Renal Transplant

Why do you need a renal transplant or kidney transplant?

The kidneys are two bean-shaped organs, the size of a fist, located on either side of your spine just below the rib cage.
Their main function is to filter blood, waste and fluid from the blood via urine.
However common kidney diseases can result in severe kidney damage including diabetes and uncontrolled high blood pressure.
Nephritis, which causes scarring of the miniscule kidney filters, and Polycystic Kidney Disease, an inherited kidney disorder, can also cause severe kidney damage.
Unfortunately many of the symptoms of kidney disease are “silent” for many years, and often by the time the disease is diagnosed it may be too late to prevent End Stage Renal Disease (ESRD).
When ESRD occurs, dialysis or transplant are the only viable options, and increasingly in Australia kidney transplantation is now regarded as the “gold standard” treatment for people with ESRD.

While renal transplant is not a cure, it can offer many patients with kidney disease a longer, more active life without dialysis.
According to the National Kidney Foundation in the US, 93% of transplanted kidneys will be working after a year; 83% after 3 years and 54% after 10 years.
However whilst many people do succeed with transplantation it is not a long-term “cure”. Most living donor kidney transplants will only last 12-20 years and deceased donor transplants 8-12 years*.
This means that many people will need a second kidney transplant in their lifetime, and sometimes three or four.
If a kidney transplant fails twice, generally dialysis is considered a more viable option than a third or fourth transplant.

Today there are 1500 Australians on organ transplant lists at any one time*, and the average wait for these patients is three years.*
The big trend in kidney transplantation today is the use of living donors, which now make up 3 out of every 10 transplants.
These donors are able to live on one kidney and can be related by blood, or can be strangers not known or related to the recipient.
To be considered a kidney donor “match” largely depends on your blood type, and you can read here to find out about compatibility blood types.
Donating a kidney is a big decision, and not everyone is suitable. People with high blood pressure, diabetes, people who are overweight, smokers or patients who have cancer, AIDS or severe psychological issues may not be eligible to donate a kidney.
If a compatible living donor isn’t available your name may be placed on the kidney transplant waiting list to receive a kidney from a deceased donor.
How long you have to wait for a deceased organ depends on:
– The degree of matching or compatibility between you and the donor
– How long you have been on the waitlist
– The time you have been in dialysis
– Predicted survival after dialysis

A kidney transplant is associated with lower risk of death, fewer dietary restrictions, not being tied to a dialysis chair for the rest of your life, lower treatment cost and a better quality of life generally.
However certain conditions prevent people from being eligible for a transplant including people with severe heart disease, people with dementia, patients of advanced age, patients with advanced cancer or patients with drug or alcohol addictions.
In this case dialysis is a better option.

Whilst a kidney transplant can be highly successful, a renal transplant is not a cure and some forms of kidney disease can come back after a transplant.
Side effects include rejection of the donor organ.
Other complications can include blood clots and bleeding, infection from the surgery, infection or cancer transmitted by the donor organ, leaking of the ureter that links the kidney to the bladder and rarely death, heart attack and stroke.
There are also side effects linked to anti-rejection medication including bone thinning, diabetes, excessive hair loss, high blood pressure and high cholesterol.
Other side effects can include puffiness, acne, weight gain and an increased risk of cancer, in particular lymphoma and skin cancer.

A recent study of more than 4000* people who have donated kidneys since 1963 show that overwhelmingly there is no difference in life quality or life expectancy for the generous folks who donated a kidney to save a mother, father, sister, friend, or sometimes even a complete stranger.
In this study, survival rate was similar to non-donors and the donors did not have an increased risk of kidney failure. Most people who donate a kidney are in hospital for only a few days, and may have discomfort for a week or two, but this can be managed with pain medication.
Driving is not recommended for two weeks or as long as you have pain, and you may be off work for 6 weeks or longer.

Further Reading

Success of Kidney Transplants