kidney_transplants by xiagong0815


									Authors: Megan Anderson and Mary Aardal, Fall 2001


Conditions leading to the need for a transplant

Kidney transplants are the second most common transplant operation in the United States

with over 9,000 cases per year. Many patients may need a kidney transplant if their

kidneys are not working to full capacity or are unable to work at all. Conditions such as

diabetes mellitus, hypertension, glomerular nephritis, polycystic kidney disease, or many

other conditions may lead to end-stage renal disease resulting in the need for a kidney


Pretransplant Evaluation Tests

Several tests must be completed before a patient can be given a transplant. First, a full

physical exam is needed. The health of the recipient’s heart must also be tested. Blood is

tested to determine immune system function and the presence of any diseases. Blood

typing is necessary for donor organ compatibility. Several other tests are performed to be

sure there are no other diseases or conditions that may compromise the success of the

transplant. Once the tests are done and passed, patients are placed on the National

Recipient List which is maintained by the United Network for Organ Sharing (UNOS).
Kidney Donation Process

Donor kidneys come from three different sources: cadaveric donor, live related donor,

and live unrelated donor. A cadaveric donor kidney is one that comes from a person who

has just died. A live related donor kidney comes from a blood relative of the recipient. A

live unrelated donor kidney comes from someone who is not related to the person.

Typically, there is a 2 to 3 year waiting list for a cadaveric kidney. Each year 1 out of 20

people waiting for a new kidney dies from kidney disease while on dialysis. Thus,

receiving a kidney from a living donor is optimal. Transplants from a blood-related

donor are considered a slightly better risk than from a cadaveric donor. Between 80%

and 90% of transplanted kidneys are functioning two years after the operation from a

blood-related donor.

The donor must be free from disease or infection, or injury that affects the kidney. The

patient must have the same or a compatible blood type as the donor. Table 1 shows the

compatibility of each blood type.

                Table 1

           Blood Type          Can receive from   Generally can donate a kidney to

           O                   O                  O, A, B, AB

           A                   A, O               A, AB

           B                   B, O               B, AB

           AB                  O, A, B, AB        AB
Kidney Transplant Process

The patient will be under general anesthesia throughout the surgery, which lasts about 3

to 4 hours. An incision is made into the right or left side of the lower abdomen just above

the groin. The surgical team will place the donor kidney into the abdomen and connect

the kidney’s blood vessels to the recipient’s iliac artery and vein. The surgeons then

connect the ureter to the bladder. (See picture) The transplant is then complete and the

abdomen is closed. Removing the nonfunctioning kidney is usually not necessary unless

there is a special medical reason to do so. The recovery period averages one month with

the average hospital stay being one week.

Post Surgery Care

The donor kidney acts as a foreign object that your body’s protective immune system

may try to attack. Medications, such as prednisone and cyclosporine, are taken to prevent

this from happening and may be required to be taken for the rest of the patient’s life.

These drugs are classified as “anti-rejection” or “immunosuppressive” drugs. The most

common medications work by lowering inflammation, blocking the action of specific

white blood cells, and decrease white blood cell function. Common side effects of these

medications include: swelling, increased appetite, unwanted hair growth, weight gain,

tremors, and mood swings. It is also necessary to monitor vital signs and keep a record

of blood pressure, pulse, temperature, and weight.
Transplant Diet Therapy

A diet containing solid food is implemented by post-operative day 2 or 3. If the patient

has not eaten by 5 days after surgery, the patient may need enteral or parenteral nutrition


The diet prescription for the first 4 to 8 weeks is 1.3 to 1.5 g Pro/kg body weight and 30

to 35 kcals/kg of dry weight. After 6 to 8 weeks the protein recommendation is to

decrease to 1.0 g Pro/kg body weight and energy sufficient to maintain body weight. Fat

intake should never be more than 30% of total calories. Cholesterol should be less than

300 mg/day. After 8 weeks from surgery the goal of nutrition therapy is to combat the

side effects of immunosuppressive drugs and to ensure adequate intake. Fluids are

encouraged as well as calcium rich foods to prevent steroid medicated osteoporosis.

Kidney transplant recipients are at risk for nutrient deficiency or toxicity. Between 5 and

10% of transplant patients develop hyperglycemia and half of these may require insulin

therapy. Hypophosphatemia occurs in as many as 50% of post transplant patients. It is

usually managed by increasing high phosphorus foods and using oral phosphorus

supplementation. Sodium restriction may be advocated if edema or high blood pressure is

present. Hyperkalemia and hyperlipidemia often develops in transplant recipients due to

the immunosuppressive drugs. Supplements of certain nutrients may be needed and

should be based on each individual patient’s needs.

Exercise is important for taking care of the new kidney. Benefits include; improved

strength, better blood pressure control, lower cholesterol levels, better sleep, better

weight        control,       stronger       bones         and        healthier        body.
Rejection of the New Kidney

Several steps must be taken to ensure the transplant is successful. There are vascular,

cellular, immunologic, and nonimmunologic mechanisms that can lead to rejection.

However, the transplant team makes every effort to

prevent rejection.     These efforts include: careful

matching, anti-rejection medications, and closely

monitoring the kidney in order to perform additional

treatments when necessary.        The kidney recipient

plays a big role in preventing rejection. The patient should get regular checkups and lab

work done, monitor vital signs, and check with the doctor before taking any self-care

products. The patient must also follow doctor’s advice on how to avoid infections,

follow proper diet and exercise program, and take the anti-rejection drugs.

Rejection can happen at any time. The three kinds of rejection are hyperacute, acute, and

chronic rejection. The three types vary by how and when a rejection episode happens.

A hyperacute rejection happens very suddenly and unexpectedly and results in complete

failure of the transplanted kidney. Acute rejection is the most common kind and it

develops over a brief period of time. The risk of an acute rejection episode is greatest

during the first two to three months. Chronic rejection comes about gradually over time.

It often gets worse and sometimes eventually results in kidney transplant failure. Chronic

rejection usually occurs after the first year.

If a rejection episode starts there are a couple of options. The dosage of one or more of

the medications may be changed temporarily or a different anti-rejection drug may be
given. In most cases a kidney biopsy is needed to confirm that rejection is due to the

immune system rather than some other problem, such as an infection.

Florida Health Site (2001). 1999-2001 Questions and answers; kidney transplant: complications. Retrieved
September 28, 2001 from the World Wide Web,

Johns Hopkins Medical Institutions. (2001). Comprehensive transplant center. Retrieved October 6, 2001
from the World Wide Web,

Manual of clinical dietetics. Sixth edition. 2000.

The Kidney Transplant Organization (2001). The kidney donation process; a patient’s guide to kidney
transplant surgery. Retrieved September 28, 2001 from the World Wide Web,

Virginia Mason (2001). Dietary requirements after transplant. Retrieved September 26, 2001 from the
World Wide Web,

WebMD (2001). Kidney transplant. Retrieved October 6, 2001 from the World Wide Web,

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