What are indications of transplant surgery?
Our kidneys are organs that play vital roles in our body.Kidney transplant is now the best treatment option for Chronic Renal Failure.However, a part of patients with chronic kidney disease prefer the dialysis option.
Since dialysis can undertake renal functions partially (only a part), it is not considered as an alternative to kidney transplant.Moreover, dialysis patients face many problems, such as solid diets, water restrictions, travel limitations, isolation from social life and absenteeism (work and school) along with growth retardation in pediatric patients.Dialysis patients have to take drugs intensively (hypertension, medications that help production of blood cells etc.), as they are devoid of most renal functions.Due to these reasons, it is a research-proven fact that the quality of life and survival are fat better in kidney transplant patients than dialysis patients.Patients can lead a healthy life by regular postoperative follow-up visits after a successful kidney transplant surgery.
Most patients with renal failure who receive dialysis therapy may undergo kidney transplant surgery.(Patients who are not eligible for the transplant form only a small group).Transplant surgery is an important treatment option for patients with kidney disease.Since kidney transplant surgeries are now performed very successfully, patients’ quality of life increases and they may lead a healthy life.The patients who are not eligible for the transplant usually fall into group of patients with advanced stage heart and lung diseases, who cannot tolerate the risk of operation, patients with advanced stage cancer and elder patients.
Are advanced age and chronic diseases a contraindication for kidney transplant?
Patients with kidney failure should undergo a transplant surgery, if they do not have any serious health problem. Elderly patients wear out in a shorter time due to the negative effects of dialysis. Although it seems that elderly patients have less chance for the kidney transplant, this group of patients benefits tremendously from the kidney transplant. In European Transplant Center’s program specific for this group, kidneys of elderly donors are removed and transferred to elderly recipients. If a patient at age 80 or older has no problem with the renal functions, very successful outcomes can be achieved with a transplant to another elderly patient. Even patients with a severe heart disease can undergo kidney transplant after necessary tests and treatment are done. The important point is to restore health of heart by instituting necessary treatment or operation following a cardiac examination. Next, kidney transplant can be successful performed thereafter. For instance, kidney transplant is not contraindicated for a patient who has undergone bypass surgery. The kidney transplant can be performed within 1 to 2 months after the cardiovascular surgery.
Is there any age limitation for kidney transplant?
Kidney transplant is a treatment option for every patient aged from 7 months to 70 years.
Advanced medical means and experienced physicians enable that the children younger than 5 and adults older than 65 can also undergo a transplant surgery. Therefore, every person who has the opportunity should undergo this operation. Kidney transplant is performed for an 86 years old patient in the U.S. and an 82 years old patient in Turkey and these patients continued their life healthily.
Do diseases of urinary bladder contraindicate kidney transplant?
The kidney failure secondary to the urinary bladder diseases can progress insidiously for years. However, the disease of urinary bladder cannot be detected in the early stage. When the diseased urinary bladder is treated, augmentation surgery is first performed that involves transferring a patch of small intestine to the urinary bladder. Thus, the new urinary bladder can be connected to the kidneys. Kidney transplant for such patients has the same success rate as other transplant patients. Previously, the treatment of patients with history of chronic renal failure secondary to a disease of urinary bladder could be performed in two sessions. In the first session, patch operation was carried out for the urinary bladder and the treatment of kidney could be started 6 to 8 weeks later. Moreover, these patients could face urinary tract infections that relapse frequently and various secondary complications. However, novel surgical techniques are developed and urinary tract infections can be diagnosed and treated at early stage thanks to regular postoperative follow-up. On the other hand, the diseased urinary bladder is operated on and kidney transplant is performed in the same session.
How are evaluations done?
Böbrek nakli, yaklaşık 4 saat süren büyük bir ameliyattır. Bunun dışında, size takılacak böbrek vücudunuza Kidney transplant is a major surgery that lasts approximately 4 hours. Moreover, the donor kidney is recognized as a foreign tissue by your body. Your body will react against the new kidney, just as your immune system fights off a microbe that enters into your body. Therefore, you will need to take immunosuppressive drugs that suppress you immune system in the rest of your life in order to avoid rejection of the donor kidney. For all these reasons, a period of detailed medical preparation is required before the renal transplant.
At the end of this period:
1. You will be investigated to understand whether your body is ready for such a major surgery and especially if your vital organs, such as heart and lungs, are ready for this surgery that bears a tremendous load on the body.
