What is a Kidney Transplant?

Kidney transplantation or renal transplantation is the implantation of the human kidney from a person (donor) to another person (recipient). A successful transplant can extend the life of the recipient and greatly improve the quality of the patient life. The patient can become free of dialysis restrictions and reversible uremia manifestations. Approximately 90% of all patients receive kidney transplants without removing their own kidneys.

 How is a kidney transplant done?

The kidney transplant is a sensitive surgery in which the surgeon makes an incision in the lower quadrant of the patient’s abdomen. After removing the layers of skin, the muscles and peritoneum of the iliac arteries located in the pelvis are exposed to the surgeon’s vision. In male patients, the spermatic cord should also be seen and put aside. The first choice for grafting is internal iliac arteries .

During transplantation, the internal iliac artery and the external iliac vein are blocked by strong clamps; first, the artery and then the vein is anastomotic to the kidney, at which point the kidney’s blood flow returns to normal and at this stage blood pressure of the patient should be carefully monitored.

The final part is the transplantation of the pelvis and proximal part of the ureter into the bladder called the ureteroneocystostomy. In this section, a small incision is made in the anterior-posterior wall of the bladder and inserts the upper end of the ureter into the bladder, and it is sutured into the bladder. Drainage at the surgical site is not needed since at the end of surgery a foley catheter for relieving the bladder pressure is inserted.

Kidney transplant surgery usually takes between 2 to 3 hours, kidney transplantation is not a one-day process, and things must be done before and after surgery. The patient is closely monitored after the operation and should be monitored by a nephrologist for the rest of his or her life.

There are usually two options for the kidney transplant:

1) Live-donor kidney transplant

A living donor who donates his kidney at his own request and can usually donate a kidney to the close relatives, because of the genetic compatibility of the individual with his or her family members or close relatives.

2) Deceased donor kidney transplant

People who are brain dead but their organs including kidneys are still healthy and able to work and can be transplanted to the patient.

Usually, as the kidney transplant demand is high, a list of those who have had brain death for whatever reason but who have a healthy kidney is provided and given to those seeking kidneys.

Transplant recipient conditions:

 The patient would not be considered a good candidate for a kidney transplant If any of the following conditions exist:

• Age over70 years
• Cancer or any life-threatening extra-renal disease, such as severe cardiovascular or brain diseases
• Active infection
• Active gastrointestinal ulcer
• The patient’s inability to tolerate surgery and postoperative drug therapy
• Having a disease that can be exacerbated by the use of immunosuppressants.

In the case of abnormality in the bladder and urethra, these conditions are necessary to be corrected before a kidney transplant.

How successful is a kidney transplant?

The success of a kidney transplant surgery depends on the extent to which the recipient’s body treats the transplanted kidney as an invader and defends it.

About 95% of the patient’s siblings’ kidneys are matched with their kidneys, and the success of this type of transplant is very high due to genetic, blood, and tissue adaptations.

The matching of the kidneys of the patient’s parents or children accounts for about 85 percent of the kidneys.

The success rate of kidney transplantation, when it is transplanted from a deceased person, is about 80%.

The percentages listed above are based on the first kidney transplant operation and if the transplant is rejected the first time, the success rate is about 10 to 15 percent lower for the second time.

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Author:Maryam Shiani