Your SlideShare is downloading. ×
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Kidney transplantation1408
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Kidney transplantation1408

1,275

Published on

Published in: Health & Medicine, Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,275
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
56
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. R E N A L R E S O U R C E C E N T R E An Introduction to Kidney Transplantation
  • 2. An Introduction toKidneyTransplantation
  • 3. This publication has been sponsored by an educational grant from Roche. An Introduction to Kidney Transplantation © 2009 RENAL RESOURCE CENTRE, 2009 37 Darling Point Road Darling Point NSW 2027 Telephone: +61 2 9362 3995 or +61 2 9362 3121 Freecall: 1800 257 189 Facsimile: +61 2 9362 4354 renalresource@nsccahs.health.nsw.gov.au www.renalresource.com
  • 4. ContentsWhy Have a Kidney Transplant? ..................................................................... 1Where are Kidneys for Transplantation Obtained .............................................. 2Kidney Transplantation Success Rates ........................................................... 3Preparing for a Kidney Transplant ................................................................... 3How You Can Prepare? ................................................................................. 5Kidney Transplantation ................................................................................. 7Post-Transplant Care .................................................................................. 10Medications Used in Kidney Transplantation ................................................. 11An Unsuccessful Transplant ......................................................................... 11Emotional Changes To Expect ..................................................................... 11Going Home With A Successful Transplant .................................................... 13Life with a New Kidney ............................................................................... 14The Renal Team ........................................................................................... 14Living Donor Kidney Transplantation .............................................................. 15New Developments in Live Donor Transplantation ........................................... 18Recipient, Donor and Family Concerns About Live Kidney Donation ................... 19Long Term Effects for Donor .......................................................................... 20Combined Renal and Pancreas Transplantation ............................................. 20
  • 5. An Introduction to Kidney Transplantationpage 6
  • 6. Why Have a Kidney Transplant?A kidney transplant involves taking a kidney from the body of one personand implanting it surgically into the body of someone who has lost kidneyfunction. The transplanted kidney can then perform the function of thatperson’s own kidneys.Whilst a transplant is not a cure for renal (kidney) failure, it does allow patientsto live a more “normal” life than that experienced on dialysis. Patients with awell-functioning transplant have a greater sense of well being and are able toenjoy a lifestyle free of dialysis treatments, although they must continue withtheir transplant medications.A transplant can mean improvement in anaemia, bone disease and inchildren, body growth. It also offers freedom from previous dietary and/or fluidrestrictions and from restrictions on time and mobility. page 1
  • 7. An Introduction to Kidney TransplantationWhere are Kidneys for Transplantation Obtained?Kidneys are donated by live donors and deceased donors.Live DonorsFor many years, most live donors were closely related to the potential recipient,such as a brother, sister or parent. Such close relatives were likely to be a closetissue match to the recipient, resulting in excellent outcomes. With the advent ofimproved immunosuppressive medications, it is now possible to achieve similaroutcomes using live donors who are unrelated to the recipient. Spouses, moredistant relatives and close friends can also have a compatible blood group andtissue matches to the potential recipient. Many live donor transplants are performedusing such unrelated donors. It is now also possible for altruistic members of thecommunity to be assessed for their suitability as anonymous live kidney donors.These people are known as “non-directed kidney donors”.Deceased DonorsKidneys from deceased donors are allocated to the best tissue matched patients onthe transplant waiting list. Potential deceased donors are screened for cancer andtransmissible viruses and their medical history is fully evaluated. Deceased Donorscan be heart-beating or non heart-beating.Heart-Beating DonorsThese donors have suffered severe trauma to the brain either by fatal head injury,such as in a motor vehicle accident or through a cerebral (brain) hemorrhage. Inorder to be considered as organ donors, these patients must be ventilated in anintensive care unit and medically certified as “brain stem” dead, meaning that allfunction of the brain