A kidney transplant or transplant is a surgical procedure that is performed to replace a kidney organ that has been damaged by end-stage chronic kidney failure. Grafted kidneys can come from donors who are still alive or have died.
Kidney organ has a function to filter and remove waste, liquid, mineral, and poison in the body through urine. When kidney function decreases, substances that should be removed will accumulate in the body. If this problem is not treated, it can be fatal.
Kidney transplantation is one of the 3 kidney replacement therapies in patients with late stage chronic kidney failure, in addition to dialysis and continuous ambulatory peritoneal dialysis (CAPD), also known as dialysis through the stomach. Named kidney replacement therapy because the kidneys that have been damaged due to chronic kidney failure can not improve, but can be replaced by its work. In a kidney transplant, the damaged kidney will be replaced by a suitable donor kidney. One study said that kidney transplants can prolong a person's life when compared to dialysis and CAPD.
Based on the donor category, kidney transplants are divided into two types, namely:
- Living-donor kidney transplant. Kidney transplants obtained from living donors. One kidney will be taken to be given to the recipient (recipient).
- Deceased-donor kidney transplant. Kidney transplants obtained from donors who have recently died, with the permission of the family or concerned (deceased) while still alive.
Kidney Transplant Indications
Kidney transplantation is carried out in patients with late stage chronic kidney failure, where kidney function has greatly decreased and there has been a buildup of toxins in the body. The following are signs of decreased kidney function that need to be watched out for:
- Retention or accumulation of fluid in the body, such as in the arms, legs, and lungs. As a result of this fluid accumulation, patients with kidney failure will experience swelling in the body, shortness of breath, and decreased urine production.
- Nausea and vomiting.
- Decreased appetite.
- Itchy.
- Absentminded to a decrease in consciousness.
- Pale.
- Easily feeling tired.
- Muscle, joint or bone pain.
Some of the following conditions can cause chronic kidney failure, including:
- Type 1 or 2 diabetes.
- Hypertension.
- Glomerulonephritis.
- Uremic hemolytic syndrome.
- Lupus
- Sickle cell anemia.
- Gout.
- Rheumatoid arthritis.
- Several types of cancer, such as lymphoma, multiple myeloma, renal cell carcinoma, Wilms tumor.
- HIV infection.
- Disorders of urine flow, for example due to urinary tract stones.
- Polycystic kidney disease.
In addition to chronic kidney failure, kidney tumors are also a reason for someone undergoing a kidney transplant.
Kidney Transplant Warning
It should be noted that there are several conditions that can jeopardize the process of kidney transplantation, such as cancer that is spread in the body, is experiencing an infection, heart problems, liver disorders, and lung disease.
Currently, HIV sufferers are still being considered in conducting kidney transplants because after a kidney transplant the patient will consume immune-lowering drugs (immunosuppressants) which are increasingly making problems in people with HIV.
Age, both donors and recipients are also one of the aspects to be considered, because with age, the possibility of complications that arise is also greater and success is reduced. In addition, the compatibility of the kidney, blood type and body tissue of the patient and donor will also be ensured.
Before Kidney Transplantation
Some evaluations will be carried out by the kidney doctor and the team of doctors in the hospital before the kidney transplant procedure is carried out, such as asking for a history of the illness, medication consumed, and a history of allergies to the anesthetic and imonusuppressant drugs.
After that, the doctor will examine the patient's condition through physical examination, blood tests, imaging (such as X-rays, CT scans or MRI), to psychological examinations to ensure patient readiness. This process can take several days.
After a potential kidney donor is present, a series of tests will be carried out including:
- Check blood type. The doctor will check whether the blood type of the patient and donor is suitable through a blood test. This is done to suppress the body's potential rejection of new kidney organs.
- Network check. If the blood type matches, the doctor will continue the examination by matching the donor tissue with the recipient. Human leukocyte antigen (HLA) tests will be carried out, namely by comparing donor genes with recipients. If suitable, the potential for rejection of donor organs will decrease.
- Blood matching test (crossmatch). In this final test, both the donor's and the recipient's blood will be mixed in the laboratory to check for a reaction between the recipient's blood and the donor. The results are expected to be compatible to reduce the risk of organ rejection.
If the donor and recipient are ready and the date for kidney transplant surgery has been determined, both the donor or recipient will be asked to fast before the kidney transplant procedure is performed.
Kidney Transplant Procedures
The patient will be asked to lie on the bed and will be given a general anesthetic injection in the operating room. When the patient's consciousness has decreased, the urologist will make an incision in the lower abdomen. The operation process will be carried out in conjunction with the donor, which begins with taking the kidney from the donor. The kidney organ from the donor will then be installed without removing the kidney for a long time, unless there are diseases such as infection, kidney stones, cancer, nephrotic syndrome, kidney cysts, or hypertension that can lead to complications. After a new kidney is installed, the doctor will connect new blood vessels (usually from the leg area) to the blood vessels in the stomach, so that the new kidney gets blood supply and functions normally.
In the final stage, the doctor will connect the ureter (ureter) from the new kidney to the bladder. Installation of a stent in the new ureter can be done to help expedite the flow of urine for 6-12 weeks after the action.
When the kidney organ is completely attached, the incision will be closed with stitches. Overall, this surgery will take 3 hours. During surgery, blood pressure, heart rate, and oxygen levels in the blood will continue to be monitored.
After a Kidney Transplant
After the anesthetic effect begins to decrease, the patient will feel pain in the incision. The doctor will give pain relievers to ease pain.
Patients need to be treated at least a week in the hospital for observation and ensure there are no specific effects or complications after transplantation. After returning home, patients will be asked to rest at home for 3-8 weeks before being allowed to resume normal activities. Patients will be asked to avoid heavy physical activity or lifting heavy objects, until the doctor allows.
Usually the new kidney will work right away. However, sometimes there are also those that take up to several days, so patients still need to undergo dialysis until the kidneys are working normally.
To suppress the potential rejection of donor kidney organs, patients will be given immunosuppressant drugs, such as ciclosporin, corticosteroids, azathioprine, mycophenolate mofetil, or tacrolimus. Immunosuppressants are drugs that suppress the immune system. If not suppressed, the immune system can attack the donor kidney organ which he considers as a foreign object.
Routine control needs to be done, while continuing to consume prescribed medicines. Doctors can also give antibiotics, antiviral, or antifungal drugs to prevent the onset of infections due to suppressed immunity.
Complications of Kidney Transplantation
Following are the complications that can occur from a kidney transplant:
- Rejection of the body against new kidneys, so the kidneys fail to function.
- Infection.
- Blood clotting.
- Bleeding.
- Urine from the kidney to the bladder (ureter) is leaking or obstructed.
- Liver disfunction.
- Stroke.
- Heart attack.
In addition to complications from surgery, kidney transplant patients may experience side effects from immunosuppressant drugs, such as:
- Zits.
- Bone loss (osteoporosis).
- Bone damage.
- Tremor.
- Diabetes.
- Hypertension.
- High cholesterol.
- Infection.
- Hair loss or precisely growing thick.
- Increased body weight.
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