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The kidney transplantation was done 40 years ago and since then a large number of renal transplants have been done. There have been remarkable improvements in the immunosuppressive agents. These are used to prevent the kidney from being rejected.

What are the different types of the kidney transplantations?

Living related kidney transplantations. Here the kidney donor is either the patients brother, sister, father or mother.

Living unrelated kidney transplantations. In this case the donor is either the patients spouse, friend or member of the community who donates for altroestic reasons.

Cadeveric donors. The kidney is obtained from a person who is brain dead. It is important to note that the heart is beating but the brain stem function does not exist.

Non–heart beating donors. In this the organ is retrieved after the heart is stopped beating. In most western countries cadeveric donation is the most predominant form of kidney transplantation. In lesser developed countries the predominant mode of kidney transplantations is from living related or unrelated donations.

What necessitated the passing of the Organ Donation Act in India?

The act was passed to curb the commercial purchase of kidneys. The situation was exploited by middlemen resulting in very little remuneration to the donor who was usually from a low socioeconomic status. In addition, there were instances when kidneys were removed from patients without their knowledge. The act also defined the criteria for brain death in order to encourage cadaveric donation.

What is the importance of the blood group in kidney transplant?

Matching of the blood groups is an absolute pre–requisite for kidney transplantation. The following guidelines are used. However the following matches are also feasible.

Donor Blood Group Donate to
A A, AB
B B, AB
AB AB
 O A, B, AB, O

The Rh typing of the blood need not be the same. For e.g: from a mother who is B (+) ve to a patient daughter who is B (–) ve.

What is the concept of kidney “Matching” in kidney transplantation?

In addition to the blood group HLA matching is done. HLA (Human Leukocyte Antigens) are proteins present on white blood cells that are the products of closely linked genes on chromosomes no 6. There are more than 100 such identifiably proteins. They are divided into different classes A, B, C and D and DR. For each of these subgroups the matching is done.

Can a kidney be transplanted if there is not a single match?

This situation does arise. It is called “Zero” match. Transplant surgeons weigh the merits of the necessity and make the decision.

Do cadaveric kidney transplants fare as well as living related transplants?

Living related transplants have the best outcome and should always be pursued as the first step in obtaining a kidney.

Is there any age limit for a recipient for kidney transplantation?

Usually patients who are less than 5 years and those who are more than 65 years are not considered for renal transplantations.

Is there any age limit for kidney donors?

kidneys are generally accepted from the donors who are 4 and 70 years of age. However carefully evaluation must be done in the donor who is more than 55 years of age.

Are there any contraindications for doing a transplant in a kidney failure patient?

The following patients do not qualify for a transplant.
  1. Advanced heart disease.
  2. Advanced lung disease.
  3. Age > 75 years.
  4. Advanced cancer.
  5. Extremely obese patients.
  6. Drug or alcohol addiction.
  7. Active nephritis.

Are both kidneys transplanted or only one kidney transplanted?

Usually only one kidney is transplanted.

Where is the kidney actually transplanted into the recipient?

The original kidney of the recipient is usually not removed. They are usually left in place unless they have to be removed for other reasons such as polycystic kidney disease or infections. The kidneys are usually placed lower down in the abdomen and the artery and the vein are anastomosis to the large vessels mainly the iliac vessels.

Are there any particular precautions that transplant patients must take after the transplant?

Yes. There are important precaution to be taken. Heavy activity or sports should be avoided. Contact with patients with active infections should be avoided. The patients can carry on a normal life but generally they should be extremely careful to report any fever or not feeling well to a nephrologist.

What is acute rejection of the kidney?

Acute rejection of the kidney usually occurs when the immune system of the patient attacks the transplanted kidney. This is usually seen within a first six months or a year after the transplantation. The patient usually complaints about the decrease urination, pain over the transplanted kidney, fever and a rise in the serum creatinine is seen.

What is the treatment for a kidney rejection?

The nephrologist usually undertakes a kidney transplant biopsy to confirm and categorize rejection and treated accordingly. The most common medicine that is used are steroids. If these steroids are not effective more potent agents such as OKT3 Ormonoclonal antibodies are used to treat these rejection.

What are the medicines usually taken by transplant patients after their transplant?

Usually after a transplant the patients are placed on medicines to prevent the kidney from being rejected. A three drug regimen is used. Cyclosporine, Prednisone (a steroid), Mycophenolate mofetil or Azathioprine.

What are the infections that can take place in the Renal transplant patients?

The transplant patients has the ability to fight infections is low. Actually 75% of the renal transplant patients will suffer at least one episode of infection in the 1st year after transplant. The infection seen in the transplant patient are different than those seen in the general community. The initial infections are in the first one month after transplantations are usually bacterial. After the first month however viral infections such as cytomegalo virus, fungal infections, tuberculoses and parasitic infections are common.

What is the survival rate of a kidney after transplant?

The first year survival for a living related kidney donation is about 85–90% for cadaveric is about 80%.

What are the side effects of the drugs used in kidney transplant?

  1. Steroids: For a long period of time can result in high blood pressure, weight gain, abnormalities in the glucose levels Cushing’s syndrome, cataracts, osteoprosis and fractures.
  2. Cyclosporin can also have an adverse affect like aggravating the hypertension because excessive hair growth and excessive gingival growth. It can also be toxic to the kidney especially if the levels are not monitored.
  3. Cell cept has effects on suppressing the bone marrow and the patients can have anemia, a low white cells count or and low platelet count. Cell cept can also cause diarrhea.