has ceased. In other words, life cannot be sustained. Heartbeat and lung function are artificially maintained by a respirator. A very smallproportion of all deaths in hospitals occur under these conditions.Non Heart-Beating DonorsAs the number of donors drawn from those who are brain stem dead is very limited,renal units also perform transplants from donors without a heartbeat, i.e. thesedonors have been cared for in intensive care units and are referred to as “nonheart-beating” donors or “donation after cardiac death” (DCD) donors.Preliminary studies indicate that although these kidneys may have initial delayedgraft function, there does not appear to be any difference in long-term graft survivalbetween kidneys from donors with a heartbeat and those without a heartbeat.page 2
  • 8. Kidney Transplantation Success RatesThe success rate of the transplanted kidney one year after transplantation(one year graft survival) of live donor kidneys is 97% and for deceased donorkidneys, is 91% (ANZDATA 2007). Five year graft survival for live donor kidneys is88% and for deceased donor kidneys, is 82%.If the transplant works well for the first year, the chances are good that it willfunction for many years. If the transplant fails, a second transplant is possibleand can be entirely successful. Many patients who received renal transplants25-35 years ago remain well with those original grafts. The average transplantgraft survival is 15 years.The refinement and development of new immunosuppressive medications hasconsistently improved the success of kidney transplantation.Preparing for a Kidney TransplantWho is Eligible?Many people with kidney failure requiring dialysis can be considered fortransplantation. Apart from having kidney failure, these people must be in relativelygood health and willing to undergo the procedures involved. For people with othermajor medical problems, such as severe heart and vascular disease, there maybe increased problems for transplantation and dialysis may be a better treatmentoption. Some people are happy with their dialysis treatment and do not wish toundergo transplantation. Each patient should discuss their own medical suitabilitywith their renal physician (kidney specialist).Donor and Recipient MatchingDonor and recipient matching can be divided into three distinct areas: bloodgroup matching, tissue type matching and cross matching. Each of these isan important aspect of donor and recipient matching and applies to living kidneydonation and deceased kidney donation. page 3
  • 9. An Introduction to Kidney Transplantation1. Blood Group In the case of a deceased donor, the ordinary blood groups (A, B, AB, O) match the red blood cells of donor and recipient and must be compatible, as for blood transfusion. In the case of a live donor, some ABO incompatible transplants are possible.2. Tissue Typing This involves matching of a type of white blood cell called “lymphocytes”. These cells (in fact, all body cells) have special markers called antigens on their surfaces. It is now known that a special group of these antigens, called HLA (Human Leukocyte Antigens) are important in transplantation. The closer the match of antigens between patient and donor, the better the chance of a successful transplant. Since these antigens are inherited from parents, each child inherits half of their antigens from each parent. Therefore, if a parent is the prospective donor for the child, they will share at least one half of the antigens. For siblings (brothers and sisters) of a recipient, the chances of a match are: 25% will have full match, 50% will have a half match, 25% will be completely mismatched.3. Cross Match Just prior to the transplant, blood is taken from donor and recipient and mixed to ensure no reaction, i.e. negative cross match. In the case of a deceased donor, the transplant will not proceed if there is a positive cross match. In the case of a living donor, new approaches may enable the transplant to proceed (see page 18)The Transplant ListPeople waiting for a deceased donor kidney in Australia have their tissue typingrecorded on a centralised computer list. Whilst tissue typing is done once, bloodis taken monthly to cross match against donor blood if a donor kidney becomesavailable. This is because new antibodies can be formed e.g. after blood transfusionor after exposure to infection, which may lead to a positive cross match with thedonor. When a kidney becomes available, the donor tissue typing is entered into thecomputer and matched with the most suitable recipient, who will then be offered atransplant. Because of the many possible tissue types, a patient’s name may notcome up for months or years. This is often frustrating and many people feel theymay have been forgotten. However, it is important that the tissue type is as closelymatched as possible, as this will help to reduce the possibility of the transplantbeing rejected. If two people have the same degree of tissue typing, the kidneyis first offered to the person who has been on dialysis longer. It is important thatpatients’ blood samples are sent to the tissue typing laboratory each month, sothat they remain active on the waiting list.page 4
