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 Kidney TransplantsKIDNEY TRANSPLANTS Why is a transplant necessary? Several diseases can damage the kidney, seriously affecting the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus. If the damage is severe enough, dialysis or transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life. Patients are referred for transplantation by either their kidney doctor ( nephrologist) or their personal physician. This can be done through a letter, fax, or a phone call to the Transplant Office. AGH performs both cadaveric and living donor transplants. Cadaveric transplants are kidneys donated by a loved one at the time of death. They may come from anywhere in the country. AGH follows all standard practices to determine the safety of cadaveric kidneys offered to our patients. Living donor transplants are those that are removed from a living family member, friend or altruistic donors. All potential candidates for a kidney transplant must first go through the evaluation process. During this process, members of the transplant team will discuss the options of living donors and cadaveric donors. Pre-Transplant Evaluation The following procedures help in evaluating a patient's health status: Physical exam - by both a transplant surgeon and a transplant nephrologist, which gives an overall picture of the patient's conditions. Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract. Complete medical and surgical history - Determines what additional tests may need to be done. Electrocardiogram - (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected. Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed. Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney. Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion, pregnancy, a previous transplant or a current infection. Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome. Mammogram - X-ray of a woman's breast that can detect signs of breast cancer. Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer. Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant. Additional tests or procedures may be required due to you past medical history, or an abnormal finding on the physical examination or routine evaluation tests. You and your physician will be notified of the need for additional testing to complete your evaluation. The pre-transplant coordinators will also be available to assist in scheduling any additional studies to expedite your evaluation. Waiting for a kidney transplant It may take weeks, months, and in many cases years to locate the right kidney for a specific patient. During this time, the patient should prepare to take positive steps to deal with the stresses of waiting, always staying focused on reaching the goal of transplant. Patients should also adhere strictly to their dialysis regime and medications during this period. This will not only keep you in the best physical condition when a kidney becomes available, but also demonstrates your ability to follow complex medical regimens, indicating your ability to follow through with your post-transplant care. Because of the increased waiting time for a cadaver kidney, we STRONGLY urge you to consider a living donor. While it may be difficult to ask a family member, or friend to help you, frequently, this is an important gift that they are ready to offer. All living donors are carefully screened to minimize the risks of surgery to both them and to you. We also have a separate staff, who work only with the potential donors, and are their advocate for the donation process. The Telephone as a Lifeline If you must wait for a cadaver kidney, it is imperative that the transplant team should be able to reach the patient wherever he or she is located. The patient should provide the team with the phone numbers of family members and close friends as well, and do everything he can to make sure that he can be contacted immediately. When the Phone Call Comes When the phone call comes, the coordinator will advise the patient when to present to AGH. The patient must move quickly, getting to the hospital without delay. Dealing With Pre-transplant Stress Waiting for a transplant can trigger a patient's feelings of stress and anxiety. To help manage stress, the patient should: --Eat right, --Take prescribed medications, --Follow a daily exercise program. --Continue studies, work, and leisure activities
–And again, follow all recommendations of your doctor. The transplant team will create a plan based on his medical needs and answer questions to help alleviate fears. The social worker can put the patient in touch with a support group in the area. New hobbies can help a patient relax and leave positive feelings of fulfillment. The patient should ask his doctor for guidelines on these activities. Good company, such as with family and friends, can take a patient's mind off waiting. Laughter and relaxation techniques, like reading and listening to music, can be especially helpful. The Living Donor Process A potential living donor must complete an extensive physical and psychological evaluation prior to being accepted as a donor. These tests include: blood work, chest-x-rays, EKG, ultrasound of the kidneys, urine studies to determine the kidney function, examinations by the surgeons, nephrologists, and psychiatrist. Lastly, the donor undergoes an angiogram, or dye study , of the kidneys. These studies are done over a period of time, and begin with the least invasive and time consuming, and progress to those studies that are more involved. During this evaluation time period, you will be in touch with the Living Donor Coordinator, who will assist you in scheduling tests, traveling, overnight accommodations ( when necessary), and most importantly to answer your questions and concerns that you may have. Costs All costs for a living donor evaluation, the surgery, and post-operative follow-up care is covered under the Medicare ESRD program. This occurs if the recipient is either on Medicare or Medicare eligible. Certain insurances also cover the cost for the donor. Each case is reviewed carefully by the Financial Coordinator on an individual basis. Travel, local accommodations and payment for missed work ARE NOT covered. A kidney is removed from a living donor by two different procedures, an Open nephrectomy, or a laparoscopic nephrectomy. The former method requires a 10 inch incision on with the right or left side to remove the kidney. The procedure lasts approximately 3 hours, and you are hospitalized for about three days. Because of the incision, your activity after surgery will be limited for approximately 6 weeks , or until you have fully recovered. Laparoscopic Kidney Removal Using narrow instruments inserted through tiny punctures no more than 2½ inches long, it is now possible for the surgeon to free up the kidney and tie off the blood vessels. This procedure, called laparoscopic surgery, is performed by inflating the abdomen with gas which creates a space between the wall of the abdomen and the organs inside. Using short incisions in the skin, narrow tubes are inserted through the abdominal wall so that instruments can be slid through them to perform the maneuvers necessary for the operation. All this is viewed directly on a video monitor which receives its picture from a video camera attached to the laparoscope. The incision points are selected on the basis of cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain. Benefits to the Donor The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized. The Operation Four or five tiny incisions are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is scooped up in a bag and extracted from the abdomen through a short incision (5 in above diagram) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It is usually removed within a few days. Risks for the Donor All operations carry some risk. Those which are the most important for you to know about are mentioned here. Most of the complicated laparoscopic procedures which we perform require full general anesthesia to allow enough relaxation of the muscles of the abdominal wall so that the operative space to work in is large enough. Modern anesthesia is very safe and the anesthesiologists at AGH are all highly skilled, board certified physicians. Even in traditional surgery, each operation has a specific complication that every surgeon strives to avoid. These potential pitfalls are still present when the operation is performed laparoscopically and will be outlined to you, depending on the type of procedure you require. Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional open procedure is for your safety. Alternatives Most live donors come to us for laparoscopic surgery. Much of the discussion of alternative forms of treatment will have taken place before coming to see us. If we feel that your best interests will not be served by laparoscopic surgery we will tell you so and suggest an appropriate alternative. After the Transplant The transplant procedure takes approximately 3-5 hours. Following surgery, you will be taken to the recovery Room, and then directly to the Transplant Unit. The average length of stay in the hospital following a kidney transplant is 5-7 days. After discharge, you will require frequent blood tests, to monitor for rejection, as well as visits to the Renal Transplant Clinic. Your coordinator will arrange for your outpatient care at the time of your discharge, including return visits. In addition to the Transplant physicians, you will return to you nephrologist or primary physician for routine care as well. The longer you have your kidney, the less frequent your visits to AGH, with most of your routine care occurring with your own physician. The transplant coordinators, however, continue to follow your blood work results, and talk with your physician regarding your status. You are also encouraged to contact your coordinator with any questions or concerns at any time after your transplant.
Call 1-877-284-2000 for more information.
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