness and the psychological evaluation is to ensure that the donor gives the kidney by his or her own and not by the compulsion. The living donor kidney transplantation has a long term success rates and now a days the number of live donors had increased tremendously.
Cadaveric Donors:
This can be of two types called as Brain dead donor and after cardiac death donors. The brain dead donors are all considered as dead but their heart continues to pump and thus it will still maintain the circulation. So the necessary organs can be taken from the person and will be transplanted to the needy after the approval of the closest relatives consent. The other donor called as after cardiac death donors here they will have very less chance of recovery. Hence the relatives may be willing to donate the organs so the kidneys will be used for the needy persons.
Pre-Operative Procedures:
The donor and the recipient should be of the same ABO blood group and the cross matching will be done initially. Various blood tests are performed which helps to determine a donor match and also to avoid the chances of rejection. Certain other diagnostic tests will be performed for both the donor and the recipient to assess the complete health like X-ray, ultrasound, dental examinations and if necessary the biopsy can also be done. If the patient is a women they may do a Pap test, general gynecological examination and if necessary a mammogram.
A complete medical history, physical examination and the diagnostic tests will be reviewed by the team of doctors before transplantation.
Transplantation Procedure:
The existing kidneys will not be removed in most of the cases. The kidney will be placed in a different location from the original kidney usually. A left donor kidney will be implanted on the right side of the recipient and a right donor kidney will be implanted on the left side of the recipient. This usually allows the ureter to be accessed easily to connect to the bladder. The renal artery and the vein of the donor kidney will be attached to the external iliac artery and the vein of the recipient. After the procedure is completed the blood flow through the implanted vessels will be checked for bleeding at the suture lines. The ureter from the donor will be connected to the bladder of the recipient.
Post-Operative Procedures:
The post operative care for both the donor and the recipient are most important. Most commonly the recipients are given more importance and the donors are left behind but the pain is often more for the donors compared to the recipients. So the donor is also taken care for the pain aspect with the proper pain management.
A kidney from a living donor will start producing the urine immediately compared to the cadaveric kidney. Dialysis may be required until the sufficient urine output is achieved. A careful monitoring of urine output hourly is maintained. Fluid management is also important in this post operative care. Antirejection and the immunosuppressive medications will be given to the recipient. Frequent blood tests will also be done to assess the new kidney as well as the other systems such as lungs, liver etc. The mobilization of the patient is also important so as to avoid the cardiac and the pulmonary complications. A multi disciplinary approach for the patients is important for the success of the transplantation.
Complications:
Post operative complications may begin from infection, bleeding, thrombosis. The major complications are transplant rejection, sepsis which may be due to drugs given, electrolyte imbalance.
Prognosis:
The prognosis is unpredictable. The typical patient will live for 10 to 15 years and it is more for the younger patients. The patients are given adequate instructions to follow in the post operative period which include diet, exercises, life style modifications, frequent follow ups etc.