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Monday, March 3, 2008

Kidney Transplant

When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation. Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant. You also need to speak to your doctor, nurse and family members.

What is a kidney transplant?

A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood.

Are there different kinds of kidney transplants?

Yes. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or close friend, and in some cases a stranger who wished to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants. These are covered in the NKF's free brochure "Kidney Transplant." You can obtain a copy by calling 800 622-9010.

How do I start the process of getting a kidney transplant?

Your doctor can discuss the transplant process with you or refer you to a transplant center for further evaluation.

How can I pay for my transplant?

Most private health insurance policies cover many expenses associated with kidney transplants, including medications. In addition, most kidney transplant candidates are eligible for Medicare, which will cover 80 percent of the cost of the transplant surgery. After transplantation, you will need to take medications to prevent rejection of your new kidney. Medicare Part B will cover 80 percent of the cost of these anti-rejection medications, but not the cost of other medications you may need. For most patients, this Medicare coverage will stop after 36 months. However, if you are eligible for Medicare coverage based on age or disability, the cost of your anti-rejection medications may be covered for as long as you are on medicare. The social worker or financial counselor at your transplant center should be available to answer questions about your coverage options.

What is rejection?

The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader."

You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus or sirolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil, azathioprine or rapamycin. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection.

What are the side effects of the anti-rejection medications?

Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.

What are the chances that a transplanted kidney will continue to function normally?

Results of transplantation are improving steadily with research advances. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients.

Will I need to follow a special diet?

Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed.

What else can I do?

You should inform yourself fully by reading and talking to doctors, nurses and patients who already have kidney transplants. You can also see the National Kidney Foundation publications listed below.

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