MedifocusHealth

Kidney transplants generally offer the best outlook for patients with end-stage renal disease. Most centers have patient and organ survivals of over 90% at one year, and more than 80% at three years. By 10 to 15 years, about 50% of transplanted kidneys are still functional. Kidneys from living related donors do better than from deceased donors.

Patients with chronic kidney disease usually receive dialysis therapy until a donor becomes available. Because of a shortage of donors, the person awaiting transplant may be on a transplant list for months or years. It is often necessary to carry a pager or cellular phone at all times so that the transplant team can contact you if a donor kidney becomes available.

The surgery takes anywhere from 3-6 hours to perform. The transplanted kidney may start producing urine immediately or within a short time. The recipient usually remains in the hospital for 1-2 weeks.

The donated kidney may be from a:

• Living related donor - genetically related to the recipient, such as a parent, sibling, or child
• Living unrelated donor - like a friend or spouse
• Deceased donor - a recently deceased individual who has no known chronic kidney disease

A kidney transplant may NOT be recommended for patients who have:

• Other medical conditions such as heart, lung, or liver disease
• Other life-threatening diseases such as cancer
• Certain infections, such as tuberculosis or osteomyelitis (infection in the bone)
• Difficulty taking medications several times each day for the rest of their lives
• Autoimmune disease
• Age extreme (very young or very old)
• Prior failed transplant
• Pregnancy
• Conditions that will likely result in a recurrence of kidney failure in the new kidney

Risks of kidney transplantation may include:

• Reactions to medications
• Problems breathing
• Bleeding
• Infection
• Rejection of the new kidney
• Leakage from the ureter (tube that leads from the kidney to the bladder)
• Blood clot in the bladder or vein connected to the kidney
• Damage to blood vessels or nerves
• Urinary obstruction
• Kidney stones
• Infection or cancer due to the immunosuppressive medications that must be taken to prevent transplant rejections

Immunosuppression

The immune system of the kidney recipient will respond to the transplanted kidney as a foreign organ and will try to destroy it (rejection). In order to prevent rejection, most kidney transplant recipients require life-long treatment with medications that suppress their immune response (immunosuppressive therapy). Because the immune system is suppressed, there is a higher risk of infection, cancer and liver disease (if you have hepatitis B or C).

The immunosuppressive medicines themselves also have side effects, which may include high blood pressure and high cholesterol, and increased risk of diabetes.

Common post-transplant medications include:

• Cyclosporines (Neoral, Gengraf, Sandimmune)
• Tacrolimus (Prograf, FK506)
• Mycophenolate mofetil (CellCept)
• Prednisone
• Azathioprine (Imuran)
• Sirolimus (Rapamune)
• Daclizumab and Basiliximab (Zenapax and Simulect)
• OKT3 (a monoclonal antibody)
• Anti-Fungal Medications (Mycelex Troche, Nystatin Swish and Swallow, and Diflucan)
• Antiviral Medications [Zovirax (acyclovir), Cytovene (ganciclovir), and Valcyte (valganciclovir)]
• Diuretics [Lasix (furosemide)]
• Antibiotics (Bactrim (septra)]
• Anti-Ulcer Medications [Prilosec (omeprazole), Prevacid (lansoprazole), Zantac (ranitidine), Axid (nizatidine), Carafate (sucralfate), Pepcid)]