The preliminary step is the identification of the donor. The recipient is subjected to a lot of health tests to confirm their ability to undergo a major surgery. Various tests are done on the recipient and donor to identify various compatibility factors between them.
Some of the mandatory tests are:
· Blood type testing- To identify the blood group
· Tissue typing – This is to identify the compatibility of human leukocytes antigens, the tissue markers found in cells and are almost exclusive to an individual. If the donor and recipient markers are the same, the transplant is called a perfect match kidney transplant. Siblings are the perfect matches most of the time.
· Cross match testing -This test is carried out two different times, to find out if the recipient reacts to the donor’s kidney.
· Serological evaluation- To identify the presence of viruses like HIV, CMV etc.
Once these tests are done and a compatible donor is found, both the donor and recipient are sent for counselling. All aspects of the surgery are discussed in detail during the session and the consent of both parties are obtained. Once this is over, the date of the transplant surgery is fixed.
Kidney transplant procedure:
A kidney transplant procedure is done under general anaesthesia. The procedure may last between three to four hours. Once the patient is sedated the surgery is started. There are three stages of the surgery.
First stage- The donor kidney is placed in the abdomen through an incision in the lower abdomen. The recipient kidneys will not be removed unless there is a chance of it causing problems like pain, infection etc.
Second stage- The adjacent blood vessels are attached to the blood vessels of the donated kidney. This provides blood supply to the transplanted kidney to get it to start functioning.
Third stage- The ureters of the donated kidney are attached to the urinary bladder of the recipient. This enables the flow of urine from the transplanted kidney to the bladder. A stent may be placed in the ureters to retain its patency. The stent is removed after a few weeks through a minor surgery called cystoscopy.
Once all these stages are completed successfully, the incision in the abdomen is closed by suturing and stapling. The patient is then shifted to the recovery room for close observation.
Risks in kidney transplant:
The rate of serious complications after kidney transplant has come down drastically in recent years. Still, the procedure has its share of risks and complications. Apart from the usual risks of surgery like bleeding, infection, blood clots etc. there are some major risks involved as well.
The major risks are:
Acute transplant rejection - A battery of tests is usually done to assess the compatibility of the donor and the recipient. Immuno-suppressants are also administered prior to the surgery to prevent transplant rejection. Even then the recipient’s body, at times, rejects the donor kidney. This rejection that occurs soon after transplant is called acute transplant rejection. It affects almost one in three recipients.
Side effects of Immuno-suppressants- People with transplanted kidneys are put on immuno-suppressants for the rest of their life to prevent transplant rejection. They act by lowering the body's immune system which creates a lot of other complications. Increased risk of infections, diabetes, hypertension, bleeding problems, mood swings etc. are the major ones.
Primary non-function- A rare condition that happens when the transplanted kidney never starts working.
Acute tubular necrosis- Also called delayed graft function. In this condition, there is a delay in the functioning of the transplanted kidney.
Dehydration- The patients who undergo dialysis are advised to reduce fluid intake. At times this becomes a habit and the patient limits fluid intake even after the transplant. This leads to dehydration.
Urine leak- The ureters are stitched into the urinary bladder during transplant surgery. Urine leak happens when the stitches give way before healing. Corrective surgery may be necessary to set it right.