  • 10. Pre Transplant PreparationMedical Investigations are necessary to ensure fitness for transplantation. Thesemay include physical examination, blood tests, x-rays of heart, lungs and sometimesstomach and bladder. It is also important that any infections are treated beforetransplantation. Patients being considered for transplantation are reviewed by thetransplant physician and the transplant surgeon.How You Can PrepareMaintaining good health is vital preparation for a kidney transplant. As well askeeping generally fit, controlling weight and blood pressure, there are a number ofimportant preparations:Smoking, Drug and Alcohol Use The use of tobacco and other addictive andmood altering drugs should cease so that your physical and mental health are inthe best possible condition. Alcohol use must be moderate: two standard drinks perday (males) and one standard drink per day (females) with two alcohol free days perweek.Dental Care Regular dental checks are essential, as risk of mouth infection aftertransplantation is increased if teeth and gums are in poor condition.Dialysis As most people with kidney failure are on dialysis prior to transplantation,maintaining the dialysis schedule is an important part of the preparation.Weight Controlling both body weight and fluid weight (i.e. not gaining too muchweight between dialysis treatments) is important in order to be ready when atransplant becomes available.Protection of Skin Against Sunlight This is particularly important for peoplewho do not have dark skin and will help prevent skin cancer after transplantation.Blood Pressure Good blood pressure management contributes to positiveoutcomes for dialysis and transplant patients. It is absolutely vital to ensure goodblood pressure control.Exercise Regular exercise under the supervision of your renal physician. is veryimportant. It improves recovery time, blood pressure control, mood and general wellbeing. For example, 30 minutes walking 3-4 times per week.Cancer Screening Regular pap smears and mammograms are recommendedfor women every 2 years. page 5
  • 11. An Introduction to Kidney Transplantationpage 6
  • 12. Kidney Transplantation: What to ExpectThe Phone CallThe phone call notifying the patient of an available deceased donor kidney cancome anytime - day or night. It is important to be prepared for this, i.e. havearrangements made so that you are able to be contacted readily and can comestraight to the hospital so that the transplant can be performed as soon aspossible. This is necessary because of the time limitation in keeping the kidneyhealthy after it has been removed from the donor.Once at the hospital, a thorough medical examination is carried out to determinefitness for surgery. This will include blood tests, x-rays an ECG and dialysis ifnecessary. Occasionally, it is necessary to cancel the surgery after arriving atthe hospital. This may occur for unforeseen reasons - such as the patient has aninfection or the kidney shows signs of deterioration or is less well matched thanexpected. This usually only occurs in kidneys coming from far away, e.g. frominterstate, where the final cross match on the monthly blood is only done when thekidney reaches your city.Consider where you will stay after discharge from hospital – it may be necessary toattend the transplant clinic daily for 2-4 weeks to ensure any rejection is detectedearly and treated. Gradually, your visits will become less frequent as your kidneyfunction stabilises.The renal unit social worker can advise about local short-term accommodation, ifyou live a very long distance from the transplant unit. Travel and accommodationassistance schemes are available to assist rural patients. page 7
  • 13. An Introduction to Kidney TransplantationThe Transplant OperationThe transplant operation takes around 3-4 hours. The transplanted kidney is placedon the right or left side of the lower abdomen, below the navel (see Diagram 1).The new kidney’s artery and vein are joined to an artery and vein in the pelvicarea. The ureter (urine drainage tube) from the kidney is attached to the bladder.Many patients are surprised to learn that their failed kidneys are not removed butleft to continue whatever small amount of function they may still have. However,if the failed kidneys must be removed, a separate operation is necessary prior totransplantation. This is only rarely required e.g. in the case of chronic infection orvery large kidneys. Blood Supply Kidney Kidney Transplant Ureter Urinary Bladder Artery to LegDiagram 1 Transplanted Kidneypage 8
