How Is Rejection Identified
The transplant team will be able to determine if kidney rejection is present by performing scheduled protocol kidney biopsies at approximately three to six months and at one year post-transplant as a diagnostic screening tool, or if you are experiencing any of the warning signs and symptoms of rejection listed above. If the transplant team thinks that you may be having problems with your kidney, the following tests may be ordered:
- Repeated blood work
- Renal ultrasound to check blood flow to the kidney
- Kidney biopsy
What Are The Risks For Kidney Transplant
As with any surgery, complications can occur. Some complications mayinclude:
Blockage of the blood vessels to the new kidney
Leakage of urine or blockage of urine in the ureter
Lack of function of the new kidney at first
The new kidney may be rejected. Rejection is a normal reaction of the bodyto a foreign object or tissue. When a new kidney is transplanted into arecipient’s body, the immune system reacts to what it thinks as a threatand attacks the new organ. For a transplanted organ to survive, medicinesmust be taken to trick the immune system into accepting the transplant andnot attacking it as a foreign object.
The medicines used to prevent or treat rejection have side effects. Theexact side effects will depend on the specific medicines that are taken.
Not everyone is a candidate for kidney transplantation. You may not beeligible if you have:
Current or recurring infection that cannot be treated effectively
Cancer that has spread from its original location to elsewhere in the body
Severe heart or other health problems that make it unsafe to have surgery
Serious conditions other than kidney disease that would not get better after transplantation
Failing to follow the treatment plan
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your transplant team before theprocedure.
More Information About Organ Donation from Johns Hopkins Medicine
What Are The Warning Signs Of Possible Rejection
It is vital for you to be aware of the possible signs of kidney rejection. If you think you are experiencing any of these symptoms, contact the transplant team immediately:
- Increase in serum creatinine
- Fever higher than 100 degrees Fahrenheit
- “Flu-like” symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
- New pain or tenderness around the kidney
- Fluid retention
- Sudden weight gain greater than two to four pounds within a 24-hour period
- Significant decrease in urine output
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High Cholesterol And Blood Lipids
What are my chances of having high cholesterol and blood lipids after kidney transplant?
Many people may have higher cholesterol and lipid levels in the blood after transplant due to medication side-effects , weight gain, poor diet, family history, or lack of exercise. Kidney-related issues that cause protein in the urine can also increase blood lipids.
Why should I worry about high cholesterol and blood lipids?
High blood lipids can lead to clogged blood vessels. When this occurs it increases risk of heart disease and stroke.
How can I control my cholesterol and blood lipids?
Your doctor will help you manage your cholesterol and blood lipids. Controlling high cholesterol and blood lipids is usually done with:
- A heart healthy diet
What Happens After Kidney Transplant
We all know that a human has two kidneys. Well, a person can survive only if one of the kidneys is working properly. But when both the kidneys get damaged, there is no option left than going for a kidney transplant. It is a surgery where a healthy kidney is put into the body of the patient. For this, obviously, a donor is required and there are two types of donor:
- Living Donor: This donor can be a friend, a family member, a coworker, or any person who is there to give away their kidney to the patient. After all, only one healthy kidney is needed for living.
There are certain tests taken to see the matching of the tissue type and blood type of the donors kidney to the patients. If there is a close tissue match, it can reduce the chances of rejection of the donors kidney by the patients body.
WHAT HAPPENS AFTER KIDNEY TRANSPLANT?
While staying in hospital for some days after you are done with the kidney transplant surgery, the functioning of the donors kidney is checked and if the kidney takes time in the urine production, the patients receive dialysis and has to take medicines like diuretics which eventually help the kidney to get rid of excess salt and water from the body. Plus, after the surgery, the patient will have to take medicines so that the immune system can be suppressed as the immune system can reject the donors kidney.
WHAT TO THINK ABOUT IT?
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Getting A Kidney Transplant From And A Person Who Has Hepatitis C When You Dont Have Hepatitis C
Within the last few years, there have been a few cases where doctors transplant a hepatitis C infected kidney into the body of a person without hepatitis C. This means that when you receive your new kidney, you will probably become infected with hepatitis C. But once you receive your new kidney, you are treated with drugs to cure the hepatitis C.
The health of people who receive a kidney transplant is better than the health of people on long-term dialysis. This makes getting a kidney transplant the top priority. Since hepatitis C can be cured without too many side effects, this is now being considered as an option.
