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kidney transplantation

Kidney Transplantation: Myths And Reality

Kidney transplantation: myths and reality
Dr Gaurav Sahai
Consultant Nephrologist
The prevalence of chronic renal failure (CRF) in India is increasing and at present is 0.78%
to 1.39% in adult population. CRF population in india is predominantly young due to delay in
diagnosis and improper treatment of renal diseases.Only about 10% of these patients get some
form of renal replacement therapy (RRT) like dialysis or renal transplant. Less than 5% patients
in India get renal transplants Less than 2% of renal transplants is from cadaver donors(dead
donors) Only 35% of the eligible CRF patients have related, willing and fit donors
How to know that patient has reached end stage renal disease (ESRD) and needs RRT ?
• This can be established by means of blood tests , signs and symptoms.
• blood tests will show increased Urea, Creatinine and phosphourus , decreased calcium.
• Symptoms such as Poor appetite Nausea, vomiting Progressive general weakness and
lethargy ,persistent breathlessness more on lying down ,Malnutrition ,uncontrolled
hypertension etc.
• Signs such swelling over body,pale appearance,rapid acidotic breathing etc
Management options in ESRD are :
 Haemodialysis (Blood dialysis by machine )
 Peritoneal dialysis(Dialysis by filling water in patients abdomen)
 Kidney transplant
What is a kidney transplant?
First kidney transplant in the world was done in 1954 by Dr Joseph E. Murray – performed the
first successful kidney transplant in identical twins. It is the surgical implantation of a donor
kidney into a recipient inside his abdomen (usually right lower side). Recipients native kidneys
are not removed .

Therefore patient will have 3 kidneys after a kidney transplant.

Who can be a donor ?
Relative- Mother, Father, Brother, Sister, Son, Daughter, Wife/Husband, in laws, etc.
Wanting to donate kidneys to the recipients “by reason of affection or attachment towards the
recipient or for any other special reasons,” subject to approval of the Authorization Committee,
established under the Act.
Who can be a recipient ?
Patients of ESRD(end stage renal disease)
No significant other organ disease
No infective Pathology
Willing to give consent
What are the contraindications to kidney transplant
Absolute contraindications…
Advanced form of major extrarenal disease like cancer etc
Active infection
Previous sensitization(allergy) to donor tissue
Psychiatric illness not controlled by medictions
Relative contraindications….
Advanced Age (> 65 years)
Presence of abnormalities of bladder or urinary tract

Vascular disease leading to poor blood flow in some blood vessels
Untreated Psychiatric problems
What is the law concerning kidney transplant in india?
The Transplantation of Human Organs Act, 1994 is meant to “provide for the regulation of
removal, storage, and transplantation of human organs for therapeutic purposes and for the
prevention of commercial dealings in human organs.” This act illegalises the buying and selling
of human organs

A kidney transplant surgery being conducted.

A donated kidney ready to be transplanted

Dressing applied over a transplant surgery site.
What are the Advantages of kidney transplant ?
Survival benefit
Better quality of life than on dialysis
Saves money after 3 years
More complete replacement of renal functions

Disadvantages
• Risk of infection
• Side effects of transplant related medicines.
What are the Outcomes expected after renal transplant?
 Average survival of patient- 12 to 15 yrs
 Slightly less survival of diabetic patients
 Can provide reasonably good quality life
 In conclusion dialysis and transplant therapy are complimentary to each other but renal
transplant is certainly a better treatment option
 Choice of therapy depends on medical and social issues.

Metro Hospital
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