A closer look at kidney transplants

Kidney transplants are vital for renal failure patients who wish to return to normal, working life. Loss of kidney function is a frightening possibility and incidences of renal failure are rising at an alarming rate. People with diabetes, hypertension and various forms of nephritis form a high-risk group accounting for 90 percent of renal failure patients. The remaining 10 percent suffer from genetic conditions like polycystic disease and neglected obstructions.

Types of renal failure
Renal failure may be of two types - acute and chronic. Acute renal failure is usually a temporary condition with a potential for full recovery following a few weeks of dialysis. It may result from infections, gastroenteritis or malaria and may even be drug-induced. On the other hand, chronic renal failure features a gradual involvement of the kidney. It is irreversible and eventually leads to end-stage renal failure. The patient is given medication for as long as the kidneys respond to the treatment. At the final stage, when the drugs no longer work, the patient has two options: (1) dialysis, whether haemodialysis available in hospitals, or the home-based peritoneal dialysis, or (2) a kidney transplant.

Transplant: the better option
A kidney transplant provides near-normal kidney function and greater quality of life allowing patients to return to their jobs and other daily activities. Improved dialysis quality has helped even patients who have been on dialysis for 10 to 15 years, to resume their careers. However, statistics show that more transplant patients than dialysis patients become gainfully employed again; after all, the former are not tied to a machine. Transplants bode well for motherhood too. Female patients, particularly those whose transplanted kidneys are functioning well, can bear children after the surgery.
The success rates for kidney transplants have improved considerably in recent years. We now see 95 percent survival in the first year, even though this figure drops to 70 percent by the fifth year. Overall results depend on various factors, including the age of the patient and the age of the donor as well as on whether the patient has diabetes or cardiac disease. Socio-economic conditions and the patient's ability to comply with post-operative requirements also play a role. It warrants mention that the risk of a kidney transplant is low, but not zero. The main risk is not of the patient dying on the operating table but of the kidney not working, thereby forcing the patient to return to dialysis. This takes place in two to three percent of all transplant cases.

Too old for a transplant?
As mentioned above, the patient's age matters. Kidney transplants are common among patients under 60 years of age and there has been considerable success with patients aged between 60 and 65 as well. However, the procedure is less frequent among patients older than 65; in such cases, transplants are recommended only if the patient is suitably fit. All prospective transplant recipients must be screened thoroughly: they should have satisfactory cardiac and liver function and no active infections.

Suitable transplant donors
Cadaveric transplants are still rare in India, thereby creating a dependence on living donors. However, patients' family members are often reluctant to donate kidneys. This sometimes stems from genuine fear of harming their health; among the richer classes, the reluctance is often because the recipient's family would prefer to buy than donate a kidney.
This is why we now advocate spousal transplants, that is, transplants between husband and wife. More than 25 percent of all transplants performed by me are spousal transplants. Nowadays, we even hear of husbands donating to their wives and not just of wives giving to husbands.
There is also the option of paired transplants wherein the spouse or relative of one patient donates a kidney to another patient in exchange for a kidney from the recipient's family. Such transplants are particularly useful when blood groups do not match among relatives. It should be encouraged to stem the crass commercialization of buying and selling kidneys. Family members should also come forward more with regard to donating the organ.

Post-operative care
A reasonable level of cleanliness is necessary in the post-operative period, particularly in the first three months following the surgery. The patient should maintain personal hygiene, drink only boiled and filtered water, and avoid contact with people suffering from fever or respiratory infections. This is because the transplant patient's immunity remains low due to the immunosuppressive drugs that are continued throughout the patient's life. These drugs are necessary because the body would otherwise reject the kidney. Nevertheless, the dosage is tapered down within three to four months. Thereafter, the patient can resume normal office work and other regular activities.

Preventing renal failure
Unfortunately there are no early indicators of kidney failure. The symptoms appear late and may include fatigue, lack of appetite, swelling of the legs, puffiness of the eyes, anaemia and hypertension.
Early diagnosis is possible only through prospective checking for renal function via urine and blood creatinine tests.

