W Power 2024

Kidney transplantation

Dr. Pratik Das, MBBS, MD (General Medicine), DNB (Nephrology), DM (Nephrology), Adult Kidney Transplant, Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata

Published: Jan 3, 2023 01:13:49 PM IST

Kidney transplantationKidney transplantation means putting a kidney inside the body of a patient suffering from kidney failure. Kidney failure means if kidney function goes below 15 ml/min GFR. Then life cannot be sustained without support from outside. This support may come either from the artificial machine called dialysis that performs the function of the kidney or it can come from a newly normally functioning kidney that can be put inside the body of a patient suffering from kidney failure. This is called renal replacement treatment. Both of them together are called renal replacement therapy.

As the kidney is a vital organ one cannot live without a kidney like other vital organs such as the brain, heart, and liver. So, when a kidney fails, the patient has to put something additional to sustain life.  Therefore, kidney transplantation is the best way to sustain life in patients who suffer from complete kidney failure. Kidney failure usually happens due to long-standing diabetes, hypertension, efferent glomerular nephritis, kidney stones, kidney disease infection, etc. Thus, kidney transplantation helps in getting a patient a long, healthy, and better quality of life with normal well-functioning kidneys.

The process of kidney transplantation is slightly complex. For that, one needs to have a donor as everybody knows transplantation of human organs is considered to be one of the miracles of the last century. This is going against nature’s practice because here somebody’s organ is put inside another’s body which should be compatible with someone who needs it so that patient can survive. This can be done with the help of two persons; one who will donate and one person who will accept. It is called a kidney donor and kidney recipient respectively.

Kidney donations are also possible for a patient who is suffering from irreversible damage to the brain. If the body of a brain-dead person is kept on a ventilator, the heart may continue to beat for 2-3 days and keep vital organs such as the liver and kidney alive for this time period. These organs can be surgically removed for donation. The family or next of kin will be asked if they want to donate his/her organs along with the permission of the hospital and state authority or government authority. Thus, by that one patient who is suffering from brain death and whose family wishes to donate two kidneys, they can save the lives of two patients because one kidney placement is enough for survival. This is the one way of getting a kidney transplant.

This is a common practice worldwide. But in a country like India, these practices are slightly in the developing phase only. In some areas, these practices are widespread, and in some areas, these practices are slightly fewer. This is one of the important ways of getting kidneys, further more and more awareness is required.

Another way of getting a kidney is from close relatives because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. People who donate a kidney can live healthy lives with one healthy kidney. The patient should be slightly prepared.  He or she should be in stable cardiac condition.

Normally, your body fights off anything that isn’t part of itself, like germs and viruses. That system of protection is called your immune system. To stop your body from attacking or rejecting the donated kidney, you will have to take medicines to keep your immune system less active (called anti-rejection medicines or immunosuppressant medicines). You’ll need to take them as long as your new kidney is working. Without them, your immune system would see the donated kidney as “foreign,” and would attack and destroy it. These immunosuppressant medicines increase the proneness of infection. So, balancing between these two is very important because, after transplantation, we can divide the timeline into different phases. In the immediate post-transplant period after 7 to 10 days when the patient stays in the hospital, in that situation, chances of rejection and infection are there. Surgical risks and bleeding risks are also there which should be taken care of by the patient.

But after the discharge from the hospital, the patient responsibility begins. Initially, first 3-4 months, the patient should take care of the infection, diet restriction, water intake should be proper, and medicine-taking time should be normally perfect.  If something happens in that situation, like infection, fever, or rise in creatinine levels, one should concern the doctor immediately. In general, transplant recipients should eat a heart-healthy diet (low fat, low salt) and drink plenty of fluids. If you have diabetes or other health problems, you may still have some dietary restrictions. A dietitian can help you plan meals that are right for you.

If these initial three-month periods go uneventfully, then they gradually come back to their normal life in terms of their diet, fluid intake, official activity, physical activity, and sexual life. At the end of six months, patients come back to 95 % of their normal life. Some restrictions are still there like taking drugs on time, dietary restrictions, and some precautions. But at the end of the day, if someone goes for kidney transplantation, it will be a much better life than dialysis because it gives the patient free and normal life. If somebody is in the stage of kidney failure, he or she should go more and more in favor of kidney transplantation as it will provide a healthy, long, and better life.

So, kidney transplantation should be done in cases where it is possible. Kidney transplantation should also be prescribed by medical fraternities, nephrologists, urologists, transplant physicians, and surgeon coordinators. Everybody should encourage kidney transplantation so that one can increase the quality of life of such patients. A successful kidney transplant gives you increased strength, stamina, and energy. After transplantation, you should be able to return to a more normal lifestyle and have more control over your daily living. It is the need of the hour of our country to go for kidney transplantation for patients suffering from kidney disease.

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