This type of transplant is still being studied by researchers, but has shown very positive results for patients who have had it done so far.
Have Your Kidney Transplant
During kidney transplant surgery, a surgeon places a healthy kidney into your body. Youll receive general anesthesia before the surgery. The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.
If youre on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.
If a family member or friend is donating the kidney, youll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.
Allograft Nephrectomy And The Chance Of Retransplantation
The rate of allograft nephrectomy before retransplantation ranges from 0.5 to 43% depending on the centre’s protocols . Some studies indicate an adverse impact of allograft nephrectomy on various clinical outcomes of a second transplant. In the cyclosporine era, a single-centre study demonstrated that allograft nephrectomy was associated with a significant increase in PRA levels, a higher incidence of DGF and reduced graft survival . In a retrospective single-centre study comparing 121 patients undergoing kidney retransplantation with preliminary allograft nephrectomy to 45 retransplant recipients without the procedure, allograft nephrectomy led to worse graft survival after retransplantation, with an increase in PRA levels, a higher rate of primary non-function and acute rejection ; pre-transplant allograft nephrectomy and PRA >70% were independent and significant risk factors associated with graft loss after kidney retransplantation . Recently, in a retrospective analysis of 109 kidney transplant recipients, allograft nephrectomy was an independent risk factor for the development of DSAs and non-DSAs after 12 and 24months and negatively impacted the chance for retransplantation; maintaining adequate immunosuppression is conversely a protective factor against allosensitization .
Getting A Kidney Transplant When You Have Hepatitis C
You can still be eligible to get a kidney transplant if you have hepatitis C. When you have hepatitis C, your transplant team will consider:
- The health of your liver
- If your liver is badly damaged, you may not be recommended for a kidney transplant.
- In certain cases if your liver is damaged but you are healthy otherwise, you may be considered for a kidney and liver transplant at the same time.
If you are approved for transplant, your doctor might suggest you get a kidney from a person with hepatitis C, or from a person without hepatitis C.
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What Are The Advantages Of Living Donation
There are three advantages to living donations versus getting a deceased donor kidney:
Donor Recipient Selection Process
The process to be approved for the transplant list may start when your kidney disease is first noticed and you are referred to a nephrologist . Your nephrologist may be able to treat your disease for many years, but when it worsens and it becomes clear that dialysis and the need for a transplanted kidney are becoming a reality, you’ll be referred to a transplant center.;
Once it is determined that an organ transplant is appropriate, you’ll be placed on the transplant list by the center. This means you are added to a national database run by the United Network of Organ Sharing that allows donors and recipients to be matched when an organ becomes available.
The transplant list is actually a very large database of over 112,000 individuals waiting for various types of organ transplants. When an organ becomes available for transplantation, a complex mathematical algorithm is used to create a unique list of the potential recipients for that organ. Thousands of these lists are generated on a monthly basis; each one is unique to a specific organ being donated by a specific donor.;
To give you a sense of the demand for donated kidneys:
- 82% of patients waiting for an organ donation are waiting for a kidney.
- The average wait time for a kidney from a deceased donor is three to five years.
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When Can I Go Back To Work After My Transplant
Our aim is to allow each transplant patient to return to an independent lifestyle with a good quality of life. Most transplant recipients remain off work for two to three months after the transplant but this depends on the individual patient and their occupation. Please discuss when you can return to work with the doctor caring for you.
There Are Two Types Of Kidney Rejections:
If you notice any of the symptoms below that might suggest rejection, please contact our office right away.
- Ankle swelling
- Feeling as if you might have the flu, including symptoms such as body aches, headache and more
- Fever of 101 degrees Fahrenheit or higher
- Pain or tenderness near your surgery site
- Sudden weight gain
- Urinating less than usual
- Very high blood pressure
If your doctor tells you your body might be rejecting your kidney transplant, it does not mean your new kidney is failing. Oftentimes, changing the dosage of your medication will correct this issue. This is why its so important to take your immunosuppression medication as prescribed.