  • 14. After the OperationAfter surgery, there is usually some pain around the operation site, which will berelieved by medication. A bladder catheter and drainage tubes from the wound areneeded for about a week to assist healing. The amount of urine produced by thenew kidney is very closely monitored and measured. Recovery from the transplantoperation is usually fairly rapid; patients are out of bed on the day after theoperation and are able to move around in a few days. A nuclear medicine scan and/or ultrasound test may be done early and repeated to assess kidney function.The Transplant WardIn many hospitals, new transplant patients are cared for in a separate area or wardfrom other patients. It is sometimes necessary for transplant patients to be nursedin this area since the medications taken to prevent rejection of the new kidney alsomake patients susceptible to infection. For this reason, the number of visitors maybe restricted. In some transplant areas flowers and fruit are not permitted, as theymay harbour bacteria.It is not unusual for kidney function to be slow in starting, especially for deceaseddonor kidneys. This delay in function is usually caused by temporary damageto the kidney cells and the kidney may take 3 weeks or even longer to recover.Sometimes, the kidney may function briefly, then stop again due to temporarydamage. If the kidney does not function well immediately following transplant, itdoes not mean it will not function satisfactorily in time. Dialysis may be necessaryfor days or weeks until kidney function is sufficient to keep the body in goodchemical balance.HospitalisationThe length of stay in hospital depends on how well the kidney works and theoccurrence of any complications. Average stay is about 1-2 weeks but may be up to4 weeks.After discharge from hospital, it may be necessary to return daily as an out-patientfor some weeks. These visits decrease in frequency as kidney function stabilises. page 9
  • 15. An Introduction to Kidney TransplantationPost-Transplant CarePossible Complications Post-TransplantRejectionThe body resists the presence of foreign cells or tissue of a donor kidney in muchthe same way that it fights off bacteria and viruses which cause illness. Therejection process occurs when the patient’s white blood cells reduce or stop thefunction of the transplanted kidney. Some patients experience a rejection episodein the first few weeks after their operation. Symptoms of rejection may includefever, decreased urine output, fluid retention and increase in weight, tendernessover the kidney and elevated blood pressure. Most rejection episodes can bereversed with drug treatment.There are three types of rejection:1. Hyperacute Rejection – can occur minutes or hours after the transplant. This type of rejection is very rare. It is untreatable and the kidney is removed immediately.2. Acute Rejection – can occur at any time from a week to a year after transplant. Occasionally, it can occur some years after transplant. This form of rejection is experienced by most transplant patients and is usually treatable. It is certainly likely to occur if the drug treatments prescribed are not taken regularly.3. Chronic Rejection – occurs slowly over a long period of time and there may be no obvious symptoms. Chronic rejection is also difficult to treat. If the transplanted kidney eventually stops working, the patient will require dialysis. Another transplant is possible and your renal physician will discuss this option.InfectionBecause the drugs used to prevent and control rejection also weaken the body’sdefences, patients are more prone to infection after transplant. Risk of infectioncommonly in the wound site, mouth, urinary tract and lungs is highest in the firstfew months after transplant because drug dosage is highest. This is the reason forstrict infection control in the transplant ward. Whilst some infections can be veryserious, most are controlled by antibiotics and/or reducing doses of anti-rejectiondrugs.Most units prescribe medications to prevent particular high risk infections aftertransplantation.Surgical ComplicationsSlow wound healing can be caused by some medications, diabetes and obesity.Those at risk are closely monitored.page 10
  • 16. Medications Used in Kidney TransplantationIn order to control rejection, a combination of medications is given which suppressor reduce the effectiveness of the body’s immune system. These medicationsare called immunosuppressives and must be taken throughout the life of thetransplanted kidney.The renal physician will determine which medications and dosages are needed.Dosages are very large at first to prevent rejection and are gradually reduced as thekidney begins to function well. These medications have a number of side effects,which usually subside as drug dosages are lowered. Each patient’s experience ofside effects is individual and each patient is monitored very closely in the post-operative period.An Unsuccessful TransplantIf the kidney does not function in spite of all the medications given, it will beremoved and dialysis treatment resumed. If one kidney is rejected, a secondtransplant will not necessarily also be rejected. Patients are usually able to go backon the transplant list once they have recovered.Emotional Changes to ExpectJust as transplantation involves many physical changes to the body, emotionalchanges are not unusual. It is an extremely exciting time but it can also be a timeof great anxiety as the patient and family and more commonly live donor, wait forthe kidney to start functioning and for blood results and overall health to improve.Anxiety about possible rejection and infection is normal and patients may find theisolation from family and friends difficult. The anti-rejection medications may initiallycause some physical changes and mood swings. Alternating feelings of elation,depression and irritability are common.Some of these feelings may be offset by an increased sense of well-being as thetransplant begins to function. However, with so many changes occurring so quickly,the patient and family may sometimes feel overwhelmed with anxiety and fear. Itis important during this time to share these feelings with someone close and todiscuss your concerns with your physician and other staff. They understand this cansometimes be an extremely tense time and will always try to anticipate your fearsand disappointment, especially if the kidney is slow to function and dialysis is stillnecessary, even if only for a short time. page 11
