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BLK Centre for Renal Sciences & Kidney Transplant >> Treatment Offered >> Kidney Transplant

Kidney Transplant

There are two main types of kidney transplants: Living Donor Transplants and Deceased Donor Transplants.

Kidney Transplant

Kidney transplant operations are guided by the and Human Organ Transplantation (Amndment ) Act 2011 of the Parliament of India. There are certains provisions which have to be fulfilled before a patient is considered for Renal Transplantation. These are the links on these provisions and the necessary affidavits for renal transplantation which are needed in each case.

This operation is provided by team of Urology and Kidney Transplant, in conjunction with the Dept of Nephrology and kidney Transplant.

Other Services provided by the Nephrology Dept include

  1. Blood Pressure Clinic
  2. Diabetic Nephropathy Clinic
  3. Management of obstructive kidney diseases, preventing stone disease recurrence
  4. Creation of AV fistula, Central line and perma cath for long term hemodialysis
  5. Care of Vascular access
  6. Individualizing dialysis dose as per patient needs and Special emphasis on nutrition and physiotherapy

 

What does a Kidney do?

Kidneys are the two bean shaped organs, each about the size of a fist, located on either side of the spine at the bottom of the rib cage. Human beings have two Kidneys, which are responsible for a number of functions. The most important function is removing waste products and balancing fluid levels in the body. Other functions include regulating Blood Pressure, production of the hormone ‘erythropoietin’ which controls the making of red blood cells, converting Vitamin D from sunlight for stronger and healthier bones.

 

What is Kidney Transplant?

Kidney Transplant or Renal Transplant is the transfer of a healthy Kidney from one person into the body of a person who has little or no Kidney function.

 

Why is a Kidney Transplant necessary?

The loss of Kidney function, known as end-stage chronic Kidney disease or Kidney failure, is the most common reason for needing a Kidney Transplant. Transplant improves quality of life along with increasing life expectancy of the patient. Post a Kidney Transplant, the patient can discontinue Dialysis, resume normal diet and fluid intake

 

What are the benefits of Kidney Transplant?

There are many advantages of having a Kidney Transplant as compared to maintenance on Haemodialysis:

  • Eliminates the need for Dialysis and help patients enjoy a life filled with less restrictions (for instance greater freedom to travel), more energy and productivity
  • Increased life expectancy and better quality of life
  • More effective and less costly than Dialysis

How will the hospital help to manage the cost associated with Kidney Transplant?

Before moving forward with patient evaluation and surgery, the financial counsellors and coordinators review the patient’s insurance policy carefully and advise them in case of any concerns. Many insurance companies now include transplant benefits. The finance team at the hospital help patients to understand the rules in detail. Medicare and private insurance plans cover much of the cost of Kidney Transplant.

What are the selection criteria for Kidney Transplant patients?

Not all patients are suitable to have a transplant. The team at BLK Super Speciality Hospital discuss the transplant procedure in detail with the patient during hospital visits. One needs to go through several screening levels to help ascertain the suitability criteria for a transplant. The selection criteria for Kidney Transplant recipients include the following:

  • Existing or impending end-stage renal disease
  • Free of malignancies
  • Free of active infection
  • Intact or correctable urological abnormalities
  • No active abuse of alcohol, drugs or smoking
  • Heart and Lung status consistent with being able to tolerate the surgery and consistent with a predicted good, long-term outcome
  • Ability to follow transplant protocols and medication regimens
  • An acceptable body weight

Every potential candidate is considered on an individual basis. A number of radiological, blood and urine tests are done and evaluated by the Urologist and Nephrologist.

How are Kidneys donated?

There are two ways in which a Kidney can be donated. The person giving the Kidney is called the Donor. The person receiving the Kidney is called the Recipient.

Living Donors:

Everyone is born with two Kidneys. Some choose to donate one of their Kidneys to a family member or a friend. This is called Living Kidney Donation. A person can live a long and healthy life with just one Kidney, because the remaining Kidney quickly takes over the work that both Kidneys were doing previously. Additionally, long-term studies have not shown any decreased Kidney function in Living Donors. However, donors should have close medical follow-up with their primary care doctor at least once a year for a Blood Pressure Check and Kidney Function Tests. Living Donors may belong to one of the following transplant categories:

  • Related Transplant - siblings, parents, spouse or children over 18 years of age
  • Swap Transplant
  • Unrelated Transplant - only in exceptional cases under recommendation of state authorisation committee

Deceased Donors:

A Deceased Kidney Donor, previously called a Cadaveric Donor, donates the Kidney post his / her death. A seniority list of all registered patients awaiting Cadaver Transplant is drawn up as per the NOTTO guidelines and then allocated accordingly.

 

What are the benefits of Living Donor Kidney Transplant?

Living Donor Kidney Transplant has many benefits, some of them are highlighted below:

  • Higher success rates
  • Shorter waiting time
  • Flexibility to schedule - living donation allows patients to schedule a surgery time that is convenient for both the patient and the donor
  • Avoidance of Dialysis – early referral may allow for transplant prior to initiation of Dialysis therapy, referred as “Preemptive Transplant”

 

What are the criteria for becoming a Living Donor?

