Information on Kidney Transplantation

Kidney transplantation refers to the surgical process of removing a diseased kidney and then replacing it with a new, healthy kidney. The first authenticated transplantation of kidney was carried out in the United States on 17th June, 1950, on Ruth Tucker, who was suffering from polycystic kidney disease. But, the donated kidney was rejected by the body. However, her remaining diseased kidney started operating, after which she survived for another five years after the transplantation.

Renal Transplantation Procedure

Kidney transplantation can be mainly divided into two types, depending on the source from where it is obtained for transplantation. It is termed as deceased donor transplantation, if the kidney to be transplanted is obtained from a deceased person and living donor transplantation, if it is donated by a living individual. The deceased donors can be classified into two types, the brain dead (irreversible loss of brain functions) donors and the cardiac death donors. The living donor transplantation can again be classified into genetically related transplant, if the donor is biologically related to the recipient and non-related transplants, when the donor is not biologically related to the recipient.

This surgical treatment is required generally in individuals with terminal renal or kidney diseases, In these diseases, the filtering capacity of the kidney slowly reduces and ultimately leads to a complete failure of the kidneys to eliminate waste products from the body. This is known as renal or kidney failure and is indicated by a high level of creatinine in blood. In such a situation, the treatments available are dialysis (removal of waste products from the blood by artificial means) and kidney transplantation. Other symptoms of terminal kidney diseases include high blood pressure, accumulation of urea, hyperkalemia or high level of potassium in blood, hyperphosphatemia (reduced elimination of phosphate).

Kidney or renal failure can be a result of diabetes mellitus, malignant hypertension, glomerulonephritis, inflammation of the glomeruli or small blood vessels of the kidney. Sometimes, genetic causes like polycystic kidney diseases, autoimmune conditions and inborn errors in metabolism can also be responsible for causing renal failure.

In a transplantation surgery, generally a single kidney is transplanted. Sometimes, the diseased kidneys are not removed from the body and the transplanted kidney is placed in the lower abdomen. In such a situation, the renal artery of the transplanted kidney is often connected to the external iliac artery of the recipient, while the renal vein of the new kidney, is usually connected to the external iliac vein of the recipient.

One of the major complication in the transplantation of kidney is the rejection, particularly when the kidney is transplanted from a genetically non-identical person. The immune system recognizes the transplanted kidney as a foreign element and hence rejects it. This necessitates the suppression of the immune system with appropriate immune suppressive medicines. On the other hand, reduced power of the immune system makes the recipient vulnerable to infections. Therefore, maintaining an equilibrium is most important, so that the transplanted kidney is not rejected and at the same time, the patient can also be protected from dangerous infectious diseases. For a successful operation, compatibility of the blood group of the donor and the recipient is also an important requisite. Besides, compatibility of HLA (Human Leukocyte Antigen) and minor antigens is also desirable. Certain complications such as heart diseases, cancer and infections have been found to increase the complications associated with transplantation surgery.

Earlier, removal of the kidney from the body, of the living donors required an open surgery. However, nowadays it can be done with the help of laparoscopic surgery, which ensures quick recovery of the donor. This has simplified the process of donating a kidney and played an important role in increasing the number of living donors. In the course of time, it is expected that research and studies devoted in this field will significantly simplify the complications associated with kidney transplantation and will add a new dimension to the development of medical science.