How Does A Living Donor Kidney Transplant Work
A living-donor kidney transplant involves surgically removing one of the donor’s healthy kidneys and implanting it in a recipient whose kidneys no longer work properly. They are left in place unless the recipient’s own kidneys are producing difficulties. The remaining kidney then continues to work with no problems.
Living donors can include parents, siblings, or other relatives. In most cases, the surgeon removes only one kidney. However, two-kidney removal is possible if both kidneys exhibit disease. The surgery requires only a small incision in the abdomen or chest and the kidney is placed in the back between the lungs where it can continue to function until it heals. Most patients need only slight support while recovering from this type of surgery.
After the living donor kidney transplant, the recipient body recognizes the donated organ as its own and makes special proteins called antibodies that fight off infection. The patient receives the same immune-suppressing drugs that prevent rejection of a cadaveric donor organ.
People who donate their organs save lives by providing transplants for others. Living donors often experience immediate benefits from their donation such as feeling better about themselves and their ability to cope with daily life challenges. Many choose to donate their organs after they die because they do not want others to go through the pain and trauma of transplantation when an alternative may exist.
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Supportive Care For Kidney Failure
Supportive care is the treatment choice for kidney failure for people who have decided that dialysis and transplant are not appropriate for them. For many, this is because they are already very frail and they do not want complex treatments. Some people have the complex treatment for a while and then wish to stop.For many who are already frail, their lifespan with kidney failure, with or without dialysis, is very similar. Supportive care means that the person’s care continues to be supervised and supported by health professionals. They may have medication and a restricted diet to improve their quality of life. Supportive care, however, will not artificially prolong life when your kidneys fail completely. If a person is unsure about choosing a treatment option, it is always possible to try dialysis for a short while to see how things go.
Why Is The Kidney Transplanted On The Right Side
The new kidney is surgically implanted on the lower right or left side of your abdomen, where it is linked to surrounding blood arteries. Because the kidney is in this position, it may readily link to blood arteries and the bladder. Your replacement kidney’s vein and artery are connected to your vein and artery. The ureter, which is the tube that carries urine from the kidney to the bladder, goes through the abdominal wall to reach the bladder.
The reason for this procedure is that if the kidney transplant were placed in the upper part of the abdomen, then some of the important organs below it would block its supply of blood and cause damage to the kidney. Also, since the intestine curves upward toward the back, placing the kidney there would require removing a large portion of the small intestine along with it. This is not only difficult surgery but also risks damaging other organs inside the abdomen while trying to remove such a large piece of tissue. Finally, because the liver lies directly above the replaced kidney, any cancerous growths in the liver could spread to the kidney.
So, the kidney transplant is placed on the lower part of the abdomen to avoid interference with the intestines and the liver as well as to maximize the amount of healthy kidney tissue available for transplantation.
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How Does A Kidney Transplant Differ From Dialysis
With dialysis treatment, a machine filters waste and extra fluid out of your blood the way your kidneys normally would. Many people undergo dialysis while awaiting a kidney transplant.
Dialysis only filters the blood during a treatment session, not in the constant way a kidney does. For this reason, dialysis patients usually have diet and fluid restrictions. Dialysis also requires an access site a vein or an implanted device where the blood can be collected and filtered outside the body.
A kidney transplant is a surgical operation to give a functioning human kidney to someone whose kidneys have stopped working or are close to failing. The functioning kidney is removed from either a living donor or someone who has recently passed away.
A transplanted kidney performs all the functions of a kidney a person has from birth. It constantly filters blood for waste and excess fluid. Most kidney transplant recipients do not have to limit their diet and fluid intake, but they do need to take medicine on a daily basis to help keep their transplant functioning.
Living Donor Kidney Transplants
The first successful live donor kidney transplant was performed in 1954. The donor and recipient were identical twins. Since then, our understanding of donor compatibility and the development of immunosuppressant medications have greatly advanced living donor procedures. Today, approximately 75% of people who receive a kidney transplant from a living donor maintain their kidney function for 10 to 20 years.
Living donor programs allow a relative or a compatible unrelated donor to donate a kidney. Siblings have a 25% chance of being an “exact match” for a living donor and a 50% chance of being a “half-match.” Donor compatibility is established through blood tests that look for matching blood types and antigens. The overall health of the potential donor is also of critical importance.
