STANDARD TEXT | LARGE TEXT

 

Complications of Diabetes

Having a Kidney Transplant

This information sheet from Addenbrookes Hospital, Cambridge, summarises the information that the transplant surgeon gives you at the time of your renal transplant assessment. If there is anything that you do not understand do please ask him or one of your doctors, or call one of the transplant coordinators.

Why do I need a transplant?

You do not need to have a transplant. When someone like yourself has kidney failure there are three ways to treat you. First you could have haemodialysis where your blood is passed through a dialysis machine and cleaned up in the same way as your kidneys used to work. Alternatively you could have peritoneal dialysis which works by passing special fluid into the tummy. Some of the toxic chemicals in your blood pass into the fluid and, after a couple of hours the fluid is drained out, toxins and all. A kidney transplant is just another means of replacing a failed kidney. In addition to filtering the blood like dialysis, it has the advantage that it also provides its own erythropoeitin (epo) and controls phosphate (no more Calcichew or Alucaps).

Is a transplant right for every body?

No. A transplant involves a major operation, and requires you to take drugs to stop your body rejecting it. For some people the operation and the side effects of the drugs are too dangerous, for example if you have bad heart disease or are very old.

Where do kidneys come from?

There are two sources of kidneys for transplantation. Kidneys can come from people who die as a result of accidents, from head injuries or from strokes, and who have expressed a wish to help someone after they die by donating their organs. The other source of kidneys is from a relative (e.g. a brother, sister or parent) or spouse (partner) who wants to donate a kidney and who has the right blood group and suitable kidney cell markers (the tissue type). Because of the shortage of suitable dead (cadaveric) donors we are performing more transplants from living donors than ever before.

Can I catch anything from my transplant?

All potential donors are carefully screened to make sure that you cannot catch potentially infectious diseases such as hepatitis or AIDS.

Do I need to take any drugs after a transplant?

Following your transplant you need to take drugs to stop your body rejecting the kidney. These drugs are called immunosuppressants. Because your body can reject the kidney at any time the drugs must be taken every day, although the doses can be reduced as you progress after the transplant. At the moment there are three main drugs which we use.

Cyclosporin is the most important drug to stop rejection. It can itself cause some minor damage to the kidney, but this is out-weighed by the effect it has to stop your body destroying the kidney. It may also cause high blood pressure and increased facial hair growth. Lastly it can cause your gums to swell if your teeth aren't in good condition so you should visit the dentist every 6 months.

Azathioprine is the second drug. It has few side-effects, apart from reducing the number of cells produced by the bone marrow, so you will have regular blood tests at the hospital.

Prednisolone ("steroids") is the third drug to stop rejection. It has some side effects as well. It can cause some swelling of the face and also increases your appetite so that patients will put on weight unless they try hard not to. Both cyclosporin and prednisolone may produce diabetes in some patients and this may need tablets or injections to correct. This is uncommon however.

Although side effects may occur they are really only a problem early on while the doses of the drugs are high, and are much less of a problem later on as the amount that you need to take is reduced. For more detailed information about drugs used in renal transplantation, go to General information about taking your medicines (http://cambridge-transplant.org.uk/drugs/drugs.htm).

Where do you put the kidney?

The kidney will be placed in the groin and connected to the blood vessels that take blood to and from the leg. Your own kidneys will be left in place, although occasionally it is necessary to take out large kidneys in patients with polycystic disease, or take out kidneys which are a source of infection.

How long does the operation take?

The operation takes about two and a half hours. You will usually be in the operating theatres for longer than this because it can take up to an hour to prepare you for your operation and give the anaesthetic, and another hour or so for you to recover afterwards before you are sent back to the ward.

How long will I be in hospital?

You will be in hospital for a minimum of ten days. Occasionally you may need to stay longer if a problem arises which needs treatment.

How often do I have to come back after my transplant?

In the first weeks after the transplant you will need to come back at least twice a week so that we can keep a close eye on you. After that the visits are gradually spaced out so that by the end of the first year you will be seen monthly, and later 4 times a year. This is because the chances of problems, such as rejection, occurring are highest in the first few days and less likely thereafter.

