Kidney Transplant - Adult

For patients with compromised kidney function and advanced chronic kidney diseases three treatment options are available- haemodialysis, peritoneal dialysis or a kidney transplant. Depending on the age and the stage of kidney disease, a nephrologist decides the course of treatment. A successful kidney transplant when indicated, provides a better quality of life as it prevents long-term issues related to dialysis.

Exploring Treatment Options for Compromised Kidney Function

Haemodialysis

Haemodialysis is a common form of dialysis that uses a hemodialyzer for waste and fluid elimination from the blood. After the blood is filtered, it is returned to the body by a dialysis machine.

Surgery will be required to get the blood flow to the hemodialyzer, where your doctor will create vascular access into your blood vessels. The vascular access can be of the following types:

- Arteriovenous (AV) fistula: This is the most preferred option and connects an artery and a vein.

- AV graft: The AV graft is a looped tube which is advanced into your arm to connect an artery to a vein.

- Vascular access catheter: A vascular access catheter may be inserted into the large vein in your neck.

The AV fistula and AV graft are intended to be used for long-term dialysis treatments, but the catheters are designed for temporary or short-term use only.

Haemodialysis treatments are carried out at a dialysis centre or a hospital. However, your doctor may allow you to give yourself dialysis treatments at home if you have been on haemodialysis for a long time.

Haemodialysis: AV fistula

An arteriovenous fistula is a surgical procedure that is used to create a connection between arteries and veins to assist the blood passage directly from the artery into the veins bypassing the huge chain of capillaries.

The most preferred long term approach to haemodialysis is an AV fistula. A safe and sound surgical procedure will connect an artery to a vein, usually in the arm, to establish an arteriovenous fistula. Considering your situation and health, you might get general anaesthesia and be unconscious during the procedure or get local anaesthesia to numb the area of operation.

Arteries are blood vessels that carry blood from your heart to your body. And veins are blood vessels that carry blood from your body to your heart. After connecting an artery and a vein, the vein grows in diameter due to increased blood pressure and allows the surgeon to place the needles for successful dialysis. The AV fistula also has a wide diameter which helps your blood to flow back to your body. Since the procedure ensures high blood flow, large amounts of blood pass through the dialysis machine in a considerably less amount of time. AV fistula ensures the highest possible blood flow for dialysis and is less likely to clot. It is considered to be the best option as it lasts longer and is a safe and quick process.

Haemodialysis: AV graft

By inserting a graft material between an artery and a vein, a premeditated connection is established. This is called an arteriovenous (AV) graft. Considering the patient’s life expectancy, physiology, mental health and other factors, the decision of going through with this procedure is taken.

A biologic prosthetic graft is inserted between an artery and a vein of the patient, which does not require maturation. The dialysis process can be started as soon as 24 hours from its installation, depending on the type of graft used. Prosthetic grafts usually do not require special handling.

AV graft is suggested for patients needing chronic haemodialysis vascular access. AV graft may be convenient as a primary choice for them or as a secondary choice for patients who failed to develop results in AV fistula haemodialysis. AV graft may be chosen for other reasons as well, like personal preference, medical conditions.

Haemodialysis: Vascular access catheter

A Y-shaped looped plastic tube is inserted to create a connection between one end of your central vein in your chest or a sizable active vein in your neck to your heart. The catheter has two other open ends that come out of your skin. Vascular access catheters can also be placed in a large vein in the groin. Catheters are used explicitly in cases where haemodialysis is urgent or requires immediate attention. A catheter can be inserted and used on the same day. It takes as little as around 20 minutes to place an HD catheter surgically and needs local anaesthesia or medicine to relax your muscles.

VA catheters are best used for a short period and only when one does not have other options for haemodialysis available.

Peritoneal dialysis

In this procedure, a peritoneal dialysis catheter is surgically implanted into the abdomen that helps to filter the blood through the peritoneum (a membrane in the abdomen). During peritoneal dialysis, a special fluid called dialysate is used to absorb the waste. After the dialysate draws the waste from the bloodstream, it is drained from the abdomen.

This procedure takes a few hours and needs to be repeated four to six times a day. Peritoneal dialysis can be of the following types.

- CAPD or Continuous ambulatory peritoneal dialysis: Here, the abdomen is filled and drained several times a day by a machine. The patient has to be awake during the procedure.

- CCPD or Continuous cycling peritoneal dialysis: In this procedure, a machine cycles the fluid in and out of your abdomen. It is usually done when the patient is asleep.

- IPD or Intermittent peritoneal dialysis: The process uses the same machine as CCPD, but takes longer.

Dialysis is an expensive and time-consuming treatment and may not be feasible for patients with severe or acute kidney failure. A kidney transplant is another option. But, patients have to consult their doctors to check whether a transplant would be right for them.

Peritoneal Dialysis: CAPD

Continuous ambulatory peritoneal dialysis (CAPD) is the most portable form of peritoneal dialysis. Bags containing peritoneal fluid need to be changed about five times a day which controls the water, cleans the body and works as a replacement for your kidney through your peritoneal cavity.

The procedure is quite simple for the patients to follow. You need to fill your abdomen with dialysate through bag changes and let the fluid remain there for the prescribed amount of time. Then let the fluid drain out, and you can resume your normal activities while the dialysate resides in your abdomen and helps clean your body.

