Kidney transplants

Posted on 20 January 2015

Once you have reached end-stage chronic renal failure you have two options – dialysis or a kidney transplant. We spoke to Dr Derek Miller, a renal physician at Mediclinic Constantiaberg.

If you’re fortunate enough to receive a donated kidney, you may live a relatively normal life again. Kidney transplantation is one of the success stories of modern medicine and quality of life with a well-functioning kidney transplant is vastly superior to lifelong dialysis.
Unfortunately not every patient is eligible for a transplant and you may be excluded if you have certain infections like TB or bone infections. Other reasons not to do the transplant may be heart, lung or liver disease or life-threatening diseases such as cancer. If you have problems taking medications several times a day for the rest of your life this is also not for you.

The gift of life
‘If you’re a good candidate with no other complications, we would first look for a live donor like a sibling, parent or a friend,’ says Dr Derek Miller, a renal physician at Mediclinic Constantiaberg. Every transplantation unit has a committee which evaluates the suitability of a patient to receive a kidney and of a donor to give a kidney. ‘If the live donor is a non-family member or a foreigner, we have to submit a dossier to the Department of Health,’ explains Dr Miller. ‘The department has a committee which then analyses the documents and decide whether to give us approval.’

With live donors it can take three to six months for the whole process in the private sector, says Dr Miller. ‘If you don’t have a live donor you have to go onto a waiting list to receive a kidney from a brain-dead donor who has no known chronic kidney diseases. On average the waiting time is three to five years.’

Patients who have been on the list for a short period of time go at the bottom and those patients who have been waiting the longest go on top. The list is normally generated by a tissue-typing laboratory, which helps to ensure your body will not reject the donated kidney.
A kidney transplant cannot be transferred from one person to another at random. Potential donors and recipients need to be matched according to blood grouping and specific HLA-agents. If two humans share the same Human Leukocyte Antigens (HLA), their tissues are immunologically compatible and they are said to be a match.

Live donors and deceased donors
In the case of a deceased donor the donor is taken to an operating table where the kidneys and often some of the other organs are removed. The kidneys are placed on ice in sterile bags and can be preserved for up to 24 hours. Each of the two kidneys from one donor will be implanted into separate recipients.

In the case of a living donor, the donor should be a healthy person with no high blood pressure, heart disease, diabetes or kidney disease. ‘If you’re fit and healthy and you remove one kidney, the likelihood of you developing problems in the long run is very small,’ says Dr Miller. ‘This is based on many studies which include people who have lost kidneys for traumatic reasons such as a car accident or even being shot in the kidney.’

What happens during the transplant?
During a living donor transplantation the two patients are operated on in adjacent operating theatres. Once one kidney has been removed from the donor it is implanted into the recipient straightaway.

At certain hospitals in South Africa donors now have laparoscopic nephrectomies, where the kidney is removed via keyhole surgery. The new kidney is implanted into the recipient’s pelvis near the bladder – and contrary to popular belief the recipient’s own kidneys are left in place. Normally the procedure will take two to three hours, and afterwards both patients need to spend about three days in the critical care unit. The donor can usually go home on the third or the fourth day, while the patient can go home by day eight, nine or ten.

According to the National Kidney Foundation of South Africa, more than 90% of transplanted kidneys will still be working one year after the operation. However, it’s not a quick fix. A new kidney requires the utmost care, including taking daily anti-rejection medication.

Published in Endocrinology

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