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Kidney Transplant

Kidney transplant is recommended for patients with end-stage renal disease (ESRD) who can tolerate transplant surgery. The kidney is the most frequently transplanted organ.

A healthy kidney can be transplanted into a person with complete kidney failure. Approximately 12,000 kidney transplants are performed every year in the United States. The donor and the recipient can function with one kidney and neither requires dialysis after successful transplantation.

Surgery is done under general anesthesia and typically takes 2 to 3 hours. The failed kidneys are left in place and the healthy one is transplanted below them in the abdomen. Blood vessels are attached to the blood vessels of the legs and the ureter is attached to the bladder with a small plastic catheter.

The kidney usually does not work during the first day following the transplant. It is necessary to monitor its function closely and to suppress the immune system with drugs such as tacrolimus (Prograf®) or cyclosporine A (Sandimmune®). Immunosuppressive antirejection medications must be taken for the remainder of the patient's life.

Contraindications (factors that make the procedure inadvisable) to transplant include the following:

• Cancer
• Heart disease
• Impaired blood circulation in the legs
• Intolerance of post-transplant medication (immunosuppressive drugs)
• Lung disease
• Physiologic frailty and malnourishment

Complications
The kidney is the most frequently transplanted organ in the world, but rejection can occur. Pretransplant kidney analysis is vital to determine a match, but the immune system may react against a healthy kidney because it is foreign to the body.

Less than 50% of all kidney recipients experience at least one rejection episode, most of which can be controlled. Rejection used to cause symptoms including fever, pain, and tenderness over the transplant site, but these are rare today with the development and use of potent immunosuppressive drugs.

Two types of rejection include acute (sudden) and chronic (gradual). A drastic rise in creatinine may indicate acute rejection, especially in the first year following transplant. A gradual rise over a longer period of time is a sign of chronic rejection. Chronic rejection is also associated with proteinuria. Generally, any high level of creatinine that persists or increases warrants a biopsy. The rise could be a sign of rejection or of the primary kidney disease.

Biopsy is protocol for people with normal creatinine levels in some transplant programs. Rejection can occur without a raise in creatinine levels. A biopsy of the transplanted kidney is done in 3-month intervals if abnormalities persist. These abnormalities can frequently be controlled with appropriate changes in immunosuppressive medication.

Patients on high doses of cyclosporine are at risk for developing cyclosporine toxicity, which is also indicated by a rise in creatinine. About 25% of transplant patients experience toxicity. Lowering the dosage usually reduces creatinine level.

Various infections can occur, such as cytomegalovirus, herpes simplex 1 and 2, fungal, and yeast in otherwise successful transplants. Cytomegalovirus, the most common infection among transplant patients, causes aching joints, fatigue, fever, headaches, blurred vision, and pneumonia. Infections are treated with antibiotics.

Antirejection medications can cause diabetes and hypertension in some people. These conditions require prompt and appropriate treatment.

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