Kidney Transplantation

The kidney is a very complex organ with several functions, including:

Waste product excretion
Control of blood pressure
Regulation of blood levels of various chemical substances (including potassium, sodium, and phosphate)
Production of hormones (including erythropoietin and vitamin D)

So it is not surprising that dialysis is an imperfect method of replacing kidney function. Renal transplantation, the implantation of one person’s kidney into another, has been available as a means of renal replacement therapy since 1954. When the transplanted kidney works well, it is able to perform all of the functions of a normal kidney and to do so 24/7, allowing a much more normal lifestyle than dialysis can provide.

Finding a Kidney

Deceased donors – The source of transplanted kidneys is usually deceased donors: people in good health who die of non-kidney-related conditions such as motor vehicle accidents or suicide. In such cases, the kidneys (and often other organs) are harvested after death and are implanted into patients within hours.

Living donors – In recent years, it is increasingly common to see kidneys for transplant obtained from living-related donors (usually a parent, sibling, or adult child) or from living unrelated donors (most commonly a spouse, sometimes a friend or even a stranger). In these instances, the donor and recipient are in adjacent operating rooms, and one kidney is removed from the donor (often via small-incision laparoscopic surgery) and implanted into the recipient within minutes.

Determining Compatibility

Before a patient can receive either a deceased or living donor kidney, both the donor and recipient must be tested to be sure that their blood types and tissue types are compatible. Living related donors obviously have a better chance of being a suitable match than do deceased or living nonrelated donors. However, while ABO blood type compatibility remains important, the tissue match (which is based on so-called “HLA antigens”) does not need to be a perfect one, thanks to the efficacy of current immunosuppressive medications that help to prevent rejection of the transplanted kidney.

Transplantation Surgery

A person’s “native” kidneys are located in the back on either side of the spine, just below the ribs. Native kidneys are almost always left in place in a patient with ESRD (unless they are infected, cancerous, or otherwise causing problems).

A transplanted kidney is placed in the lower part of the front of the abdomen, either on the left or the right lower side, just above the groin area. The transplanted kidney’s blood vessels are attached to the patient’s own leg blood vessels, and the transplanted kidney’s ureter (the tube that carries urine from the kidney to the bladder) is implanted into the patient’s own bladder.

After Surgery

Transplanted kidneys sometimes fail to work. Other times, partly because of the shock of being removed from the donor and transported (often long distances) to the recipient, a transplanted kidney does not work immediately but may take several days to begin to work.

Once the transplanted kidney begins to function, the recipient is able to stop dialysis. If the kidney functions properly, the recipient is able to assume a relatively normal lifestyle, although they must be constantly vigilant for signs of rejection or infection.

Preventing Rejection

It is important for the recipient to faithfully take immunosuppressive medications in order to avoid rejection of the kidney, which can occur at any time, but is most likely to occur within the first few days to months after the transplant. If rejection does occur, there are a number of medications and treatments that can be used to reverse (or at least halt) damage to the transplanted kidney.

Because the recipient’s immune system is suppressed, there is also a greater risk of developing infections, including unusual infections that do not occur in normal people. These unusual infections, if properly diagnosed, can generally be successfully treated.

Immune system suppression also carries with it a greater risk of developing certain types of cancer. Nevertheless, statistics for survival of patients and survival of the transplanted kidneys are excellent in this day and age, and many patients find that the benefits associated with renal transplantation are well worth the risks.

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