Kidney Transplantation: Myths And Reality
Kidney transplantation: myths and reality
Dr Gaurav Sahai
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
- Haemodialysis (Blood dialysis by machine )
- Peritoneal dialysis(Dialysis by filling water in patients abdomen)
- 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.
- Patients of ESRD(end stage renal disease)
- No significant other organ disease
- No infective Pathology
- Willing to give consent
- 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
- A kidney transplant surgery being conducted.
- A donated kidney ready to be transplanted
- Dressing applied over a transplant surgery site.
- Survival benefit
- Better quality of life than on dialysis
- Saves money after 3 years
- More complete replacement of renal functions
- Risk of infection
- Side effects of transplant related medicines.
- 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.
Management options in ESRD are :
What is 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 ?
What are the contraindications to kidney transplant
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 –