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Tuesday, December 16, 2008

Kidney Transplant - Q. & Ans.

The following will help answer questions you may have about kidney transplants.

1. What is a kidney transplant?

A kidney transplant is an operation performed by a transplant surgeon in which a healthy kidney from another person is placed into your body. Normally the non-working kidneys remain. However, in rare cases, they are removed to control infection or high blood pressure. A kidney transplant is the treatment option which is most like normal kidney function.

The new kidney performs the functions of your own non-working kidneys. Because the time spent waiting for a transplant may be lengthy, dialysis is usually required while you are waiting for your transplant.

Additionally, transplanted kidneys may not work immediately and a short period of dialysis may be required after the operation.

2. Where does a donor kidney come from?

A donor kidney may come from any of these sources:

  • Living related donors: A member of your family can donate one of their kidneys if your tissue and their tissue match. Family members who are related by birth are the most likely to have matching tissue.
  • Living unrelated donors: Sometimes people who are not related by birth are willing to donate a kidney. Usually people who are not related will not have tissue that matches yours, but it is possible.
  • Cadaver organs: A cadaver donor is a person who has recently died (usually accidentally.) These people have indicated that they would like to donate their organs when they die.
  • In most instances, donors must be adults, age 18 or older.

3. Do I have the right to refuse a transplant if a kidney becomes available?

Yes. If for any reason you are uncertain about accepting a kidney for transplant, you may decline the offer without jeopardizing your ability to receive another offer. You should discuss your concerns with your doctor.

4. How do we find a kidney that "matches" mine?

The best match for a kidney transplant is an identical twin because identical twins have perfectly matching kidneys. Brothers and sisters (by birth), or your mother or father, may also have a kidney that is compatible. The relative who wishes to donate must talk with the doctor about additional tests, the surgery, and possible risks. Tests include a complete medical evaluation, blood and urine tests, an EKG (electrocardiogram) and x-rays. To determine a good, healthy match, the following steps are done:

  • The donor's blood is tested to rule out hepatitis or AIDS
  • The blood type and tissue type are tested to see if they match (Tissue typing is done on a sample of blood and does not require taking any tissue from your skin or body.

5. What does the kidney donor have to go through? Is it dangerous?

The person who wishes to donate must talk with their doctor. The suitability of the donor depends on: 1) the donor wanting to donate a kidney, 2) normal kidneys in the donor, and 3) the kidney match being good (based on the test results) and his or her medical evaluation.

The hospital stay for the donor is usually 5-7 days. Like any major operation, there is some pain afterwards. The donor should plan for 1-2 weeks at home and 1-2 months with no heavy lifting or labor.

Many people worry donating a kidney will leave the donor in a dangerous situation. The living donor of the kidney is left with one healthy functioning kidney, which should be more than enough for the rest of the donor's life. His or her activities are not usually limited.

6. How many people have successful kidney transplants?

As of 1997, there were over 76,000 people living in the U.S. with a functioning kidney transplant. That same year, there were over 8,000 kidney transplants performed in the U.S. About a third of the patients with renal failure are eligible for a transplant.

7. How will the kidney transplant affect my lifestyle?

The transplanted kidney works 24 hours a day, doing the work of normal kidneys. This often gives the person who has the new kidney more energy than he or she had while on dialysis. Also, a working kidney keeps you healthier overall. Once you have had a kidney transplant, you can resume a fairly normal lifestyle. The kidney will react to chemical and fluid changes in the body immediately. Multiple medications will be required on a strict schedule for the rest of your life.

8. Can I travel?

Transplant patients are free to travel as long as they follow treatment guidelines. Patients should always make sure they have enough medication with them, and should always make sure to take their doctor's phone number with them.

9. Are there any diet restrictions?

Medications to prevent rejection make soMedications to prevent rejection make some patients very hungry. Since it is easy to gain weight after a transplant, you may need to watch calories closely. Some patients find it difficult to manage this weight gain, which can affect a patient's body image, or the way they feel about themselves. In addition, if you have high blood pressure, you may also need to limit the amount of sodium (salt) you eat. Protein and phosphorus are not limited as they are when you are on dialysis. A dietitian or a member of your health care team will be able to help you with any special diet recommended by your doctor. They will help you and your family select the right foods

10. Can people tell that I've had a kidney transplant?

Other than the scar that remains after a kidney transplant, there is little evidence to indicate that the surgery ever took place. However, the medications that your doctor prescribes to keep you from rejecting your transplant may result in some changes in your physical appearance. Some of these may include:

  • Weight gain
  • Increased sweating
  • Acne
  • Muscle weakness
  • Puffiness of the face and abdomen
  • Gum problems
  • Hand tremors
  • An increase in the amount of hair

Not all patients suffer from all of these side effects.

