FAQ : Renal Transplant
For more enquiries on Renal Transplantation or to make an appointment, please call
The Transplant Coordinator at ILBS on 46300000 extension 7053.
What are the different sources of kidneys?
Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys, in India, come from living donors; however, the utilization of deceased donors in India is on the rise. Living donation in India is governed by Transplant of Human Organ Act (THOA), which came into existence in 1994 with revisions done from time to time. At present; parents, children, spouses between 18-65 years of age are eligible to donate if they are found to be medically fit. The law also allows donations from grandparents, grand children and near relatives if there is no eligible donor in immediate family. All recipient-donor pairs are to be approved by appropriate authorization committees before transplant is done. Majority of donations are from same blood group, but now-a-days transplants across the blood groups are also possible. However, the risks of rejections are high in such transplants and also the there is stronger immnuo-suppressive requirements and cost involved.
What is the procedure involved in Renal Transplant?
The donor and recipient surgeries are almost done simultaneously in living donor transplants. Each surgery takes 3-4 hours. Majority of surgeons, now-a-days, remove kidneys from donor in a minimally-invasive way using the “key-hole technique”. In this technique, the kidney is mobilised through small 5 and 10mm incisions and then removed through an incision in supra-pubic area. This incision is barely visible and usually gets hidden in the pubic hairs. The donor usually gets discharged in 3-4 days and can resume his normal routine work by the end of one week.
This is the photo of one our donors exactly seven days after surgery. At ILBS, we remove all kidneys by this “key-hole” method.
In recipients, the barely functioning existing kidneys are not removed, as this has been shown to increase the rates of surgical morbidities. However, there are certain indications where in native kidneys are required to be removed prior to transplant. The kidney is usually placed in a location different from the original kidney, often in lower abdomen, the iliac fossa, so it is often necessary to use a different blood supply:
- The renal artery of the kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac or internal iliac artery in the recipient.
- The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.
When this is complete, blood will be allowed to flow through the kidney again. The final step is connecting the urine pipe (ureter) from the donor kidney to the bladder. In most cases, the kidney will soon start producing urine. Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3–5 days to reach normal functioning levels, while cadaveric donations stretch that interval to 7–15 days. Hospital stay is typically for 8-10 days
Immunosuppressant drugs are used to suppress the immune system from rejecting the donor kidney. These medicines are usually started 1-2 days prior to transplant and must be taken for the rest of the recipient's life. The most common medication regimen today is a mixture of tacrolimus, mycophenolate, and prednisone.
Some strong immune-suppressive injections are given during and immediately after surgery. These injections have been shown to result in decrease in acute rejection episodes and better graft survival.
Kidney transplantation is a life-extending procedure. The typical patient will live 10 to 15 years longer with a kidney transplant than if kept on dialysis. People generally have more energy, a less restricted diet, and fewer complications with a kidney transplant than if they stay on conventional dialysis.
Acute rejection occurs in 10–25% of people after transplant during the first 60 days. Rejection does not necessarily mean loss of the organ, but it may necessitate additional treatment and medication adjustments.
What will be various measures of Post Transplantation Care?
You will receive detailed discharge instructions specific to you, from your nurse and physicians before leaving the hospital. We have included some general recommendations here.
- Follow-up Visits
For the first 3-4 months after the transplant you will be seen in clinic once or twice a week, and return to the lab for blood tests more frequently and possibly be temporarily readmitted (this can happen in up to 50% of patients in the first 6 months). It is your responsibility to ensure that you can get back and forth from the hospital when needed. It is very important to let all of your other doctors and your dentist know that you have had a kidney transplant.
- Monitoring Your Kidney
It is important to check your blood pressure, and follow your fluid intake and urine output and weight. We encourage kidney transplant recipients to take an active role in monitoring their kidney function.
It is important to make sure you drink enough fluids after you leave the hospital. 3.5 – 4 L per day is appropriate. It is normal to have a slightly decreased appetite after major surgery. Take it easy and eat what feels right. If your kidney function is normal, you have no dietary restrictions.
- Avoid alcohol
Excessive alcohol drinking can lead to liver problems and dehydration that can hurt your transplanted kidney.
- Do NOT smoke
Smoking can shorten your life and the life of your transplanted kidney.
- Weight Gain
Weight gain is common after kidney transplantation because, aside from the fact that you may feel better, and food will taste better, your anti-rejection drugs may increase your appetite. Always ask to see a dietician if you are at all in doubt about how and what you should be eating. The key to avoiding weight gain is watching what you eat, and exercising regularly. It is also important to adopt healthy eating habits, and avoid nibbling in front of the television, or eating out of habit.
- Follow-up Visits
What are the various tips to avoid Weight Gain Post Transplant?