  • 17. An Introduction to Kidney Transplantationpage 12
  • 18. Going Home with a Successful TransplantLeaving hospital with a new kidney is an exciting time but contact with thetransplant unit does not end upon discharge from hospital. In the first few monthsafter discharge from hospital, frequent visits to the transplant renal physician arerequired. Daily visits for the first few weeks are common. This is so the physiciancan closely monitor the transplanted kidney’s function and any signs of infection orrejection. It is therefore necessary for patients from rural and remote areas to stayin accommodation close to the hospital for some time after the transplant surgery.Clinic visits become less frequent as kidney function stabilises and general healthimproves. Follow-up for rural patients can also be maintained through the localdoctor and renal physician..There are a number of important precautions that every transplant patient mustobserve when returning home:Medication Management A very important part of treatment is taking themedications in the dosages prescribed by the doctor daily and for the life of thetransplant.Avoid Sources of Infection For a short period immediately after the transplant,it is suggested that patients avoid crowded places and people with colds or viruses(especially small children). Good hand washing and treatment of scratches helpsprevent infection. Chicken Pox is very contagious and dangerous. Vaccination priorto transplantation is recommended.Skin Care The drugs given will make the skin very sensitive to the sun. Theincidence of skin cancer is very high in transplant patients, so it is essential towear protective clothing and SPF 30+ sunscreen when outdoors. Reapply thecream regularly.Report Any Illness This is particularly important in the first year. Prompttreatment of any problems can prevent further complications.Diet Whilst the diet is relatively free of restrictions, transplant medications increasethe appetite, making it difficult to control weight gain. Food hygiene and avoidingfoods that contain large amounts of bacteria (eg: pate, soft cheeses. salami, rawseafood) is important. The renal dietitian is available to advise on a healthy andsatisfying diet.Risks There is a 1% per annum risk for each patient of a non-skin tumour. Regularcancer screening is advised. page 13
  • 19. An Introduction to Kidney TransplantationLife with a New KidneyA kidney transplant can offer a “new lease of life” for patients and their families.There are some readjustments in the first year after transplant, and maybe a degreeof anxiety about how long the kidney will function. As time goes on, these feelingsusually decrease.Most people are able to return to normal activities and work within 3 to 6 monthsafter transplant. Exercise (gentle at first) is also an important part of toning musclesand maintaining good health.For many people, sexual function improves after transplant. Sexual activity will notharm the transplanted kidney nor increase risk of infection. However, as is the casefor any major surgery, it is advisable to wait about four weeks before having sexualintercourse.Having a baby after receiving a kidney transplant is possible but not usuallyadvised until at least 1-2 years of good kidney function. The need for contraceptionshould be discussed with your doctor. There are considerably increased risks ofpregnancy complications, such as premature births and hypertension in women whohave kidney transplants. Careful monitoring of the pregnancy is needed. Couplesconsidering pregnancy should seek advice from their doctor, as x-rays and othertests might be necessary and preferably done before the pregnancy.The Renal TeamIt should now be clear that deciding to have a kidney transplant is a major decision.The patient and family are advised to discuss all the practical and emotionalissues together. The renal team, consisting of physician, surgeons, nursing staff,dietitian and social worker are available to talk over all aspects of transplantation.Many units also offer regular transplantation information workshops, which cancomplement the discussions with members of the renal team.page 14