One can be a Living Donor, if he / she matches the following criteria:

  • Age between 18 and 65 years
  • Normal renal function with two Kidneys
  • Free of active infections
  • Free of malignancies for at least 2 years (medical history is evaluated individually) with exception of primary brain solid tumours in which Kidneys can be taken anytime for donation
  • No history of diabetes
  • No active / untreated substance abuse
  • Excellent physical and mental health condition

 

What are the blood and tissue types of Living Kidney Donors?

A Living Kidney Donor should have blood types of either A, B, AB or O. A brief table of compatible blood types is listed below:

Blood Type Can recieve from Can Donate to
O O O/A/B/AB
A A/O A/AB
B B/O B/AB
AB O/A/B/AB AB

 

Can non-compatible blood type still become Living Kidney Donors?

Living Donors who are not a compatible blood type may still be able to donate by doing a “donor swap” with another pair that is incompatible. A second alternative is ABO Incompatible Transplant - treatment of the recipient before the transplant that would allow his or her body to accept the incompatible blood type. In addition to blood type, tissue typing (white blood cell / lymphocyte or HLA type) is tested and examined for compatibility. HLA type is inherited, and this is the reason, related Living Donors may be more likely to be compatible. An HLA compatibility test is done before every transplant.

 

Is there any criterion while selecting which Kidney (right or left) to be used for donation?

DTPA Renal Scan and CT Angiography of donors are undertaken and Kidney with Lesser GFR (Function) and complex vascular anatomy are considered for donation. The Donor Nephrectomy operation can be open or Laparoscopic depending upon anatomy complexness and previous history of surgery. Right-sided Donor Nephrectomy is usually done by open method for technical reasons like want of IVC Cuff Endo staplers.

 

What procedures does the Donor have to go through before donating a Kidney?

Individuals interested in becoming Living Donors should first undergo medical screening. A person should only consider donation if he or she is in excellent health and genuinely wishes to donate without any outside pressure. The Donor has to undergo blood testing to ascertain his or her blood and HLA type (tissue typing) in order to determine compatibility with the recipient.

The potential Living Donor has to undergo detailed evaluation to enable the transplant team to decide his / her eligibility to donate. The evaluation includes a complete medical / surgical history and physical exam; blood tests, X-rays and procedures to check for general overall health, Cancers, Heart and Lung diseases and infections. CT Angiography, Psycho / Social Evaluation and Gynaecological examination should be undertaken amongst females.

If any problem is detected with the routine evaluation, additional testing may be necessary. The transplant team may decide a potential Donor is unacceptable to donate at any time during the evaluation.

 

How long will the Donor have to stay in the hospital?

The Donor’s hospital stay is normally for four to five days. The ability to return to normal activities and work varies, but generally this is possible within four to six weeks. Many Donors find Living Kidney Donation to be extremely rewarding and meaningful. Many family members have come forward and stated that it has further strengthened their bond with the loved ones. Those who choose to donate are regarded as a true hero by the recipient and the recipient’s loved ones. The transplant team is committed to facilitate the Living Donation process as easy as possible for the Donor.

 

What happens during the Kidney Transplant operation?

During the transplant operation, the Kidney is placed into the lower part of the abdomen, on either the right or left side just above the hip bone. It is put in this spot because it is close to the bladder and gets the blood supply it needs. The incision for the surgery is usually about 4 to 6 inches long. The Kidney blood vessels are attached to branches of the patient’s iliac artery and vein. The Ureter is attached to the Bladder. In most instances, the recipient’s own Kidneys are left in place.

The surgery usually takes two to four hours. Family members can expect a five to six hour wait from the time the patient is taken to surgery until the time he / she is shifted to the recovery room. After the surgery, the transplant surgeon meets the family members to apprise them about the patient’s condition.

 

What are the risks and complications involved in the Kidney Transplant surgery?

All medical and surgical treatments have risks. Although a transplant is likely to increase a patient’s quality of life, there are chances of problems to occur. These complications are seen in less than 1% of the time and can occur within 1 month after the surgery:

Surgical Complications

  • Clotting of the blood vessels to the Kidney
  • Bleeding - blockage of urinary drainage from the Kidney to the bladder
  • Urine leak

Non-Urological Complications

Rejection: Rejection occurs when the body recognises the transplanted Kidney as not its own and tries to destroy it. The highest risk for rejection is within the first three months after the transplant. Hence, close monitoring is critical during this period.

But, it is important to remember that rejection can happen at any time, even years later. Therefore, it is critical that the patient follows all medical guidelines advised by the transplant team.

Infection: The immunosuppressant drugs can decrease the patient’s ability to fight infections. Infections in a transplant patient can be serious and even life threatening. Patient’s immunosuppressant medications has to be closely monitored and adjusted as needed to keep the risk of infection as low as possible.

