Renal Transplantation

A person with end-stage renal failure may have a renal transplant.

This would be from a deceased donor (in 2/3 of cases), or a living donor, and the living donor may or may not be genetically related to the recipient.

The donor and recipient should be ABO Blood Group compatible, and share as many other similarities in order to avoid rejection of the transplanted kidney. The best figure for survival of a transplanted kidney is 80% at 5 -10 years. The transplanted kidney is placed in the pelvis below the kidneys (the original kidneys are not usually removed), the blood vessels are attached to the iliac vessels in the recipient, and the ureter is inserted into the bladder.

Immunosuppressive treatment is normally needed for as long as the transplanted kidney is in place, and the risk of rejection is highest in the first 3 months when the kidney is recognised by the person’s immune system as a “foreign” object, and rejected.

Acute graft rejection occurs in the first 3 months, and can often be treated successfully with immunosuppressive medication.

Chronic graft rejection shows when there is a slow decline in renal function more than 3 months after transplantation and it does not respond well to treatment.

In most cases it will be known by three months after the transplant whether or not it has been successful and whether or not the person will need further dialysis, and indeed, another transplant.

Immunosuppressive medications are:

1. Cyclosporin

2. Azathioprine

3. Steroids

4. Antilymphocyte globulin

Newer ones are:

1. Tacrolimus

2. Rapemycin

3. Myclofenate mofetil

The medications used vary according to the person’s needs.

In the majority of instances following a transplant there is an improvement return of normal renal function. This is usually immediate but may take up to three weeks.

Compared to dialysis it improves quality and length of life in the majority of patients, but some patients may have emotional difficulties as a result of adapting to a less restricted lifestyle, when they have been previously dependant on dialysis treatments.

Following transplantation, patients need frequent follow-up at hospital outpatients with regular blood testing. The majority of patients still have chronic kidney disease with a glomerular filtration rate (GFR) of around 60 ml/minute. This will affect their well-being and independence. Each case will need to be assessed individually.

Complications:

• Operation failure/ complications
• Rejection
• Steroid therapy causing complications such as weight gain, diabetes, high blood pressure, thinning of the skin and osteoporosis
• Cyclosporine carries long- term toxicity to kidneys
• Immunosuppressant medication carries an increased risk of opportunistic infection, cancers and lymphomas
• Increased risk of cardiovascular disease.

Amended April 2008