Peritoneal Dialysis: CCPD

Continuous cycling peritoneal dialysis(CCPD) is a surgical procedure that involves an automated cycler machine performing multiple cycles of blood exchange while you are asleep at night. The machine automatically fills your abdominal cavity with the dialysate fluid, dwells the fluid there for the prescribed amount of time and then drains it away into a bag which you dispose of when you wake up.

This procedure involves you to keep the machine for 10-12 hours at night. In the morning you will need another exchange which will last you for another day. It is a convenient method than CAPD since you have to use it way less frequently.

CAPD is preferred for patients according to your doctor’s advice, medical condition, lifestyle and personal preference. Some modifications might be made by your doctor to the surgical procedure accordingly.

Peritoneal Dialysis: IPD

Intermittent peritoneal dialysis is the most primitive mode of dialysis for chronic treatment. It involves frequent cycles of exchange through 8-10 hour sessions over 3-5 times a week. The cavity tends to dry between sessions, so it is performed on a regular nightly basis called nocturnal IPD. It consists of dialysate solutions exchanged through limited removals. This procedure is advised to patients with high requirements for fluid transport and limited exchanges. Sometimes smaller cycles of IPD ultrafiltration can be better than more astronomical cycles of CAPD or CCPD. The total amount of dialysis fluid for ultrafiltration per treatment varies from 8L to 12L.

Kidney Transplant

It is a surgical procedure that involves replacing a failed or poorly functioning kidney with a healthy kidney from a living or deceased donor. In comparison to the never-ending dialysis process, going for a kidney transplant seems like a better treatment choice for kidney failure.

In the case of complete kidney failure, one might need a kidney transplant. The kidney works to filter the waste content from the blood through urine. It also helps in fluid body regulation and maintaining electrolyte balance. Kidney failure can build up waste in your body and be fatal.

Kidney failure is usually treated with dialysis. But a condition of acute kidney failure qualifies for a kidney transplant. In this process, both kidneys are replaced with donated kidneys from a living donor or a deceased person. As per medical conditions and other factors, kidney transplants have their advantages and disadvantages.

Dialysis procedures are time-consuming and require labour intensified surgical procedures. Moreover, dialysis involves frequent or regular treatment and machine-based dialysis processes. You will have to buy dialysis supplies and learn its uses and probably perform a few procedures at home.

A kidney or renal transplant can prove to be fruitful and free you of responsibilities and long term dependency on dialysis procedures. This procedure can allow you to live a more active lifestyle instead of following strict schedules of machine dialysis dependency. Then again, kidney transplants are not actively suitable for all patients.

During kidney transplant surgery, a surgeon will surgically remove the infected or failed kidney and replace it with compatible donated kidney. Although humans are born with two kidneys, one can live a healthy life with only one functioning kidney. After this procedure, the patient will have to take immunosuppressants and other medications to keep his immune system from attacking the foreign organ.

A condition called ESRD (end-stage renal disease) or ESKD (end-stage kidney disease) diagnosed by your doctor will allow you to avail dialysis. Apart from putting you in dialysis, your doctor will suggest if you are a suitable candidate for a kidney transplant.

Apart from ensuring a healthy, enough body to go through the surgery, you will need to follow a strict regimen of medication afterwards. Also, you will have to follow strict instructions from your doctor and take your medications timely.

In case you already have an underlying condition or have unhealthy body weight, a kidney transplant might be dangerous for you or unsuccessful. History of cancer, infections like tuberculosis or hepatitis, severe cardiovascular conditions or liver diseases are some serious medical conditions which might affect your choice of a kidney transplant. In some cases, doctors recommend that you don't choose this procedure if you drink, smoke or use drugs.

If your doctor suggests you are suitable for a kidney transplant surgery and you are interested as well, then you will be further evaluated for the procedure at a transplant centre.

This evaluation will require frequent visits and checkups to assess your physiological, visceral and genetic conditions. You might also need to complete a physical examination to prove that you are healthy for the surgery.

In case you are receiving your transplant from a living donor, your doctor can timely schedule the renal transplant surgery in advance. But in case you are waiting for a deceased donor to match your compatibility, you will have to be available at short notice for the procedure. You will have to clear an antibody test by resulting in a negative crossmatch for this.

A kidney transplant surgery requires general anaesthesia through IV fluids. Your surgeon will make an incision in your abdomen and attach the donor kidney inside you. Likely you will have to stay a few days at the hospital to ensure good health and stability before being discharged.

Your transplant team will schedule a checkup routine to evaluate the functionality of the new kidney. You will also be given specific instructions on when and how to take your medications afterwards.

Apart from immunity suppressing drugs, a few additional medications might be advised to reduce risks of internal infections. A few months of regular follow-ups with your doctor will be needed. Your total recovery might take up to six months before you freely resume your active and healthy lifestyle.

certain conditions may prevent you from being eligible for a kidney transplant. Therefore, your doctor will evaluate you first to see whether you meet the eligibility requirements for a kidney transplant.

A relatively new procedure Laparoscopic Donor Nephrectomy which is minimally invasive is performed in donor surgeries for kidney transplantation. In this procedure the donor’s kidney is surgically removed through a keyhole. This process is particularly helpful for donor since the recovery process is very quick

Our highly skilled kidney transplant surgeons ensure care that gives a rapid recovery. The support of our excellent infrastructure and advanced diagnostic facility adds to our ability to provide comprehensive kidney care and ranks our hospitals as one of the best kidney transplant hospitals in India.

Kidney Transplant - Adult FAQ's