Kidneys from perfectly matched sibling donors on average can function for over 35 years. Live donor procedures of all types, however, offer better outcomes than deceased donor procedures:
- Live donor recipients spend less time waiting for a donor organ. The wait for a deceased donor kidney in New York averages five to seven years.
- Immediately upon transplantation, 97% of live donor kidneys are fully functional, versus 50-60% of deceased donor kidneys.
- Live donor recipients face less risk of organ rejection.
Drug Companies Could Create New Drugs To Protect The Covid Vulnerable Why Arent They
Twice, Janet Handal thought she would get a reprieve from semi-lockdown life. The first was when she was vaccinated in January, 2021. But a negative antibody test quickly dashed those hopes the same immunosuppressants she took to prevent her body from rejecting a kidney transplant also prevented it from responding adequately to vaccines.
So the 71-year-old New Yorker turned her attention to a drug, then in clinical trials, designed to protect immunocompromised people like her, enriching their blood with antibodies they struggled to make on their own. Evusheld was authorized last Dec. 8 six days before lab data showed it would be significantly less effective against Omicron, the immune-evasive variant about to sweep the globe.
Positive Crossmatch And Sensitized Patient Kidney Transplant
This program makes it possible to perform kidney transplants in patients who have developed antibodies against their kidney donor, a situation known as positive crossmatch.
The process is similar to that for blood type incompatible kidney transplants. Patients receive medications to decrease their antibody levels or they undergo plasmapheresis treatments to remove the harmful antibodies from their blood. If their antibody levels are successfully reduced, they can then go ahead with the transplant.
Blood type incompatible kidney transplants and positive crossmatch/sensitized patient kidney transplants have been very successful in the United States and internationally. Success rates are close to those for transplants from compatible living donors and are better than success rates for deceased donor transplants.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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What Happens After A Kidney Transplant
Most people spend about three days in the hospital after a kidney transplant. This way, your medical team can keep a close eye on you and make sure youre recovering well.
Your new transplanted kidney may start working immediately. Or, you may need dialysis temporarily until it starts working. This might take several days or weeks.
Youll also need to start taking medications to keep your immune system from rejecting your new transplanted kidney.
What will my kidney transplant scar look like?
Your scar will be about 2 to 5 inches long, on the right or left side of your lower abdomen.
How long does a kidney transplant last?
How long a kidney transplant lasts can vary from person to person. In general, kidneys donated by a living person last longer than kidneys donated by a deceased person. On average, however, transplanted kidneys last approximately 10 years.
Incompatible Living Donor Transplant
Ideally, to be eligible for transplantation, kidney donors and recipients should have compatible blood and tissue types. Too often, however, willing live donors do not meet these medical criteria. While it remains preferable to receive a kidney from someone who is fully immunologically compatible, recipients can be successfully transplanted from a donor with mismatched antibodies.
When antibodies are present, the blood of the recipient and donor react to each other, much like an allergic reaction. In the past, this reaction has caused the recipient’s body to reject the donor organ. Today, we can successfully transplant from an incompatible donor if the recipient’s blood is first “cleaned” of antibodies through a process known as plasmaphereis.
First, the amount of antibodies present must be quantified. This level helps to determine the number of treatments required. Next, the recipient’s blood is separated into cells and plasma . The plasma is removed and replaced with a commercially available plasma substitute. Removing the plasma removes the antibodies. In essence, plasmapheresis is similar to dialysis it removes antibodies just as dialysis removes waste products.
Depending on the level of antibodies present, plasmapheresis may be performed anywhere from 2-10 times. Most patients receive the treatment every other day, for up to three times a week. Once the quantity of antibodies drops to a low enough level, the recipient can undergo the transplant.
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How Do I Know My New Kidney Is Working
Blood tests help you know your donor kidney is working. Before you leave the hospital, youll schedule an appointment at the transplant center to test your blood. The tests show how well your kidneys are removing wastes from your blood.
At first, youll need regular checkups and blood tests at the transplant center or from your doctor. As time goes on, youll have fewer checkups.
Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You also may have other symptoms that your body is rejecting your donor kidney. If you have these problems, your transplant surgeon or nephrologist may order a kidney biopsy.
What Does Kidney Transplant Surgery Involve
You only need 1 working kidney to be healthy, so only 1 kidney is transplanted during surgery. Your 2 original kidneys will usually remain in place and the new donor kidney will be placed in another area of your abdomen. The ureter attached to the donor kidney will then be attached to your bladder. If the kidney transplant surgery is successful, your new kidney will take over the tasks of filtering your blood and making urine, just like your own kidneys did before you had kidney disease.
