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Friday, February 15, 2008

Kidney transplant: When your kidneys fail

A kidney transplant is often the best treatment option for kidney failure. Find out about donor kidneys, transplant surgery and post-transplant care.

Kidney failure is a life-threatening condition. A kidney transplant — which can help you feel better, boost your energy and improve your quality of life — is often the best treatment option. If you have kidney failure, here's what you need to know about a kidney transplant

What causes kidneys to fail?

The kidneys filter excess fluid and waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body — a condition known as kidney failure.
Sometimes kidney failure develops suddenly (acute kidney failure). This type of kidney failure is often related to surgery, trauma, infection or disrupted blood flow to the kidneys. With intensive treatment, acute kidney failure is often reversible.
In other cases, kidney failure develops slowly (chronic kidney failure). This type of kidney failure is often related to diabetes, high blood pressure or a chronic kidney disease. Left untreated, chronic kidney failure can progress to end-stage kidney disease. At this point, the kidneys function at a fraction of normal capacity. You'll need either artificial filtering (dialysis) or a kidney transplant to stay alive.

Who might be considered a candidate for a kidney transplant?

Sometimes chronic kidney failure can be managed with diet, medication and treatment for the underlying cause of kidney failure and any related complications. If your kidneys can't keep up, however, you might be a candidate for a kidney transplant. In fact, if you have no other life-threatening medical conditions, a kidney transplant may be a better option than dialysis because it provides a better quality of life. However, you may need dialysis until a suitable kidney donor is found.

Where does the donated kidney come from?

One donated kidney can do most of the work that your two failed kidneys used to do. A donor related by birth is likely to provide the closest match, but you can receive a kidney from any compatible adult. If a living donor isn't available, you may be placed on a waiting list to receive a kidney from a deceased donor. The wait may be several years or even longer.

What should I consider when choosing a transplant center?

If your doctor recommends a kidney transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
When you're considering transplant centers, ask about the number and type of transplants the center performs each year, as well as its organ and recipient survival rates. You can compare transplant center statistics through a database maintained by the Scientific Registry of Transplant Recipients.
Also consider additional services provided by the transplant center. Many transplant centers coordinate support groups, assist with travel arrangements, help secure local housing for the recovery period and offer referrals to other helpful resources.

Do I need to be accepted by the transplant center?

When you select a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements for a kidney transplant. The team at the transplant center will assess whether you:
  • Are healthy enough to have surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would hinder transplant success
  • Are willing and able to take medications as directed
  • Have family and friends to support you during this stressful time

What can I do to prepare for the kidney transplant?

Whether you're waiting for a donated kidney to become available or your transplant surgery is already scheduled, it's important to keep your mind and body healthy.
  • Take your medications as prescribed.
  • Follow your diet and exercise guidelines.
  • Keep all appointments with your health care team.
  • Stay involved in healthy activities, including relaxing and spending time with family and friends.
  • Keep a positive outlook.
  • Consider joining a support group.
If you're waiting for a donated kidney, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and arrange transportation to the transplant center in advance.

What happens during the transplant?

Kidney transplant surgery usually lasts about three hours. The surgeon will place the new kidney in your lower abdomen. Unless your own kidneys are causing high blood pressure or infection, they'll probably be left in place. The blood vessels of the new kidney will be attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's ureter — the tube that links the kidney to the bladder — will likely be connected to your bladder.
Your new kidney will make urine just like your own kidneys did when they were healthy. Often this starts immediately. In other cases it takes up to a few weeks. Expect soreness or pain around the incision site while you're healing.
Recovery time in the hospital is usually three to five days, followed by close monitoring for an additional three to four weeks. During this time, you'll need to stay fairly close to the transplant center.

What can I expect after the transplant?

Even with the best possible match between you and the donor, your immune system will try to reject the new kidney. Your drug regimen will include medications to suppress your immune system. You'll likely take these or other drugs for the rest of your life.
Some of these medications may cause noticeable side effects. Steroid-like medications can make your face become round and full. You may gain weight, develop acne or facial hair, or experience stomach problems. These effects may decrease as time goes on.
Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications. Some immune system medications can also increase the risk of developing or aggravating certain conditions, such as high blood pressure and cancer.
Your post-transplant treatment will be a delicate balancing act between preventing rejection and managing unwanted side effects. Your doctor will monitor your treatment closely and adjust it as needed.
You'll also need to follow a diet designed to keep your new kidney healthy — although it'll likely be less restrictive than a diet associated with dialysis. You may need to count calories and limit your salt intake.

What are typical survival rates?

Most people who receive a kidney transplant enjoy a high quality of life. About 95 percent of people who receive a living-donor transplant are living after one year and more than 80 percent after five years, according to the Organ Procurement and Transplantation Network. When the organ is a close match, more than 90 percent of people who receive a deceased-donor transplant are living after one year and nearly 70 percent after five years.

What if the new kidney fails?

A kidney transplant offers no guarantees. Organ rejection — which can happen suddenly or slowly — is possible. In other cases, the underlying cause of kidney failure may damage the new kidney.
If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. This important decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life. Discuss the choices with your doctor, transplant team and family to determine what's best for you.

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