Kidney transplantation

Transplantation and dialysis are the only two treatment options for persons with end-stage kidney disease. Not everyone with end-stage kidney disease is a suitable candidate for kidney transplantation. Those with infection, acute glomerulonephritis, unstable coronary artery disease, or other severe medical problems generally are considered not to be in good enough condition to undergo a major operation. They can have adverse reactions, including death, after transplantation than are healthier individuals. However, when successful, transplantation provides a healthier and better-quality life.

The operation itself is not a complicated procedure. What can be complicated is finding the right donor, which is important to lessen the chance of rejection of the new kidney. Compatibility is determined by blood tests that provide information about both the donor and the recipient, such as blood type and the nature of the antibodies present in each. A brother or sister of the recipient generally has compatible tissue. Unfortunately, it is not always possible.

When a living donor is not available, hospitals and clinics throughout the country are called on the help locate acceptable donors from among accident victims and others who offered to donate their kidneys after their death. A kidney from a cadaver must be transplanted within 48 hours after the death of the donor. Thus, some people have to undergo long periods on dialysis until a compatible cadaver donor is available.

After the transplantation operation, the person receives immonusuppressant drugs to keep his/her body from rejecting the foreign kidney. If the donor is a blood relative of the recipient, the chances are 85 to 95 percent that by 1 year after the transplantation, the kidney will still be functioning. With a cadaver donor, the chances are about 80 percent that the kidney will still be working quite well by 1 year after the transplant operation. In cases in which the transplanted kidney is rejected, a second or even third transplantation can be done.

Improvements in preparing patients for transplantation and in monitoring their recovery have decreased mortality to as low as 5 percent in some medical centers.

Transplant recipients usually are hospitalized for 5 days to 6 weeks, depending on how well their body accepts the new kidney. The major hurdles are rejection and infection. Immonusuppressant drugs have greatly decreased rejection, but they make it harder for the body’s immune system to fight infection. For this reason, the physician will often give antibiotics to prevent viral and fungal infection for the first few months after transplantation. This is the most likely period in which infection may develop. Because transplant recipients must take an immonusuppressant medication for the rest of their lives, they are prone to have infections.

Kidney transplant recipients need careful medical follow-up to enhance the success of the operation and to ensure good general health.