Renal Transplant

A renal transplant is a surgical procedure wherein a kidney from a donor, either living or deceased, is put into the body of a recipient whose kidneys are no longer working properly.

What is the Need of a Renal Transplant?

The role of the kidneys is to remove the toxic wastes present in the blood from the body. During the various metabolic processes inside our body, several waste products are formed. These products ought to be removed from the body otherwise they may produce toxicity. Kidneys filter the blood and remove the excess fluids and waste products in the form of urine.However, in certain people, the kidneys fail to do their normal function. This may lead to accumulation of the toxic products inside a body, which is a highly dangerous situation. This condition is called as end stage kidney disease or renal failure.In such a scenario, in order to stay alive, the patient either has to get is blood filtered on a regular basis through a procedure called as dialysis or he may require a new kidney by way of a renal transplant.

Causes of End Stage kidney Disease

There are several reasons behind end stage kidney disease. They include:

• Diabetes
• Uncontrolled hypertension lasting for long duration may damage the kidneys
• Chronic glomerulonephritis- an inflammatory condition that affects the glomeruli of the kidneys. Glomeruli are the main functional units of the kidneys involved in filtration of blood.
• Polycystic kidney disease which is a genetic condition.

How can a Patient Get a kidney for Transplant?

There are several mechanisms through which a patient of end stage kidney disease can get a kidney for transplant. They are:

• Through a Live Donor: A live donor may be related to the recipient or not. The only necessary condition is compatibility of blood and tissue.

• Through a Deceased Donor: in case a person is unable to find a live donor, he can get his name placed on the waiting list for deceased donor kidney. As kidneys from deceased donor are few in number compared to people requiring renal transplant, a patient may have to wait for several years before he gets a kidney.

• Paired kidney Donation: This is done if the blood and tissue of the donor are not compatible with the recipient. In such a case, rather than donating the kidney directly to the patient, the donor gives his kidney to a person whose blood and tissue match with the patient. The other person then gives his kidney to the patient.

It is important to note that one kidney is sufficient to filter the blood in a person. So, a person suffering from end stage kidney disease requires only one donor kidney.

Renal Transplant Surgery

Once an ideal donor, whether living or deceased, is found, the doctor prescribes certain medicines to the recipient. He is supposed to take his medicines and follow the diet and exercise regimen as prescribed.On the day of surgery, the patient is administered general anesthesia. Kidney excised from the donor is placed in the lower abdominal cavity of the recipient. The blood vessels of the kidney are suitably anastomosed, and the ureter is attached to the bladder of the recipient. The old non-functional kidneys are removed only if there is some infection, pain or renal stones.The new kidney becomes functional almost immediately. The patient is prescribed immunosuppressant medicines so that his body does not fight with the new kidney and rejects it. He may also require medications to fight off any potential infection. He is supposed to take these medicines life-long. The patient is kept under observation in the hospital for some days but is supposed to come for regular check-ups.In case of live donor transplant, life expectancy is around 5 years for 90% of the patients. In case of deceased donor transplant, 82% patients survive for five years following the transplant.Reference:Barry JM, Conlin MJ. In: Renal transplantation. Wein AJ, ed.Campbell-Walsh Urology