The kidneys are two bean-shaped organs located near the mid-backside of the body. Their main function is to filter waste and excess fluid from the blood to produce urine. Kidney failure, also called end-stage kidney disease, occurs when the kidneys are no longer able to effectively remove waste and regulate fluid levels. There are several possible causes of kidney failure, including diabetes, high blood pressure, glomerulonephritis (inflammation of the glomeruli), polycystic kidney disease (fluid-filled cysts develop in the kidneys), and toxic exposures. Untreated kidney failure is fatal, so patients require dialysis or a kidney transplant to survive.
Dialysis as a Treatment Option
When the kidneys fail, a process called dialysis is needed to artificially filter waste and fluids from the blood. There are two main types of dialysis - hemodialysis and peritoneal dialysis. In hemodialysis, blood is pumped out of the body to a dialysis machine where it is cleaned before returning it to the body. A hemodialysis treatment lasts several hours, typically three times per week. Peritoneal dialysis uses the lining of the abdomen, called the peritoneum, as a natural filter. A cleansing fluid is introduced into the abdomen, and it absorbs wastes and extra fluids before draining them out. Dialysis is life-sustaining but is not a cure - it only mimics some kidney functions and patients remain dependent on the treatment.
Kidney Transplant as a Treatment
A Kidney Transplant is currently the best treatment option for end-stage kidney disease as it restores nearly normal kidney function. The new kidney removes waste and regulates fluids in the same way as a healthy kidney. In a transplant, a donor kidney is surgically placed in the lower abdomen and attached to blood vessels to provide a new filtering system. The donor kidney can come from a deceased donor (after being recovered soon after death and preserved on ice until transplantation) or a living donor (with one of their two healthy kidneys removed through laparoscopic surgery). After a transplant, patients require anti-rejection medications for life to prevent their immune system from attacking the new organ. With good self-care and medical follow-up, transplanted kidneys can last 10-15 years on average.
Preparing for Transplant Surgery
Before being listed for a transplant, patients undergo rigorous testing to ensure they are healthy enough for major surgery and their body is primed to accept an organ without immediately rejecting it. This includes an extensive medical history review, physical exams, lab work, imaging tests, and a psychological evaluation. Once listed, patients are prioritized based on factors like time spent waiting, medical urgency, and blood type compatibility. When a suitable kidney becomes available, transplant surgeons prepare the recipient for a 4-6 hour operation. Nearby hospitals are alerted so additional support staff can arrive quickly if needed.
The Transplant Surgery Process
In the operating room, transplant surgeons first remove the recipient's non-functioning native kidneys if they have not already been removed during prior dialysis access procedures. Next, the donor kidney is carefully transported on ice to the operating room. Surgeons then connect the donor kidney's renal artery and vein to blood vessels in the patient's pelvis area, restoring blood flow. The ureter is connected to the bladder to allow urine drainage. Once blood flow is established in the new kidney, it will immediately begin functioning. Surgeons close the incisions and the recipient is transferred to the intensive care unit for close monitoring during recovery. Overall success rates for kidney transplants exceed 90% if performed at experienced centers.
Post-Transplant Care and Medications
After transplant surgery, recipients require close medical management to avoid complications and rejections. In the hospital, vital signs and kidney function are tracked daily. Anti-rejection medications are precisely dosed to the individual to minimize side effects while maintaining adequate immune suppression. Common drugs include steroids like Prednisone along with antimetabolites like Mycophenolate and calcineurin inhibitors like Tacrolimus or Cyclosporine. Recipients must strictly adhere to their medication schedules. Blood tests monitor drug and antirejection antibody levels. Some potential post-op issues include infection, internal bleeding or clots, lymphatic leaks, and acute rejection episodes. Most are managed successfully with additional treatment and supportive care.
Long-Term Health and Follow Up
Over the long-term, transplant recipients require vigilant self-care and regular provider monitoring to preserve their precious donor organ. In addition to strict medication compliance, a healthy diet, exercise, adequate hydration, and prompt treatment of any illnesses help prevent medical problems that could damage the transplanted kidney. At established intervals, recipients return to their transplant center for comprehensive check-ups including lab work and scans or biopsies as needed. Any signs of rejection or other issues are evaluated and addressed early on.
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