Kidney (Renal) Transplant Procedure
In this article, we have covered the following aspects of Kidney Transplant Procedure:
- Best Kidney Transplant Hospitals of India
- Top Kidney Transplant Urologists in India
- Cost of Kidney Transplant procedures
- Understanding Kidney Transplant Procedure
Best Kidney Transplant Doctors and Hospitals of India
Following is a list of the most reputed specialists in India for Kidney Transplant.
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Cost of Kidney Transplant procedures
Package cost of Kidney transplant is approximately USD 15000. The above package will include the following:
- Kidney Transplant Cost
- Surgeon’s Fee
- Initial work up and investigations
- Stay of about 8 days for the patient and about 5 days for the donor in the hospital
- Dialyses before the transplant
- Cross match and HLA Test
- Anti-rejection injections
- Post-surgery investigations
- All meals for the patient and donor in the hospital during the transplant programme
Understanding Kidney Transplant Procedure
- Treatment of choice for end-stage renal disease (ESRD)
- Improvements in early graft survival and long-term graft function have made Renal transplant a more effective alternative to dialysis financially
- Before introduction of immunosuppression, it was limited to identical twins and was not possible in the majority of patients with ESRD
- Immunosuppression improved the results of transplantation but still acute rejection and complications associated with steroid therapy persist.
Indications for Renal Transplantation
- Chronic kidney disease (CKD)
- Renal tumors
Renal transplant prolongs patient lifespan compared with dialysis.
Combined kidney-pancreas transplantation is the treatment choice for patients who have ESRD along with Type 1 Diabetes. In these patients kidney transplant alone won’t help. Patients undergoing this are typically younger than 50 years and do not have significant coronary artery disease (CAD)
- Metastatic cancer
- Ongoing or recurrent infections
- Cardiac or peripheral vascular disease
- Liver disease
- Conditions that are unlikely to improve after renal transplantation
- Unable to undergo rehabilitation after transplantation
HIV positive is NOT a contraindication for kidney transplantation, provided they meet certain criteria
Contraindications for immunosuppression
Basic pre-transplant studies
- Echocardiography and a stress test
- Chest x ray
- Pulmonary parameters
- Colonoscopy or barium enema (depending on patient age)
- Mammography, Papanicolaou (Pap) smear, and prostate-specific antigen (PSA) test (depending on patient age)
- Noninvasive vascular studies
- Abdominal along with renal ultrasonography
- Viral Serologic tests such as HIV,Hepatitis
- Human leukocyte antigen (HLA) typing
- Panel-reactive antibody (PRA) titer.
Evaluation of potential living donors
- Assessment of renal function
- General health evaluation
- Imaging of the renal vessels
- HLA typing
- Cross matching
- Spiral computed tomography (CT) allows evaluation of the parenchymal abnormalities.
Monitoring and Follow-up
Two key tasks:
- Maintain the fluid balance of a new kidney
- Administration of immunosuppression
Two phases of immunosuppression:
- Induction – It is continued during and after transplantation
- Maintenance – It includes various combinations
Kidneys are taken from:
- Living donors
- Deceased (brain-dead) donors
The living unrelated transplants incidence ( between individuals who are not related by blood) is increasing.
Living donation is a scheduled event which helps minimize organ preservation time. The total time from removal of the donor kidney to restoration of blood flow in the recipient is less than 1 hour which may be longer in paired donation..
Introduction of laparoscopic and laparoscopy-assisted techniques has proved to be a major advantage in surgery for living donation. Laparoscopic donor nephrectomy has many of the benefits as It reduces donor postop hospital stay and recovery time.
Laparoscopic donor nephrectomy is associated with a considerable increase in the willingness to donate as potential donors face less postoperative morbidity and less economic disincentives when this technique is used.
As discussed earlier living donation occurs among persons who know each other, deceased donation is generally anonymous.
Allocation of organs is based on a waiting list system, with special priorities to the following:
- HLA zero-mismatch pairings (because of their proven improved graft survival rate)
- Pediatric recipients (to minimize the impact of on growth due to chronic renal failure)
- Patients having high panel-reactive antibody titer (to increase their probability of transplantation)
In present scenario, most deceased-donor kidneys come from cadavers whose brains are dead but whose heart is functional. Increasingly, Donation after Cardiac Death (DCD) is on a rise, especially if the DCD kidneys are preserved by pulsatile perfusion.
- Most active infections, HIV infection
- Extra cranial malignancy
Poor renal function in the donor
- Advanced donor age (especially with hypertension or diabetes)
- Other factors likely to compromise long-term graft function
Transplant across a positive cross-match
A large number of patients have preformed antibodies to kidney donated by potential living donors. The antibodies develop as the result of exposure to foreign antigens by prior transplantation, blood transfusions, or pregnancy. Because of this , these recipients have positive crossmatches against identified living donors.
Many transplant centers enable these sensitized patients to receive kidneys from living donors against whom they have a positive cross-match. These centres usually do several pre-transplant pheresis sessions to remove the offending antibodies and usage of intravenous immunoglobulin (IVIg) to inhibit the return of antibodies. The transplant is then performed when the cross-match converts to negative.
Another option for patients with a positive cross-match is to enroll in a donor exchange program. Incompatible donor-recipient pairs are screened with other incompatible pairs to see whether the donors could donate to another recipient.
Implantation of Renal Allograft
Various approaches have been developed. The most common approach involves a curvilinear incision in a lower part of the abdomen.
Occasionally, a midline incision is used.
Numerous complications are associated with kidney transplantation. These include the following:
- Delayed graft function
- Vascular thrombosis and stenosis
- Ureteral obstruction
- Urinary leakage
- The prognosis after kidney transplantation is excellent.
- HLA-identical (HLA-ID) transplants from living related donors have the best survival rate, whereas transplants from complete-mismatch non living cadaveric donors have the worst.
- Complete-mismatch living-donor transplants have outcomes same as those of zero-mismatch deceased-donor transplants.
Other factors affect outcomes such as:-
- Kidney preservation time
- Donor age: older age of the donor can adversely affect both immediate graft function along with long-term outcomes.
To achieve significant improvements in graft and patient survival, patients’ comorbid conditions must be taken care of more effectively. Foremost are cardiac diseases, which get increased by complications of immunosuppression.
Hypertension, hyperlipidemia, and diabetes should be taken care of.
Note (for foreign patients):
Besides South Asian countries (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka), every year, India gets thousands of medical tourists from African countries- Nigeria, Kenya, Ethiopia, Sudan, Uganda, Ghana, Somalia,Gambia etc and Middle Eastern countries like Iraq, Iran, Saudi Arabia, Oman, UAE, Yemen etc. Hence, if you are a citizen of any of these countries, there is good likelihood that you will be meeting some fellow citizens or same language speakers in the major hospitals in India. Almost all the top hospitals have translators for people of these region. Our patient support team is also well placed to assist you.