2. Several tests will be performed to determine the tissue match between the donor and the recipient. Thus, the risk of rejection of the new kidney by your body will be minimized.
3. As you already know, you will need to take immunosuppressive drugs that suppress your immune system in the rest of your life in order to avoid rejection of the donor kidney. Therefore, your immune system will be partially weak. The medical team will strive for clarifying whether there is any condition, such as cancer or severe infection that poses a challenge against your immune system.
Briefly, you will have following tests while you are prepared for organ transplant surgery:
- Blood tests, urine tests,
- X-rays, ultrasound and computerized tomography.
- Moreover, you may be consulted with physicians of other medical disciplines, such as cardiology, pulmonary medicine and gynecology and obstetrics, if it is deemed necessary by nephrologists or organ transplant surgeons.
- Kidney transplant team will need to know whether you take the drug regularly that should be taken after the transplant surgery.
After all tests and examinations are completed, the patient is discussed by surgeons and nephrology team in Kidney Transplant Council and the final decision is made in this Council.
How does transplant surgery performed?
Kidney transplant implies transferring a healthy kidney of a donor to the body of the patient in an operation.
There are two types of renal transplant:
1. Living donor kidney transplant,
2. Deceased donor kidney transplant
The kidney to be transplanted can be obtained from a related donor or a deceased donor. If the donor kidney is sourced from a relative of the patient, the procedure is called “living-donor kidney transplant”, while “the deceased donor kidney transplant” implies that the donor kidney is obtained from a deceased person.
Unless otherwise is required, an incision, measuring 15 to 20 cm in length in average, is made in the skin of the lower abdomen (pelvis). Great vessels of the pelvic cavity are liberated in order to prepare the area, where the kidney will be anastomosed. After the donor kidney is appropriately prepared, the vessels of the donor kidney are anastomosed to the vessels of the recipient and thus, transplant surgery is completed. Ureter of the kidney is anastomosed to the urinary bladder of the recipient. The surgery takes approximately 4 hours. Your native kidneys do not harm your body. Therefore, your native kidneys will not be removed. Your kidneys will either minimize or completely stop functioning after the transplant surgery. New kidney will undertake all functions.
Your native kidneys will not cause damage. However, removal may be required in case there is possibility of harm to the body. In this case, one kidney or both kidneys may be removed in the transplant surgery. In some cases, it is necessary to remove one kidney or both kidneys and perform the transplant surgery after a certain period of time. Your doctors will make decision about the course of action considering your status.
What will change in my life after transplant surgery?
You will no longer need to maintain dialysis treatment after a successful transplant surgery. Our transplantation center team will always be with you so that you can live a longer and healthy life with your transplant kidney. As already demonstrated by statistics, the transplant kidneys have a longer lifespan as a result of recent scientific advances.
We intend to further improve quality of life and prolong the life span of outpatient after the transplant surgery in the light of future advances in technology and medications. Patients are not imposed any restriction, excluding the use of prescribed medications. You will be free to engage in all activities of pre-transplant life after the transplant surgery.
Don’t be afraid. What matters is that you take your medications regularly and attend follow up examinations.
There used to be certain restrictions in a patient’s life following kidney transplant. Patients were recommended not to leave their homes or even rooms, wear medical masks constantly and avoid social life. Use of modern methods and accumulated medical experiences revealed out that none of these measures were necessary. The experiences demonstrate that transplant surgery provides patients with a comfortable life. Patients are recommended to maintain the same lifestyle after the transplant and no restrictive measures are imposed.
After kidney transplant:
- You don’t need to wear masks.
- You may go outside and/or your friends can visit you at home
- It is not necessary to set up a special room at home for the patient.
- You may use public transportation means such as taxi, jitneys and buses.
- You may visit shopping malls.
- You may drive vehicle 1 month later.
- You may return to work after the sick leave period that is left to the discretion of your doctor.
- Our female patients can have children and breastfeed their babies.
- You can go swimming; however, you should avoid excessive sunbathing.
- You may have pets.
We recommend you consider following issues after the transplant:
- Eat low-salt diet and remember to check your blood pressure regularly.
- Avoid carbohydrate-dominant and fatty foods.
- Avoid grapefruit and pomegranates so that absorption of the medication you use after the transplant is not disrupted. There is no contraindication for consuming fruits such as lemons, oranges or tangerines.
- Try to do exercise and walk regularly.