Malignancy: Transplant patients have a slightly higher risk of Cancer than the general population. Skin Cancers and Lymphoma are the most common forms. The risk can be decreased by avoiding prolonged exposure to the sun and wearing sunscreen.

Recurrent disease: Although uncommon, certain types of Kidney diseases may reoccur in the transplanted Kidney which can lead to progressive loss of Kidney function like Rapidly Progressive Glomerulonephritis or Hemolytic Uremic Syndrome.

Other complications related to general Anaesthesia and Abdominal surgery are given below:

  • Heart attack
  • Stroke
  • Hernia
  • Reaction to anaesthesia
  • Bowel problems
  • Pulmonary embolus (blood clot developed in the vein to the lung)
  • Poor healing of the surgical incision
  • Death

 

How long does the patient have to stay in the hospital after Kidney Transplant surgery?

The patient has to undergo preoperative evaluation and testing before either a Living or Deceased Donor Kidney Transplant. After routine lab tests and Donor / Recipient cross matching, final evaluation of the patient is done. If the final evaluation confirms an acceptable crossmatch with no further medical complications, then the transplant surgery is carried out as per schedule. After the surgery, the patient has to stay for about 7 to 8 days in the hospital.

 

How is Donor Nephrectomy operation performed?

Donor Nephrectomy operation can be performed by Laparoscopy or Open Surgery technique. Pneumoperitoneum is established through either a closed technique with a veress needle or an open technique. The patient is catheterised with 16 Foley catheter after induction and lateral position is made. Pneumoperitoneum is created using veress needle and then 3 to 4 ports are inserted.

Laproscopically Kidney is freed from all around along with its Ureter, Renal Artery or Arteries and Vein or Veins are ligated and cut. Then, the Kidney along with Ureter is delivered outside the body by a small cosmetic incision. Following are the advantages of Laparoscopic Donor Nephrectomy:

  • Lesser post-operative pain
  • Shorter stay in the hospital
  • Faster recovery

 

What is Open Donor Nephrectomy operation?

Open Nephrectomy operation is performed with the patient properly positioned and prepped, a 6-8 cm incision is made from the tip of the 10th rib to the edge of the rectus abdominis muscle. This rib is not resected; instead the fascia and muscle layers are split in the line of their fibers to minimise post-operative pain.

The peritoneum is retracted medially with deaver retractors to expose the retroperitoneal space and the Kidney. Dissection starts at the Ureter, which is separated from the retroperitoneal tissues. Thereafter, Kidney is freed from all around along with its Ureter, Renal Artery or Arteries and Vein or Veins are ligated and cut. Then, the Kidney along with Ureter is delivered outside the body and layered closure of the wound is done.

 

What happens after the transplant surgery?

The post-operative care is monitored around-the-clock by a team of Intensive Care Specialists, Transplant Doctors and Nurses. After surgery the patient is sent from the operating room to the recovery room and is closely monitored. Post recovery from anaesthesia, the patient is shifted to the specialised Organ Transplant ICU.

During the surgery, the recipient patient has a catheter inserted in his / her bladder so that urine can be drained out and the output can be carefully measured and monitored. The catheter is usually taken out four to five days after surgery. At that point, the patient might feel the need to urinate frequently. Eventually, the bladder adjusts and the normal urination frequency returns within few weeks.

Activity: In most cases, the staff helps to get the patient up in a chair within 24 hours of surgery. The patient is also encouraged to do deep breathing and coughing exercises to prevent lung complications.

Pain control: The Nurse provides the patient with pain medication and consequently monitors its effectiveness.

Monitoring vital signs and fluids: The patient has an IV (intravenous) line placed in surgery so IV fluids and medicines can be administered to the patient. Frequent checks of the patient’s vital signs and measurements of fluid intake and output are done.

Kidney Function Testing: The patient has to undergo frequent blood and urine tests to check the function of his / her transplanted Kidney.

Nutrition: The patient has to get started on a liquid diet immediately after surgery. The diet of the patient has to be similar to a healthy heart diet. Double J (DJ) Stent Removal: A DJ stent (plastic tube) is put in the Ureter to keep it open to drain urine. It is removed about two weeks after the transplant during an outpatient procedure called Cystoscopy.

 

What happens when the patient is discharged from the hospital?

After the patient is discharged, he / she is recommended a strict follow up regimen within one or two days. The patient is given the day and time of the appointment before leaving the hospital. After receiving the new Kidney the patient needs to attend the transplant clinic twice a week for the first month and thereafter once a week for the next two months, followed by monthly follow up for the first year and then three months. These clinical appointments are important as the risk of transplant rejection or infection is highest during the first few months. The transplant team at the Hospital closely monitors the progress of the patient during this critical time.

The nursing staff and clinical coordinators are responsible for teaching and imparting information about proper care and skills such as blood pressure monitoring, intake and output measurement, consumption of medications as per schedule.

 Additional information about Kidney function and Kidney Failure

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