Kidney transplantation offers an excellent option for some patients whose kidneys are no longer functioning adequately. There are approximately 140,000 people living in the U.S. with kidney transplants and about 16,000 new kidney transplants are done yearly. Transplantation in general offers a longer life expectancy for many patients and it also offers an enhanced quality of life.
There are two ways in which kidney transplants can be done – from living donors or from deceased donors. Living donors make up more than one third of transplants and have several advantages. Because they can be scheduled weeks to months in advance, the transplants can ideally be done at a time before dialysis is ever needed (called pre-emptive transplantation) and at a time convenient for both the patient (recipient) and the donor. Living transplant donors can be biologically related such as a parent, sibling or son or daughter. Other donors are not related biologically; the major example of this is transplantation from the patient’s husband or wife. Occasionally close friends or other people who have a relationship with the patient also volunteer to become kidney donors.
There are over 100,000 patients currently on the waiting list for a deceased donor kidney transplant in the U.S. Deceased donor kidneys usually come from victims of trauma who are diagnosed with brain death. The quality of the donor kidneys is an area that has been clarified with the concept of the ‘expanded criteria donor.’ There are specific criteria such as older age (> 60) and coexisting hypertension that indicate that these kidneys may not have the same lifespan in the new recipient as kidneys from ‘standard criteria donors’. This idea of allowing prospective deceased donor recipients to choose to accept kidneys offered from the expanded criteria list leads to better matching of donors and recipients. For example, a young patient with kidney failure who is otherwise healthy would clearly want an optimal kidney from the standard criteria list. Alternatively, an elderly patient with coexisiting medical problems may choose to accept a kidney from the expanded criteria list because 1) the kidney will be adequate for his needs and longevity and 2) there is a significantly shorter wait for the expanded criteria kidneys. The expanded criteria kidneys are carefully screened by the transplant surgeon before being used.
Not all patients with advanced kidney disease are appropriate candidates to receive a kidney transplant. They must be able to
–safely undergo the surgery
–utilize family or other support system to help with frequent clinic follow-up visits
–adhere to a complex and changing medication regimen
–tolerate anti-rejection medications that also reduce the immune system’s ability to fight infections
Kidney donors must be free of any medical illness that would pose a significant lifetime risk.
There are 2 centers in Connecticut (Yale New Haven Hospital and Hartford Hospital) that perform kidney transplants and many others in surrounding states, primarily New York and Massachusetts. Referral to one of these centers is the first step in the transplantation process. After a thorough medical, psychosocial and financial evaluation patients may be approved for transplantation and are either scheduled for a living donor transplant (if a suitable donor is found and approved), or placed on the deceased donor waiting list. Unfortunately, the average waiting time in Connecticut is 4-5 years. Some patients with specific blood types or for whom a perfectly immunologically matched kidney is found can be transplanted sooner.
The surgery itself requires general anesthesia and the average hospital stay is about 5 days. The most common early complication is ‘delayed graft function’ in which the transplanted kidney does not function immediately. This may require continued dialysis support for some period of time, usually days to weeks. Other potential risks and complications will be reviewed by the transplant center staff and the surgeon. Transplant recipients are usually able to resume full activity after 6-8 weeks.
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