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Transplantation
When an individual’s kidneys fail, three treatment
options are available: hemodialysis, peritoneal dialysis, and kidney
transplantation. Many patients feel that a successful kidney transplant
provides a better quality of life because it allows greater freedom
and often is associated with increased energy levels and a less restricted
diet. You may find it helpful to talk to patients who have already
have had a kidney transplant. You also need to speak to your doctor,
nurse, and family members.
What is a kidney transplant?
A kidney transplant is an operation in which a person whose owns kidneys
have failed receives a new kidney to take over the work of cleaning
the blood.
What are the different kinds of kidney transplants?
The two types of kidney transplants are those that come from living
donors, and those that come from unrelated donors who have died (cadaver
donors). A living donor usually is someone in your immediate or extended
family or maybe your spouse or close friend.
What are the advantages and disadvantages of living
donation?
One advantage of receiving a kidney transplant from a living donor
is that the average long-term success rates tend to be somewhat higher
than transplants from cadaver donors. Another advantage is that the
operation can be scheduled to suit the patient’s needs because
it is not necessary to wait for a kidney to become available from
a cadaver donor.
The disadvantage is that the donor must be perfectly healthy and must
undergo major surgery to remove a kidney to be transplanted into you,
the recipient. Usually, the operation involves no serious risk for
a healthy donor. In addition, studies have shown that one remaining
healthy kidney is enough to keep the body healthy by removing wastes
and excess fluid from the blood. Living donors usually experience
positive feelings about their courageous gift.
What are the advantages and disadvantages of cadaver
donation?
Technical advances have resulted in very good success rates for kidney
transplants from cadaver donors. However, due to the shortage in the
supply of cadaver kidneys for transplantation, you must remain on
a waiting list until a suitably matched kidney becomes available.
How can one afford the cost of the transplant and
the medicines?
Medicare and private insurance cover most transplant and medication
costs. Medicare covers 80% of the cost of the drugs you need to prevent
transplant rejection and you pay 20% of the cost. At present, Medicare
covers these drugs for three years. However, Medicare does not pay
for all of the drugs you may need to take. Other sources of assistance
include your state supported medical programs and veterans’ programs.
You may also qualify for different programs offered by the drug companies.
The social worker or financial coordinator at your transplant center
is available to answer your specific questions.
What does the transplant operation involve?
The kidney transplant operation involves an incision or cut on the
lower part of the abdomen to connect your blood vessels to the new
kidney and the ureter (urine tube) of the new kidney to your bladder.
The operation usually takes about three hours. Expect to feel groggy
and sore as you would after any type of surgery. You will find a tube
(catheter) in your bladder to collect and measure the urine. There
will be an intravenous (IV) tube in your arm to supply you with nutrients
and fluids. The IV and catheter will be removed in several days. Often,
the recipient can be out of bed within a day or two. Many times, the
new kidney begins to work right away.
When does one expect to go home?
Most patients can leave the hospital in one to three weeks. Once you
are home, the most important part of your transplant begins: the follow
up. To be successful, you will have to be monitored carefully and
your medications adjusted. This involves blood tests several times
a week just after the transplant. Before long, it will not be necessary
for blood tests or doctor visits to be so frequent. However, you always
will need to have your kidney function and medicines checked from
time to time.
Do the old kidneys have to be removed?
No. Removal of your old kidneys is usually not necessary before or
during a kidney transplant.
How long before one returns to work?
The main goal of transplantation is rehabilitation. How soon a patient
is able to return to work depends on factors such as: age, the type
of job, and other medical problems. Many patients can return to work
in three to eight weeks after their transplant.
What is rejection?
The most important complication that may occur after transplant is
rejection of the kidney. The body’s immune system guards against
attack by all foreign matter, such as bacteria. This defense system
may recognize tissue transplanted from someone else as "foreign"
and act to combat this "foreign invader." Anti-rejection
medications, such as steroids, azathioprine and cyclosporine, help
to prevent this, but when it does occur, additional treatment often
can reverse rejection episodes. Frequent checkups according to your
doctor’s recommendation will ensure early diagnosis of rejection.
What are the side effects of the anti-rejection
medicines?
Anti-rejection medicines have a large number of possible side effects
because the body’s immune defenses are suppressed. Fortunately,
these sides effects usually are manageable for most patients. If side
effects do occur, changing the dose or type of medicines will usually
take care of them. Some of the most common side effects include: high
blood pressure, weight gain and a susceptibility to infections and
tumors.
What are the chances that a transplanted kidney
will continue to function normally?
A variety of factors influence the success of kidney transplantation.
The chances that a transplanted kidney will continue to function are
between 80 and 90 percent one year after the operation. Results of
transplantation are improving steadily with research advances. For
instance, research has led to improvements in surgical techniques,
preservation of donated kidneys and drugs used to prevent rejection
of transplanted kidneys. In the event that a transplanted kidney fails,
retransplantation is a good option for many patients.
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