  • 20. Live Donor Kidney TransplantationGeneral IssuesIn the 1960’s, most renal transplants performed in the United States were fromlive donors. For many years, the majority of transplants performed in Australiawere from deceased donors. However, the increasing gap between the number ofpotential recipients and donated kidneys has led to a steady increase in live donorsin Australia. Around 50% of all transplants performed in Australia now use livedonors.The issue of donating a kidney is a difficult one for patient and family. Both are likelyto have mixed feelings. Most patients are hesitant about asking a family member todonate a kidney and family members may be concerned about the risks involved forthem. Questions often asked are: Would I be a suitable match? What will happento my other kidney? What will the surgery be like? Would I have to take much timeoff work and other activities? The following information attempts to address theirconcerns.Advantages for a Live Donor Recipient1. Transplantation may sometimes be possible before dialysis is commenced (pre-emptive transplantation).2. Time dependent on dialysis is reduced. This is particularly important for people with diabetes and young children.3. Transplant surgery can be planned to suit the donor and recipient.4. In the case of well matched donors, the recipient may require less immunosuppressive medication. page 15
  • 21. An Introduction to Kidney TransplantationWho can be a Live Donor?Live donors can be related or unrelated to the recipient and can be of a differentsex. Prospective donors must be an adult (over the age of 18 years) and be in goodhealth.A close blood relative, such as a brother, sister, parent or child may be a suitabledonor as well as less immediate blood relatives, such as cousins, uncles, aunts,nephews and nieces. Brothers and sisters may be a half or perfect match andparents can be a half match. Unrelated donors include spouses, friends, in-laws,distant relatives and altruistic members of the community, known as non-directeddonors. It is also possible to match perfectly with an unrelated donor, although aperfect match is not necessary for a successful transplant.What Tests are Necessary?Blood tests are performed to determine if a donor and patient are a suitablematch. If recipient and donor are compatible, further extensive medical screeningis necessary. This includes x-rays and renal function tests to determine whether thedonor’s kidneys and urinary system are healthy. Potential donors are assessed bytheir own, independent renal physician. If other health problems such as diabetes,heart or lung disease present, the transplant will not proceed.Preparation for SurgeryProspective donors will be advised to minimise health risks by not smoking,achieving a healthy weight and ceasing oral contraceptives three months prior tosurgery.page 16
  • 22. page 17
  • 23. An Introduction to Kidney TransplantationNew Developments in Live Donor TransplantationABO Blood Group Incompatible and Positive Cross Match TransplantsBoth ABO blood group incompatibility and positive cross matching had previouslyprecluded transplantation, with a high risk of very rapid severe rejection anddestruction of the kidney within hours or days, in a process known as acuterejection. Over 30% of patients with a potential live donor have blood groupincompatibility or a positive cross-match with their intended donor. Over 35%of potential live donors have been unable to donate because of blood groupincompatibility with the intended recipient.Recent advances now make ABO blood group incompatible and positive crossmatch transplants possible for suitable patients. The key elements to successappear to be combining techniques before and after the transplant that removenaturally occurring and blood group antibodies, while also preventing new antibodiesbeing formed by the recipient. Recent studies reveal similar short and long-termpatient and graft survival as observed in blood group compatible transplantation.Several transplant units in Australia have started performing such operations. In theevent that you have an incompatible or positive cross-matched donor, your renalphysician will advise if this procedure is suitable for you.Paired Kidney ExchangeThe Australian Paired Kidney Exchange Program (AKX) is a nationwide live kidneydonor program, established by the National Organ Donation and TransplantationAuthority to increase available organs from live donors. The goal of AKX is toincrease live kidney donor transplants by identifying matches for incompatibledonor-recipient pairs. Approximately 30% of potential donors fail to fulfil their wishto donate a kidney to a relative or friend due to incompatible blood group or tissuematches.Paired kidney exchange involves pairs who are either incompatible or mismatchedby blood group or tissue type to be exchanged or swapped. The potential recipientand their kidney-donating but incompatible partner are matched with another pair inthe same situation. The donors in each pair donate to the matching recipient in theother pair. In a four-way operation, a kidney would be removed from each donor andgiven to the other person’s partner.Should you wish to register with AKX and participate in this program, contact yourrenal physician.page 18