11. Will I be able to keep working and/or go to school?

Once you have received a kidney transplant and have recovered completely from the surgery, you may return to work or school outside the home as long as your health remains stable.

12. What should I know about exercise?

There are some activities you may be asked to avoid after a kidney transplant. You should discuss this with your doctor. You will be urged to pace yourself and do as much as you feel able to do. Keep busy with activities at work, at home, with family and friends, or within the community. This will help you both physically and emotionally.

13. Are kidney transplants expensive? How can I afford one?

Costs associated with a transplant can add up quickly. Few patients are able to pay all the costs from one single source. Most likely, you will have to rely on several sources. These might include: private insurance, Medicare, the Veterans Administration (VA), and prescription drugs assistance programs.

There are also costs associated with a transplant after surgery, including the cost of the anti-rejection drugs, which must be taken for as long as you have your transplanted kidney.

Ask your transplant financial team, your insurance provider, and your employee benefits officer for the latest information or help.

14. My doctor said there are medications to take after the transplant. What do they do?

As a transplant patient, you will need to take immunosuppressive medications to stop your body from rejecting the donor kidney. These medications protect the kidney from attack by your immune system. These oral medications must be taken daily for as long as you have the transplanted kidney.

Immunosuppressive medications lower your ability to fight off illness. To stay healthy, you should stay away from people who have contagious conditions such as colds, flu, or chicken pox. After you go home from the hospital, it is important that you take the correct dose of medicine, and that you visit your doctor on a regular basis. Your doctor will then be able to routinely check your kidney function and adjust your medicine as needed.

Using immunosuppressive medications has been associated with mild to severe side effects. Some of the side effects are temporary, and some are related to the dose and can be prevented by adjusting the dose. It is important to note that not everyone has all of these side effects. Some of the most common side effects include:

  • Weight gain
  • Increased sweating
  • Elevated blood pressure
  • Acne
  • Muscle weakness
  • Puffiness of the face and abdomen
  • Gum problems
  • Upset stomach
  • Hand tremors
  • Mood swings

15. What happens if my body rejects the kidney transplant?

Rejection is the major problem with kidney transplants. This means your body is trying to get rid of something that doesn't belong there. The body's immune system, which normally protects us from illness by recognizing and attacking foreign bodies such as bacteria and viruses, can also recognize a transplanted kidney as something foreign. When this happens, it tries to attack it the same way as it would with a virus. Rejection stops the transplanted kidney from working. Rejection episodes are relatively common in at least half the people in the first 3 months. Treatment for rejection includes increasing the dose of your current medications and possibly taking steroids. Of the rejection episodes, 90 to 95% occurring in the first 3 months can be reversed. However, 10 to 15% of all transplants are still lost to rejection in the first year. If the transplanted kidney is rejected totally by the body, a patient will need to return to dialysis and await another transplant. It is up to you to take your medication every day for as long as you have your new kidney. You should take it at the same time every day. The success of the kidney transplant is directly related to taking this medication.

The first 3 months after receiving a transplant are the most unstable. It is during this time that the patient is most likely to experience rejection. Clinic visits are usually scheduled once a week for the first 3 months. If all goes well during this period, you will have to see your doctor less often after this time.

16. What do I do to take care of my kidney transplant?

To keep a transplanted kidney healthy, you need to take care of it. Following treatment guidelines are key to keeping healthy. You will need to:

  • Take your immunosuppressive medicine as directed by your doctor, for as long as you have the transplanted kidney
  • Visit your doctor as scheduled
  • Follow your doctor's guidelines
  • Control your diet
  • Keep active
  • Watch for and report any problems
  • Once you have your transplanted kidney, you will continue to visit your doctor on a regular basis.
  • Clinic visits are more frequent for the first 3 months. Your doctor will check your kidney function and adjust your immunosuppressive medications.

It is up to you to take your medication for as long as you have the transplant. It is too easy to forget the transplant exists and to forget to take your medication.

Medications to prevent rejection make some patients very hungry. Since it is easy to gain weight after a transplant, you may need to watch calories more closely than on dialysis.

17. How do I know if I'm a candidate for transplant?

You must not be a substance abuser. You should be free from cancer and free from infection. You should be close to your ideal body weight. Remember that you must actively involve yourself in the process if you want to be placed on the waiting list for a transplant.

18. Is the transplant surgery dangerous for the recipient?

Same risk as any major surgery

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