What is rejection and does it matter?

When you catch a cold it gets worse over the course of a few days. Shortly after that it goes away. It goes away because your body, or more specifically the immune system in your body, attacks the infection and gets rid of it. In the same way if we were to give you a kidney without any other treatment your immune system would attack and destroy the kidney. Giving you the three immunosuppressants described earlier stops your immune system attacking the kidney, but occasionally your body still succeeds in attacking it, a process that we call acute rejection.

Acute rejection is treated by giving you a high dose of steroids for three days, and occasionally you may need a second treatment with something a little stronger. Each episode of rejection may damage the kidney a little bit if we do not treat it soon enough. Because rejection is more likely to occur soon after transplantation we like to see our patients very frequently just after the transplant.

Will I be involved in trials?

From time to time the Transplant Unit trys out new treatments or drugs which may possibly be helpful to you because they may offer less side effects or better kidney function. You may be invited to take part in such a trial. If you are invited please remember that you do not have to take part, and that if you decide not to participate then you will have the standard treatment which will not be affected in any way by your decision. Please feel free to discuss this with the transplant surgeon or any of the doctors you see at any time.

How long will my transplant last?

On average a kidney from a dead person (a cadaveric donor) will last 8 years. This does not mean that yours will last that long - some last a few weeks and others may last 20 years or more.

What are the risks from having a transplant?

  • There is the risk from having the operation, particularly if you have heart problems or lung problems.
  • There are risks due to having immunosuppression. Because immunosuppression suppresses your body's ability to fight infection you are more prone to infection, including some infections which you won't have heard of because they only affect immunosuppressed patients. Some of these infections can be life threatening, and occasionally people die as a result of infections after their transplant. This risk is high early after the transplant operation, but becomes less of a problem after a year as the amount of treatment you require gets less. The risk is also higher in the elderly patient who may not be strong enough to fight serious infections.
  • Lastly transplantation puts you at risk of certain sorts of cancer, in particular skin cancer and cancer of the lymph glands. The risk of skin cancer is higher if your skin has been exposed to the sun a lot (e.g. if you work outdoors) or to high intensity sun (e.g. if you have lived in the Tropics or Australia). These cancers can usually be cured by a small operation. Cancer of the lymph glands occurs in two in a hundred patients and is due to the immunosuppression. Its treatment often results in loss of the transplant, and some patients will die from it. Although cancers can be frightening, transplantation is often a better alternative than dialysis which may also cause life-threatening problems such as arterial disease. It is the opinion of most experts that the small risks of cancer are much less important than the longer life and better life quality that can be achieved with a kidney transplant.

How long will I have to wait?

The transplant waiting list is not a queue. Instead we try to match donor kidneys with our recipients because well-matched kidneys last longer than poorly matched kidneys, and are less likely to reject. This means that we don't need to give so much treatment in order to stop rejection, which means that you will suffer less side effects.

In order to give you the best chance of a good match we are part of a large network in the United Kingdom which matches kidneys, so potentially your kidney may come from Aberdeen or Penzance if that is where the best match is.

In the first year on the waiting list approximately 3 out of 10 new patients will receive a transplant. However, if you are not lucky in the first year it may be that you are difficult to match in which case you may have to wait several years. If you have had a previous transplant, a rare blood group, or previous blood transfusions it may take longer to find you a kidney. Be assured that we do our best to find kidneys for everyone on our waiting list as soon as we can.

What can I do to keep myself in the best shape for a transplant?

  • You should try to stay as fit as possible while you are on the waiting list.
  • You should go to the dentist regularly (every 6 months) so that any potential problem teeth can be treated, and any gum disease controlled.
  • Ladies should have a cervical smear at least once a year.
  • If you have a blood transfusion while on the waiting list you should let us know, or make sure that your doctors let us know. We will need a further sample of your blood two and four weeks after the transfusion for our tissue-typing laboratory.

 

Author: Mr Chris Watson, Consultant Transplant Surgeon at Addenbrooke's Hospital