Such testing must be carried out regularly for all individuals above the age of 40 years as well as for patients of diabetes and hypertension. Basic prevention involves controlling diabetes and hypertension. As far as possible, one should also avoid nephrotoxic drugs and particularly painkillers. (Reprint)

 

A closer look at kidney transplants

Kidney transplants are vital for renal failure patients who wish to return to normal, working life. Loss of kidney function is a frightening possibility and incidences of renal failure are rising at an alarming rate. People with diabetes, hypertension and various forms of nephritis form a high-risk group accounting for 90 percent of renal failure patients. The remaining 10 percent suffer from genetic conditions like polycystic disease and neglected obstructions. Types of renal failure Renal failure may be of two types - acute and chronic. Acute renal failure is usually a temporary condition with a potential for full recovery following a few weeks of dialysis. It may result from infections, gastroenteritis or malaria and may even be drug-induced. On the other hand, chronic renal failure features a gradual involvement of the kidney. It is irreversible and eventually leads to end-stage renal failure. The patient is given medication for as long as the kidneys respond to the treatment. At the final stage, when the drugs no longer work, the patient has two options: (1) dialysis, whether haemodialysis available in hospitals, or the home-based peritoneal dialysis, or (2) a kidney transplant. Transplant: the better option A kidney transplant provides near-normal kidney function and greater quality of life allowing patients to return to their jobs and other daily activities. Improved dialysis quality has helped even patients who have been on dialysis for 10 to 15 years, to resume their careers. However, statistics show that more transplant patients than dialysis patients become gainfully employed again; after all, the former are not tied to a machine. Transplants bode well for motherhood too. Female patients, particularly those whose transplanted kidneys are functioning well, can bear children after the surgery. The success rates for kidney transplants have improved considerably in recent years. We now see 95 percent survival in the first year, even though this figure drops to 70 percent by the fifth year. Overall results depend on various factors, including the age of the patient and the age of the donor as well as on whether the patient has diabetes or cardiac disease. Socio-economic conditions and the patients ability to comply with post-operative requirements also play a role. It warrants mention that the risk of a kidney transplant is low, but not zero. The main risk is not of the patient dying on the operating table but of the kidney not working, thereby forcing the patient to return to dialysis. This takes place in two to three percent of all transplant cases. Too old for a transplant? As mentioned above, the patients age matters. Kidney transplants are common among patients under 60 years of age and there has been considerable success with patients aged between 60 and 65 as well. However, the procedure is less frequent among patients older than 65; in such cases, transplants are recommended only if the patient is suitably fit. All prospective transplant recipients must be screened thoroughly: they should have satisfactory cardiac and liver function and no active infections. Suitable transplant donors Cadaveric transplants are still rare in India, thereby creating a dependence on living donors. However, patients family members are often reluctant to donate kidneys. This sometimes stems from genuine fear of harming their health; among the richer classes, the reluctance is often because the recipients family would prefer to buy than donate a kidney. This is why we now advocate spousal transplants, that is, transplants between husband and wife. More than 25 percent of all transplants performed by me are spousal transplants. Nowadays, we even hear of husbands donating to their wives and not just of wives giving to husbands. There is also the option of paired transplants wherein the spouse or relative of one patient donates a kidney to another patient in exchange for a kidney from the recipients family. Such transplants are particularly useful when blood groups do not match among relatives. It should be encouraged to stem the crass commercialization of buying and selling kidneys. Family members should also come forward more with regard to donating the organ. Post-operative care A reasonable level of cleanliness is necessary in the post-operative period, particularly in the first three months following the surgery. The patient should maintain personal hygiene, drink only boiled and filtered water, and avoid contact with people suffering from fever or respiratory infections. This is because the transplant patients immunity remains low due to the immunosuppressive drugs that are continued throughout the patients life. These drugs are necessary because the body would otherwise reject the kidney. Nevertheless, the dosage is tapered down within three to four months. Thereafter, the patient can resume normal office work and other regular activities. Preventing renal failure Unfortunately there are no early indicators of kidney failure. The symptoms appear late and may include fatigue, lack of appetite, swelling of the legs, puffiness of the eyes, anaemia and hypertension. Early diagnosis is possible only through prospective checking for renal function via urine and blood creatinine tests. Such testing must be carried out regularly for all individuals above the age of 40 years as well as for patients of diabetes and hypertension. Basic prevention involves controlling diabetes and hypertension. As far as possible, one should also avoid nephrotoxic drugs and particularly painkillers. (Reprint)