Kidney Transplant - The Alternative to Dialysis
Kidney transplantation: a short history
In 1954, Dr. Joseph E. Murray performed the first successful kidney transplant at Peter Bent Brigham Hospital in Boston. The patient, Richard Herrick, received a donated kidney from his identical twin, Ronald. Previous kidney transplant attempts on other patients had failed due to organ rejection. The Herrick case owed its success to earlier research done on the body's reaction to skin grafts.
Organ rejection was a major problem in transplants. During World War II, scientist Peter Medawar was asked by Britain's Medical Research Council to investigate why skin taken from one person would not form a permanent graft to the skin of another person. Medawar discovered that a graft from a donor that was related to the patient had a lower risk of rejection. He also learned a graft donated by a twin had a dramatically reduced rate of rejection. More research revealed that the body’s immune system was responsible for organ rejection. Foreign tissue was treated as an invader and attacked by the body. Tissue from a genetically-related donor was more likely to be accepted by the body and safe from the immune system’s assault.
Once scientists realized the immune system was responsible for organ rejection, work began to find a way to stop the immune response. Radiation was first used, but discontinued because the side effects were too severe. Scientists discovered that a drug called azathrioprine (also called AZA or Imuran) helped suppress the immune response when it was used with a corticosteroid. This drug therapy led to higher success rates for organ transplants. In the 1980s, a more effective immunosuppressant called cyclosporine was discovered. This immunosuppressant, along with advanced techniques to match patients with donors, helped boost transplant success to over 85 percent.
According to the United Network for Organ Sharing (UNOS), more than 19,000 people received kidney transplants in 2016.1 The average success rate one year after transplant surgery was over 90 percent. To date, there are over 97,000 patients waiting for a kidney.1
Exploring the possibility of a transplant
Patients interested in a transplant should speak to their kidney doctors (nephrologists). Your doctor will refer you to a transplant center where a transplant team will evaluate your condition and determine if you are a candidate for a kidney transplant. A thorough medical exam and various tests will be performed. Health conditions such HIV infection, hepatitis C and cancer may prevent you from being considered for a transplant. The medical evaluation will not only determine whether your current health can benefit from a transplant, but it will also take into account any existing health issues that may compromise your health and strength when you undergo the procedure.
In addition to being examined at the transplant center and interviewed by the transplant team, you’ll also be required to see your dentist for a full dental evaluation. If your medical and dental evaluations indicate you are a good candidate for a kidney transplant, the search for a donor can begin.
Matching donors with patients
There are two types of organ donors: a living donor and a non-living, or cadaver, donor. Living donors elect to donate one of their kidneys and undergo surgery for its removal. Non-living donors are those who have allowed usable organs to be taken from their bodies at their death. Both types of donor organs can be successful transplants.
Compatibility between a patient and the donor reduces the chances of organ rejection and increases the chances of a successful transplant. Your transplant team will determine if a potential donor is a good match based on the following tests:
- blood type matching: matches your blood type to the potential donor's blood type.
- tissue matching: measures and defines certain proteins, called antigens, present in the patient and potential donor’s blood and tissue proteins. The best compatibility is called a six-antigen match, which occurs 25 percent of the time between siblings who share the same mother and father. It can occur between members of the general population, but it is rare. Due to advanced immunosuppressants, a strong tissue match is not required for a transplant.
- crossmatching: performed by mixing a small amount of the patient's and potential donor’s cells. Testing involves different phases and as many as 10 to 15 tests. If the patient’s cells do not react to the donor’s cells, the chances of organ rejection are low. If the crossmatching tests show that the patient’s cells react to the donor’s cells, there is a high chance of organ rejection.
If you have a potential living donor and the transplant team has determined that person is a good match, they will also undergo a thorough medical evaluation at the transplant center. If things go well, you and your living donor will be scheduled for the transplant surgery.
If you do not have a living donor, you will be placed on the waiting list for a cadaver organ.