- If you are diabetic, try to regulate your blood glucose.
- Do not lift objects weighing 10 kilograms or heavier for two months until your wound heals. Avoid movements that specifically increase abdominal pressure or strain abdominal muscles.
- Do not work out for 2 months; however, you may go on walks, perform daily activities and do household chores.
Your immune system functions to protect your body against bacteria and viruses and to fight off them. Your new kidney will also be recognized as a foreign tissue by your immune system and it will also try to reject it. Therefore, you need to take certain drugs regularly that suppress your immune system. Kidney transplant surgery will not be successful unless these drugs are taken.
Take care of yourself!
The prescribed immunosuppressive medications that you take until your body accepts the transplant kidney weaken your immune system and it may be unable to fight diseases. An infection in your body may quickly aggravate and transform into a serious condition relative to other people. Therefore, diagnosis should be established and treatment should be instituted as soon as possible.
Should your body temperature is over 38 ℃, do not try to self-medicate and don’t be alone at home. Do not take antibiotics on your own discretion. If this happens, definitely contact your doctor or visit a hospital.
In addition,
You should not self-medicate before you consult your doctor in following conditions!
- Blood in urine,
- Decrease in output of urine,
- Pain or burn while voiding,
- Redness, swelling and discharge in the suture line,
- Persistent nausea, vomiting and diarrhea,
- Abnormal weight gain, weight loss or edema,
- Shortness of breath, cough and secretion,
- Itching, rashes and lesion in skin,
- Abnormal vaginal discharge and bleeding in female patients,
- Extra-ordinary fatigue and drowsiness,
- When medications other than ones prescribed for you are required
Can I become a mother or father after the transplant?
Couples can have children at the right time and mothers can breastfeed. In male patients who receive dialysis therapy due to kidney failure, low sperm count may be observed due to the effect of urea. Thus, the fertility may decrease. A successful kidney transplant increases chance of conception in couples who fail conception due to renal failure. When the transplant eliminates effects of urea on the body, the fertility increases and sperm parameters are restored to normal ranges. Since female fertility functions are normalized, they can conceive and give birth to baby 1 to 2 years after the transplant.
Deceased Donor Kidney Transplant
What does deceased donor kidney transplant mean?
“Deceased donor kidney transplant” implies transplanting kidney of a deceased donor to the patient. It is useful to emphasize a few important issues in this process. The first one is about the necessity that organ transplantation can be mentioned only if the death occurs in an intensive care unit. Organ donation is not an option in case of deaths that occurred at home, in traffic accidents, in natural disasters and even in any department of the hospital other than the intensive care unit. For patients, who die in intensive care unit despite all efforts and treatments, their relatives can be contacted for organ donation.
Another issue that needs to be mentioned is “brain death”. Indeed, the death mentioned here is the definitive diagnosis of “brain death”. People die due to insufficient blood supply to brain – insufficient oxygen and nutrient supply to the brain – secondary to dysfunction or one or more than one organ, not only secondary to dysfunction of heart, liver or lung.
What is brain death?
Brain death can be defined as no blood supply to the brain and resultant failure of signal transmission from the brain. Failure of spontaneous breathing or “taking the last breath” is a simple fact that proves this condition. It is necessary to do many tests and evaluations that are specified in regulations to establish diagnosis of brain death or to declare a person “exitus”. Two physicians assess the case independently. Finally, additional tests (angiography, CT, Doppler, Ultrasound, scintigraphy etc.) are instituted to make sure that there is no blood supply to the brain. Unless all these procedures are completed, family is not contacted for organ donation.
In the event of a death in intensive care unit, the person is mechanically ventilated and air can be pumped into the lungs by a device for a while. This increases oxygen level in blood and sustains heart beat for a while. Heart will stop beating after a while irrespective of the life support. The time between the declaration of brain death and total absence of heart beats may be prolonged for a while only in intensive care unit and this time makes organ donation possible.
Besides, family is necessarily contacted, whether the deceased has already donated an organ or not. Final decision is always made by relatives. However, it is necessary to clarify that relatives respect the will of patients, who have already expressed an opinion on that issue before the death.
Conditions that should be notified to your transplant coordinator;
- Inpatient treatment for any reason whatsoever,
- In case of any contagious disease,
- History of blood or blood product transfusion,
- Change in address or phone number,
- Going out of town for a prolonged period of time.
Donor
What should my donor expect in transplant surgery?