  • 24. Recipient, Donor and Family Concerns AboutLive Kidney DonationWhen and if a family member decides to donate a kidney, the decision to donatemust be voluntary and free of feelings of being “pressured”. It is important forthe donor to discuss their intention with their immediate family and the potentialrecipient.Sometimes, for a variety of reasons, family members and/or the patient may beopposed to the donation. The process is often complex and so it is essentialto work through these issues with staff who can assist. Feelings and concernsabout the donation should be discussed in confidence with the renal physician,social worker or psychiatrist caring for the donor. The patient should have similardiscussions with their renal team. Every prospective donor has the right, afterconsideration of all the facts to withdraw the donation, just as every recipient hasthe right to refuse the donation.The Operation for Live Kidney DonorsWhen all tests have been completed, a date for the transplant surgery is scheduled.Both donor and recipient go to the operating theatre at the same time. Followingthe surgery, the donor will be cared for in a surgical ward. The recipient will be caredfor in a separate transplant ward, to minimise the possibility of infection.Donor surgery can be performed as either an open procedure, involving a largeincision under the ribs or increasingly, as laparoscopic (keyhole) surgery,involving much smaller incisions in the abdomen. A camera is used to guide theremoval of the kidney through a much smaller incision. The transplant surgeon willadvise if this procedure is possible.Laparoscopic surgery provides the donor with a faster, easier and less painfulrecovery from surgery. Donors can be discharged from hospital 2-4 days after thesurgery. They can usually return to work within 4 weeks of surgery but should avoidany heavy lifting during those first 4 weeks. Open surgery requires a hospital stay ofabout one week. Heavy lifting must be avoided for about 12 weeks. page 19
  • 25. An Introduction to Kidney TransplantationLong-Term Effects for DonorMost kidney donors recover quickly after the surgery and are able to resume workand other activities in 4-6 weeks. Resuming active sports will take longer.Living with one kidney does not interfere with a woman’s ability to have childrenand does not change life expectancy or increase the risk of acquiring kidneydisease. Long term follow up with annual blood pressure, blood and urine testing isrecommended.Giving a kidney can be a very rewarding and satisfying experience for both donor andrecipient, providing considerable forethought is given. Renal unit staff will provide youwith all the information and counselling needed to make this decision.More detailed information on the process of living kidney donation is available in“Kidney Donation by Live Donors”, produced by NSW Health and available fromtransplant units or the Renal Resource Centre.Combined Renal and Pancreas TransplantationIn people with renal failure due to the complications of diabetes (diabeticnephropathy) and for whom renal transplantation is being considered, a combinedrenal and pancreas transplant is a possibility.Combined renal/pancreas transplantation in Australia has been possible since1987 and several hundred have been performed since then. The group of patientsconsidered suitable for the combined procedure are those:a) with diabetes mellitus who are insulin dependent (Type 1 Diabetes)b) with impending renal failure or on dialysis, requiring a renal transplantc) aged less than 50 years with no heart diseaseIn conjunction with the above requirements, individual suitability is determinedthrough a number of medical, surgical and nursing assessments. The transplantwork-up involves an assessment of the diabetic changes within the blood vessels,eyes, nerves and kidneys. This work-up is required both to exclude life threateningcontra-indications to the operation and to assess the value of any benefits that maybe gained through the addition of a renal/pancreas transplant. There are a numberof potential benefits that may be gained from this procedure. However they are quitevariable from person to person and should be discussed on an individual basis.Combined transplants are performed in Australia at the National Pancreas TransplantUnit at Westmead Hospital in New South Wales and at Monash Medical Centre inVictoria. Further information on this procedure and eligibility requirements can beobtained from your renal physician.page 20
  • 26. The Renal Resource Centre is anational unit established to provideinformation and educational materialson kidney disease for patients andhealth professionals.The primary objective of the Centre An Introduction tois to ensure that patients have easy Kidney Transplantationaccess to such information, are wellinformed and can actively participate intheir own health care.The Renal Resource Centre iscommitted to providing education andservice to the renal community. RENAL RESOURCE CENTRE, 2009 37 Darling Point Road Darling Point NSW 2027 Telephone: +61 2 9362 3995 or +61 2 9362 3121 Freecall: 1800 257 189 Facsimile: +61 2 9362 4354 renalresource@nsccahs.health.nsw.gov.au www.renalresource.com page 21
  • 27. RENAL RESOURCE CENTRE37 Darling Point RoadDarling Point NSW 2027Telephone: +61 2 9362 3995 or+61 2 9362 3121Freecall: 1800 257 189Facsimile: +61 2 9362 4354renalresource@nsccahs.health.nsw.gov.auwww.renalresource.com

×