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What Are The Side Effects Of Anti
Some anti-rejection medicines may change your appearance. Your face may get fuller, you may gain weight, or you may develop acne or facial hair. Not all people have these side effects.
Anti-rejection medicines weaken your immune system, which can lead to infections. In some people over long periods of time, a weakened immune system can increase their risk of developing cancer. Some anti-rejection medicines cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease.
When used over time, these medicines may also cause liver or kidney damage in some people. Your transplant team will order regular tests to monitor the levels of anti-rejection medicines in your blood and to measure your liver and kidney function.
Blood Type Incompatible Kidney Transplant
This program allows patients to receive a kidney from a living donor with an incompatible blood type. To be able to receive such a kidney, patients must undergo several rounds of plasmapheresis, which is similar to dialysis, before and after the transplant. Plasmapharesis removes antibodies from the patients blood that can lead to rejection of the transplanted kidney.
Patients require multiple treatments with plasmapheresis before transplant, and may need several more after transplant to keep their antibody levels down.
Some patients also need to have their spleens removed at the time of transplant surgery to lower the number of cells that produce antibodies. The spleen, a spongy organ about the size of a persons fist, produces blood cells. Located in the upper left part of the abdomen under the rib cage, the spleen can be removed using laparascopic surgery.
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Contraindications For Kidney Recipients
Contraindications to receive a kidney transplant include both cardiac and pulmonary insufficiency, as well as hepatic disease and some cancers. Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications.
Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age and require that one must be in good health . Significant cardiovascular disease, incurable terminal infectious diseases and cancer are often transplant exclusion criteria. In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant. People with mental illness and/or significant ongoing substance abuse issues may be excluded.
HIV was at one point considered to be a complete contraindication to transplantation. There was fear that immunosuppressing someone with a depleted immune system would result in the progression of the disease. However, some research seem to suggest that immunosuppressive drugs and antiretrovirals may work synergistically to help both HIVviral loads/CD4 cell counts and prevent active rejection.
Get Tested At A Transplant Center
At the transplant center, youll meet members of your transplant team. Youll have tests to make sure youre a good candidate for transplant.
Tests will include blood tests and tests to check your heart and other organsto make sure youre healthy enough for surgery. Some conditions or illnesses could make a transplant less likely to succeed, such as cancer that is not in remission, or current substance abuse.
Youll also have tests to check your mental and emotional health. The transplant team must be sure youre prepared to care for a transplanted kidney. Youll need to be able to understand and follow a schedule for taking the medicines you need after surgery.
In a process called cross-matching, the transplant team tests the donors blood against your blood to help predict whether your bodys immune system will accept or reject the new kidney.
If a family member or friend wants to donate a kidney and is a good match, that person will need a health exam to make sure he or she is healthy enough to be a donor. If you have a living donor, you dont need to be on a waiting list for a kidney and can schedule the surgery when its best for you, your donor, and your surgeon.
Testing and evaluation at the transplant center may take several visits over weeks to months.
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How Do I Get A Donor Kidney
If your doctor thinks a transplant is an option for you, theyâll put you in touch with a local transplant center. Thatâs a hospital that does organ transplants. Youâll then have exams, X-rays, and scans to make sure youâre healthy enough to go through the transplant process.
There are two different ways you can get a healthy kidney. The first is through whatâs known as a âliving donor.â This might be a family member or close friend who is willing to give you one of their kidneys. Or, it could be a stranger whoâs willing to give you one of theirs. The second way you could get a kidney is from a deceased organ donor.
Either way, your blood and tissue will need to be tested to make sure yours matches that of the donor. This raises the chances that your immune system will accept the donor kidney and not try to attack it.
If you have a living donor, youâll be able to schedule the date of your transplant surgery. Getting a kidney from a deceased organ donor may take much longer. Youâll be placed on a waiting list. Then, when a kidney is ready, youâll receive a call telling you to get to the hospital right away.
Where Does My New Kidney Come From
Kidneys for transplantation might come from living donors or deceased organ donors. Immediate family members, spouses and friends may qualify for kidney donation. Deceased donor kidneys come from those who have elected to donate their organs upon death.
Potential kidney donors are carefully screened to make sure theyre a match. This helps prevent complications.
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