Kidney transplant, this is what you need to know
Kidney transplant or transplant is a surgical procedure that is performed to replace a kidney organ damaged by chronic end-stage renal failure. Transplanted kidneys can come from living or deceased donors.
The role of the kidneys is to filter and remove waste, fluids, minerals and poisons in the body through urine. When kidney function decreases, substances that must be eliminated accumulate in the body. If this problem is not resolved, it can be fatal.
Kidney transplantation is one of the 3 kidney replacement therapies for patients with end-stage renal failure, in addition to continuous ambulatory dialysis and peritoneal dialysis (CAPD), also known as abdominal dialysis. Named kidney replacement therapy because the kidneys that are damaged due to chronic kidney failure cannot improve, but can be replaced by their work. In a kidney transplant, the damaged kidney will be replaced with a suitable donor kidney. One study shows that kidney transplantation can prolong a person's life compared to dialysis and CAPD.
Based on the donor category, kidney transplants are divided into two types, namely:
Indications for kidney transplantation
Kidney transplants are performed in patients with advanced chronic kidney failure, where kidney function has decreased significantly and accumulation of toxins has occurred in the body. The following signs of decreased kidney function should be monitored:
The following conditions can cause chronic kidney failure, including:
Aside from chronic kidney failure, kidney tumors are also a reason for kidney transplantation.
Kidney transplant warning
It should be noted that some conditions can harm the kidney transplant process, such as cancer that spreads in the body, characterized by infection, heart problems, liver disorders and lung disease.
At present, HIV-positive patients are also being continually considered in performing kidney transplants because, after a kidney transplant, patients will consume immunosuppressive drugs (immunosuppressive drugs) which increase the problem for patients. people living with HIV.
Age, donors and recipients, are also aspects that need to be taken into account because, as we get older, the risk of complications is also greater and success is reduced. In addition, the compatibility of the kidney, blood type and tissue of the patient and donor will also be ensured.
Before a kidney transplant
Some assessments will be carried out by the kidney doctor and the team of doctors at the hospital before the kidney transplant procedure, such as asking for a history of the disease, medications taken and a history of allergies to drugs and inhibitors of depression.
After that, the doctor will examine the patient's condition through a physical examination, blood test, imaging (x-ray, CT or MRI), then a psychological examination to ensure patient readiness. patient. This process can take several days.
After the presence of a potential kidney donor, a series of tests will be carried out, including:
If the donor and recipient are ready and the kidney transplant date has been determined, the donor or recipient will be asked to fast before the kidney transplant procedure.
Kidney transplant procedure
The patient will be asked to lie in bed and receive an injection of general anesthesia in the operating room. When the patient's consciousness decreases, the urologist will make an incision in the lower abdomen. The operation process will be carried out in collaboration with the donor, which begins by taking the donor's kidney. The donor kidney organ will then be installed without removing the kidney for a long time, except for diseases such as infections, kidney stones, cancer, nephrotic syndrome, kidney cysts or high blood pressure can cause complications. After the installation of a new kidney, the doctor will connect new blood vessels (usually from the leg area) to the blood vessels in the stomach, so that the new kidney receives blood supply and functions normally.
In the last phase, the doctor will connect the ureter (ureter) of the new kidney to the bladder. Stenting into the new ureter can be done to help speed up the flow of urine for 6 to 12 weeks after the procedure.
When the kidney is fully attached, the incision will be closed with stitches. Overall, this operation 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 diminish, the patient will feel pain during the incision. The doctor will give painkillers to relieve pain.
Patients must be treated for at least one week in the hospital for observation and to ensure that there are no specific effects or complications after transplantation. After returning home, patients will be invited to rest at home for 3 to 8 weeks before they can resume normal activities. Patients will be asked to avoid heavy physical activity or lifting heavy objects until the doctor allows it.
Usually, the new kidney will work immediately. However, sometimes it happens that some patients survive several days. Patients must continue to undergo dialysis until their kidney function is normal.
To suppress the potential rejection of donor kidney organs, patients will receive immunosuppressive drugs, such as cyclosporine, corticosteroids, azathioprine, mycophenolate mofetil or tacrolimus. Immunosuppressive drugs are drugs that suppress the immune system. If not eliminated, the immune system can attack the donor kidney organs which he considers to be foreign.
Routine control must be exercised while continuing to consume the prescribed medication. Doctors can also give antibiotics, antiviral or antifungal agents to prevent infection due to suppressed immunity.
Complications of kidney transplantation
Following are the complications that can occur with a kidney transplant:
In addition to surgical complications, kidney transplant patients may experience side effects from immunosuppressive drugs, such as:
Kidney transplantation is one of the 3 kidney replacement therapies for patients with end-stage renal failure, in addition to continuous ambulatory dialysis and peritoneal dialysis (CAPD), also known as abdominal dialysis. Named kidney replacement therapy because the kidneys that are damaged due to chronic kidney failure cannot improve, but can be replaced by their work. In a kidney transplant, the damaged kidney will be replaced with a suitable donor kidney. One study shows that kidney transplantation can prolong a person's life compared to dialysis and CAPD.
Based on the donor category, kidney transplants are divided into two types, namely:
- Kidney transplants from living donors. Kidney transplants are obtained from living donors. Kidneys will be taken to be given to recipients (recipients).
- Kidney transplants from deceased donors. Kidney transplants are obtained from donors who have recently died, with family permission or died (died) while still alive.