- Drink plenty of water : We often mistake thirst for hunger. Drink a full cup of water before meals. It makes you feel more full and is good for the kidney
- Eat 3 regular meals : Have a larger breakfast and smaller lunch and dinner
- Eat slowly : To allow brain to register that you are full! Spend 20-30 minutes on each meal
- Choose a regular place to eat and sit down
- Have 1-2 small snacks in the mid morning and afternoon : Examples of healthy snacks: Fruit ; Salads; Unsalted nuts; Curd
What is the way to eat right food?
If you eat the right food, you don’t have to feel hungry.
- Choose carbohydrates that are less refined.
Unrefined carbohydrates come from plant foods in their natural form, for example, fruits, vegetables, grains, and beans. Whole grain and cereals are good sources of unrefined carbohydrates. These foods are filling and take a longer time to digest. As a rule, fresh fruit and vegetables are very healthy. Eat at least 5 servings/day. It is better to eat fresh fruit than to drink juice, because it contains fiber. Remember that potassium restriction is not required with a functioning kidney. You can now eat bananas!
- Sugary foods can cause high blood Sugar.
Eating sugary foods (sugar, candy, soft drinks, honey, jelly) and refined carbohydrates (Pizza, white bread, white rice) makes your pancreas work hard to produce insulin. All transplant patients have a tendency to develop diabetes (because diabetes is a possible side effect of immunosuppressive medications).
- Don’t make meat, poultry or fish the main dish
Eat meat products in moderation, and make vegetable dishes Trim all fat from meat and remove skin from chicken. However, we do encourage you to have 1-2 servings of fish per week Keep your salt intake low if you have high blood pressure or fluid retention (swollen ankles)
- Choose carbohydrates that are less refined.
What level of Activities and Physical Exercise be done Post Transplant?
After a few days in hospital, most people feel more tired than they expect to when they get home. Many times, whether or not you are up to a particular activity will depend upon whether or not you are back to a regular well balanced diet and good sleep pattern. Once you are at home, start out by doing just those activities you know you could do while in hospital. Think about adding one new activity at a time and make sure you are well rested when you begin. Plan on taking pain medicine, if needed, half an hour before trying a new activity. Avoid doing exercises that strain your abdominal incision (eg. Crunches, heavy lifting) until checking with your doctor. Start by spending 10-15 minutes on the new activity to see how you feel. Begin slowly and pace yourself. If you feel tired, you can slow down or stop and plan to try a little later. Doing a little at a time will help you to build your strength and endurance. Frequent rest periods will help you to stay active during recovery from any illness. If you feel short of breath or have chest pain, you should check with your doctor immediately. The following includes common daily activities listed by how much work or energy they require. Activities at the top take the least energy. These recommendations are based on our general collective experience and common sense. We encourage you to discuss each item below with your nurses and doctors to get the most appropriate information specific for you.
Activity When to Resume Walking/Exercising Check with your doctor before doing strenuous exercise like jogging, aerobics, weightlifting and tennis.
Avoid exercise if you experience pain in your joints, have chest pain, have a fever or you are a diabetic and your glucose is over 300 or less than 70 mg/dL. Talk to your doctor about these things.
Drink plenty of fluids when exercising.
After discussion with your doctors.
Before you travel, check with your transplant team – certain destinations will require special precautions such as: vaccinations or antibiotics.
Locate the nearest transplant center at your destination, BEFORE you travel.
Take along enough of your medications for your entire trip (include extra doses just in case) and keep them with you at all times (NOT in checked baggage).
Back to Work After discussion with your doctors. Taking a Shower Immediately, but allow the water to run over your incision. Avoid having the water hit it directly. Dry the incision completely by gently patting instead of rubbing. Sexual Activity When you feel comfortable or as instructed by your doctor. There is no reason why you should refrain from sexual activity unless you or your partner is sick or has a vaginal infection. If either you or your partner has an infection, both of you should seek treatment prior to intercourse. Driving Not until you have stopped taking pain medication. Lifting With an abdominal incision, avoid lifting more than 5 kg (about the weight of a bag of groceries) for 6 weeks to allow your inner tissues and muscles time to regain their usual strength.
What is the way to eat right food?
If you experience any of the following symptoms when you go home, please call the transplant centre/team
- Temperature >100.5F
- Chest pain, shortness of breath, rapid heart beat
- Signs of infection (redness, swelling, increase pain, pus)
- Nausea and vomiting and unable to keep medicines down
- Draining wound
- Easy Bruising
- Increased pain despite pain medications
- Blood in your stool or urine
- Rapid weight loss or gain
- Black tarry stools
- Leg or calf swelling, tenderness or redness
- Sudden weakness or numbness on one side of the body or the face.
- Sudden change in vision
- Difficulty talking
- Sudden severe headache
Please use this list to help you think about the things you will need before you leave the hospital. We will do everything we can to help you prepare for your discharge, BUT it is also your responsibility to make sure you have all your questions answered before you leave.