Aside from medical process, there is no doubt that donor will live a happy and peaceful life because of gifting a life to someone else. On the other hand, the main priority for all physicians in our center and even the patient with kidney failure should be to prevent any harm to the related donor, who makes such a great sacrifice. The volunteer donor also undergoes a very detailed examination not only for this purpose, but also for evaluating whether the conditions required for the transplant are met.
At the end of this period:
- The donor will be assessed to understand whether he / she voluntarily consent to donate his/her kidney on his/her own free will to a relative, whether he/she is motivated for this procedure, whether he/she is able to fully comprehend this process and its results and whether he/she is ready for familial, psychological and social outcomes of this process.
- We will also evaluate whether the body of your donor is ready for kidney transplant surgery and the extent of the risk exposed by his/her body due to this surgery. Your doctors will want to make sure that this surgery poses no important risk for the donor.
- Your doctors will also review whether the donor is at risk of a future kidney disease or of being a person with a kidney disease in the future. Doctors will want to make sure that the risk of kidney disease will not increase for the donor in the future due to these procedures.
Briefly, your donor will have following tests while s/he is prepared for the surgery:
- Blood tests,
- Urine tests,
- X-ray,
- Ultrasound/tomography
- Moreover, donor may be consulted with physicians of other medical disciplines, such as cardiology, pulmonary medicine and gynecology and obstetrics, to evaluate general health status, if it is deemed necessary by nephrologists or organ transplant surgeons.
After preparation tests and investigations are completed, Kidney Transplant Council makes the final decision on the donor status.
Does kidney donation harm the donor?
Donors are undergone a series of detailed medical examinations and only strictly healthy persons are allowed to donate an organ. Even if a minor risk is identified that contraindicates donation of a kidney, the donor will be properly notified and the donation will be refused.
If no problem that will affect health of the donor is found in the light of all these examinations and assessments, living-donor kidney transplant can be performed.
How is the donor surgery performed?
When the health and postoperative comfort of living kidney donors are considered, laparoscopic removal of kidney (closed method) is now the gold standard. In the closed method, the surgery is carried out through small holes opened in the abdomen, instead of a large incision on the body. This technique gained global popularity in the last decade, and laparoscopic method is, now, used for many conditions that were managed with open surgery in the past. Surgical removal of kidney with closed method was first performed in the U.S. in 1995 and it spread around the world and became the standard treatment approach. All techniques of kidney removal with closed method are applied successfully in our center and closed method has been used to date for all the donor surgeries.
Patient's can be discharged the day after the surgery.
For the kidney surgery with closed method, two holes, measuring 0.5 to 1 cm in size, are opened in the abdominal skin and the kidney is taken out through a 6-cm incision at the inguinal region at the end of the surgery. Compared to the open method, patients experience less postoperative pain, stay in the hospital for shorter period and can engage in normal daily life and jobs more quickly. Side effects of open surgery that was used in the past, such as incisional hernia, numbness, surgical site infection and air entrapment in lungs, are almost never seen. Since this operation is carried out through only two holes and a small incision is made to remove the kidney, cosmetic outcomes are far better compared to the open surgery. Donors can go out and drink water on the evening of the operation and eat and take a shower in the next morning. Patients can be discharged the day after the surgery. There is no need to place small tubes, called “drain”, in the operation. Hidden and aesthetical stitches are placed and it is not required to remove these stitches after the surgery.
“Single-port surgery” leaves no incision scar.
For this surgery, a 2-cm incision that cannot be seen from outside is made inside the belly button and a single port is placed where all laparoscopic instruments can be passed through. Next, a camera and specific surgical instruments are passed through this port and the surgery is carried out. A high-definition camera system transmits the image to a high-definition screen and the surgery team conducts the surgery by seeing even the smallest details. Special laparoscopic tools that vary from standard laparoscopic tools and have tips that can move to all directions are used for these surgeries. On the other hand, special camera systems that are recently used and generate images from various angles due to flexible tips facilitate the surgery technique. A large part of kidney operations are performed by this technique, called “Single-Port Surgery through the Umbilicus”. For instance, dysfunctional and inflamed kidneys are removed with this surgery. Irrespective of the kidney size, it is placed in a special bag at the end of the surgery and taken out of the body through the umbilicus, after it is fragmented with a device called “morcellator”. Thus, it is possible to remove the kidney through the 2-cm umbilical incision, even if it measures 15 cm in length.