Indications for kidney transplantation
Kidney transplants are performed in patients with advanced chronic kidney failure, where kidney function has decreased significantly and accumulation of toxins has occurred in the body. The following signs of decreased kidney function should be monitored:
- Fluid retention or accumulation in the body, especially in the arms, legs, and lungs. Because of this fluid buildup, patients with kidney failure will feel swollen in the body, will run out of breath and experience decreased urine production.
- Nausea and vomiting.
- Decreased appetite.
- itchy
- Not interested in decreased consciousness.
- pale
- Feeling tired easily.
- Muscle, joint, or bone pain.
The following conditions can cause chronic kidney failure, including:
- Type 1 or 2 diabetes.
- Hypertension.
- Glomerulonephritis.
- Uremic hemolytic syndrome.
- lupus
- Sickle cell anemia.
- drop
- Rheumatoid arthritis.
- Some cancers, such as lymphoma, multiple myeloma, kidney cell carcinoma, Wilms tumor.
- HIV infection.
- Impaired urine flow, for example due to urinary stones.
- Polycystic kidney disease.
Aside from chronic kidney failure, kidney tumors are also a reason for kidney transplantation.
Kidney transplant warning
It should be noted that some conditions can harm the kidney transplant process, such as cancer that spreads in the body, characterized by infection, heart problems, liver disorders and lung disease.
At present, HIV-positive patients are also being continually considered in performing kidney transplants because, after a kidney transplant, patients will consume immunosuppressive drugs (immunosuppressive drugs) which increase the problem for patients. people living with HIV.
Age, donors and recipients, are also aspects that need to be taken into account because, as we get older, the risk of complications is also greater and success is reduced. In addition, the compatibility of the kidney, blood type and tissue of the patient and donor will also be ensured.
Before a kidney transplant
Some assessments will be carried out by the kidney doctor and the team of doctors at the hospital before the kidney transplant procedure, such as asking for a history of the disease, medications taken and a history of allergies to drugs and inhibitors of depression.
After that, the doctor will examine the patient's condition through a physical examination, blood test, imaging (x-ray, CT or MRI), then a psychological examination to ensure patient readiness. patient. This process can take several days.
After the presence of a potential kidney donor, 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 are suitable for a blood test. This is done to reduce the potential for rejection by the body of new kidney organs.
- Tissue check. If the blood type matches, the doctor will continue the examination by comparing the donor tissue with the recipient. A human leukocyte antigen (HLA) test will be conducted, including comparing donor and recipient genes. If this happens, the potential for donor rejection will decrease.
- Blood compatibility test (cross compatibility). In this final test, the blood of the donor and recipient will be mixed in the laboratory to look for a reaction between the recipient and donor blood. The results must be consistent to reduce the risk of organ rejection.
If the donor and recipient are ready and the kidney transplant date has been determined, the donor or recipient will be asked to fast before the kidney transplant procedure.
Kidney transplant procedure
The patient will be asked to lie in bed and receive an injection of general anesthesia in the operating room. When the patient's consciousness decreases, the urologist will make an incision in the lower abdomen. The operation process will be carried out in collaboration with the donor, which begins by taking the donor's kidney. The donor kidney organ will then be installed without removing the kidney for a long time, except for diseases such as infections, kidney stones, cancer, nephrotic syndrome, kidney cysts or high blood pressure can cause complications. After the installation of a new kidney, the doctor will connect new blood vessels (usually from the leg area) to the blood vessels in the stomach, so that the new kidney receives blood supply and functions normally.
In the last phase, the doctor will connect the ureter (ureter) of the new kidney to the bladder. Stenting into the new ureter can be done to help speed up the flow of urine for 6 to 12 weeks after the procedure.
When the kidney is fully attached, the incision will be closed with stitches. Overall, this operation 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 diminish, the patient will feel pain during the incision. The doctor will give painkillers to relieve pain.
Patients must be treated for at least one week in the hospital for observation and to ensure that there are no specific effects or complications after transplantation. After returning home, patients will be invited to rest at home for 3 to 8 weeks before they can resume normal activities. Patients will be asked to avoid heavy physical activity or lifting heavy objects until the doctor allows it.
Usually, the new kidney will work immediately. However, sometimes it happens that some patients survive several days. Patients must continue to undergo dialysis until their kidney function is normal.
To suppress the potential rejection of donor kidney organs, patients will receive immunosuppressive drugs, such as cyclosporine, corticosteroids, azathioprine, mycophenolate mofetil or tacrolimus. Immunosuppressive drugs are drugs that suppress the immune system. If not eliminated, the immune system can attack the donor kidney organs which he considers to be foreign.
Routine control must be exercised while continuing to consume the prescribed medication. Doctors can also give antibiotics, antiviral or antifungal agents to prevent infection due to suppressed immunity.
Complications of kidney transplantation
Following are the complications that can occur with a kidney transplant:
- Rejection of the body against new kidneys, so the kidneys do not function anymore.
- Infection.
- Blood clots.
- Bleeding.
- Urine from the kidney to the bladder (ureter) is leaking or obstructed.
- Liver insufficiency.
- AVC
- Heart attack
In addition to surgical complications, kidney transplant patients may experience side effects from immunosuppressive drugs, such as:
- Zits.
- Bone loss (osteoporosis).
- Bone damage.
- Tremor.
- Diabetes
- Hypertension.
- High cholesterol
- Infection.
- Hair loss or thick growth with precision.
- Increased body weight
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