Waiting for a donor
According to the United Network of Organ Sharing (UNOS), there are approximately 97,000 people waiting for a donor kidney.1 The average wait time is 3.5 years.2 People who are in end stage renal disease (ESRD) and have less than 15 percent of their kidney function must undergo dialysis until a kidney is found. Transplant surgery often takes place on very short notice. Your transplant team and your kidney doctor will advise you to live a healthy lifestyle in order to be in the best condition possible for your surgery. This means following your kidney doctor’s recommendations, eating according to the diet guidelines given by your renal dietitian and taking prescribed medicines.
Your transplant center will place you on their waiting list for a kidney and you will need to register for the national transplant waiting list at UNOS. You will also be required to list several phone numbers—home, work, family, friends and neighbors—where you can be reached if a kidney becomes available. You may even carry a pager, so you can be reached immediately.
When a kidney becomes available, the nearest transplant center is notified and it is logged into the UNOS database. If UNOS finds a perfect match for the kidney, it will be offered to that person regardless of their location. If not, the transplant center will call patients on their waiting list who may be potential matches.
Once a patient is called, they will only have a few hours to get to the transplant center. Although a call is a good indication, it is not a guarantee of a kidney. Crossmatching tests will be performed and the best candidate will be offered the kidney.
The transplant surgery
Different techniques for kidney transplant surgery have been developed over the years. Typically, a large incision is made into the patient’s side. Advances in surgical tools and techniques have allowed surgeons to make as small an incision as possible. Your transplant surgeon will discuss the procedure with you, their choice of technique and answer any questions you have.
The new kidney is grafted to the renal artery, above or below the existing kidneys. Depending on your condition, your surgeon may opt to remove the damaged kidney(s) or leave them. After the surgery, you will be hospitalized for several days and closely monitored for complications like infection, excessive bleeding and organ rejection.
Some newly transplanted kidneys begin working right away. Others may start working after a couple of days. If your new kidney isn’t working right away you’ll receive dialysis until it does. You will remain hospitalized until your doctors are satisfied the new kidney is functioning and you are healthy enough to be released. The living donor can be discharged from the hospital after a couple of days.
After the transplant
Initially your transplant doctor and nephrologists will require many follow-up visits and tests for a couple of months after the transplant. They want to make sure your new kidney is healthy. Your doctors will also look for signs of complications like:
- Narrowing of the artery, also called kidney stenosis
- Blood clots: clots in the artery or vein could prevent circulation and cause the kidney to fail
- Kidney rejection
- Weight gain
- High blood pressure
- Cancer: use of immunosuppressants may leave you vulnerable to disease
You will remain under the care of your nephrologist for routine visits.
Caring for your transplant
Having a new kidney doesn’t mean you can eat or treat your body the same way you did before your diagnosis of chronic kidney disease. It is even more critical you maintain healthy habits so your new kidney will function properly and give you years of use.
Part of the transplant aftercare is taking required medications. Your doctor will prescribe immunosuppressants, which you will need to take for as long as you have your new kidney. Any pre-existing health conditions you experienced before the transplant will need to be managed as well, especially conditions that contributed to your initial kidney damage (like diabetes or high blood pressure).
By keeping yourself healthy and following your doctors' recommendations, your kidney transplant may last on average from 8 to 25 years. Of course, there are no guarantees. There have been transplants that have failed before 8 years and others that have lasted more than 25.
Learn more about kidney transplants
You can learn more about kidney transplants, the donor waiting list and transplant statistics at the following websites:
- National Kidney Foundation at www.kidney.org
- American Association of Kidney Patients at www.aakp.org
- United Network of Organ Sharing at www.unos.org
1. United Network for Organ Sharing website. https://www.unos.org/data/transplant-trends/Based on OPTN data as of May 25, 2017. Accessed May 25, 2017.
2. United States Renal Data System. 2014 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014.
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