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Potential Benefits Of Allograft Nephrectomy
Recorded mortality rates range from 0.7 to 14%. The main complications are related to infections and haemorrhage and range from 17 to 60% of surgical procedures, while this percentage is higher in urgent life-threatening procedures . Although nephrectomy is the conventional technique in managing failed kidney allograft, in recent years transvascular embolization has been widely described as a less invasive alternative technique, with minimal complications compared with transplantectomy . In a systematic review and meta-analysis comparing transplant nephrectomy and graft embolization, the mortality rate, as well as procedural complications, was significantly higher in the nephrectomy group . In addition, in patients with residual kidney function, a retained graft may allow more liberal fluid intake and improve anaemia, erythropoietin resistance, hypoalbuminaemia and the chronic inflammatory state .
A retrospective study using the USRDS database demonstrated that nephrectomy was associated with a 32% lower relative risk for all-cause mortality in a mean follow-up period of 2.9years . Moreover, patients receiving graft nephrectomy were more likely to receive a second transplant during the follow-up period and the death rate within 30days was only 1.5% . Interestingly, in a large retrospective study of 19;107 patients with allograft failure, this procedure was associated with increased mortality among those with early graft loss .
Limit Your Exposure To Germs
Don’t have a large number of houseguests during the first 6-8 weeks after surgery. Ask family members and friends who may have colds or infections to stay away. Keep preschool children at arm’s length, especially if they are in daycare where other children may be sick or infected. Avoid eating from salad bars as they can harbor bacteria.
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What Does The Operation Involve
The operation is different depending on whether it is an open surgery or by laparoscopy. Both start with an incision made in the persons side, the blood vessels to the kidney get tied off, and the ureter is tied off and the kidney is taken out. Typically, donors recover from laparoscopic surgery within a week and from the open surgery within a couple of weeks.
Will I Have Any Diet Restrictions After The Transplant
For the first 24 hours after your transplant, you will be limited to ice chips and/or clear liquids. Your diet will gradually be increased to solid food.
If your transplanted kidney is not working properly right after the surgery, you will have a diet similar to the diet you had when you were on dialysis. If your transplanted kidney is working well, you will have a regular diet that might be low in sodium. If you have diabetes, you will follow the same diet you had before your surgery.
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What Happens After A Kidney Transplant
Although the concept of surgery is scary, undergoing a kidney transplant when you have a chronic renal condition will significantly improve your quality of life. It removes dietary restrictions, reduces treatment costs, and improves your risk of surviving and having a relatively normal life. However, as with all surgeries, kidney transplants come with risks. Therefore, youll have to stay hospitalized for several days after a kidney transplant. This is done to allow your surgeon and nurses to monitor you closely in case of complications.
Youll feel soreness around the site of the incision during this time. Once youre released from the hospital, youll have to return several times a week for blood testing. Youll be able to return to your normal life within eight weeks after surgery. However, you will need to take medications known as immunosuppressants for the rest of your life. This is because the immune system contains proteins called the Human Leukocyte Antigen which regulate how your body reacts to foreign substances. Its possible for your immune system to develop antibodies to fight off the HLA from the new kidney. Left untreated, it could result in organ failure. This is when infusion therapy can help.
How To Prepare For Living Donor Transplant Surgery
One; of the benefits of living donor transplant is that you, your donor, and the transplant teams will be able to schedule the surgery at a time that works for you and your living donor.
Scheduling your surgery allows you to:
- Plan for time away from work
- Arrange childcare
- Plan transportation to and from the hospital
- Prepare for your hospital stay, such as pack a bag and collect important papers, like insurance information.
If your living donor is a family member, there may be more steps to take as you prepare for surgery. Watch this video to help you think about what steps you need to take.
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What Happens During Surgery
A kidney transplant often takes 3 hours, but can last as long as 5.
Youâll be given anesthesia so you stay asleep the whole time. Then once youâre âunder,â the surgeon will make an opening in your abdomen, just above your groin. Your own kidneys wonât be removed unless theyâre infected or causing pain, but the donor kidney will be put in. Its blood vessels will be attached. Then, the surgeon will connect the ureter to your bladder.
The opening will be closed with stitches, special glue, or staples. A small drain may be put into your abdomen to get rid of any extra fluid thatâs built up during the surgery. Your surgeon will also insert a tiny tube called a stent into your ureter to help you pee. This will be removed 6 to 12 weeks later during a simple procedure.
If your damaged kidney is removed, you have the option of giving it to a kidney research group. Doctors will study it to learn more about kidney disease and hopefully get closer to a cure. If this interests you, youâll need to tell your transplant doctor ahead of time.