Kidney Transplant

• Under general anesthesia, the transplant surgery is being performed. The operation can range from 2 to 4 hours.  Since the kidney is placed in a different location than where it originally and naturally exist, this kind of procedure is called heterotypic transplant, unlike liver and heart transplant surgeries which are like orthotopic transplants involving the removal of the diseased organ and placing the transplanted organ in the same location.
• In kidney transplantation, the organ is placed in the anterior part in the pelvic region in the lower abdomen.
• Kidney transplant procedure involves a lot of preparation and testing prior to the day of the surgery. First of all, a kidney donor, whether living or deceased, is required to transplant. The compatibility of the patient’s body to that of the donor must be checked to bring down the chances of rejection as much as possible.
• Additionally, a number of medications are administered to keep the body from rejecting the newly transplanted organ. But the kidney transplant procedure does not necessarily require a genetically similar donor.
• Depending upon the current health status and the geographic location of the patient, the kidney transplantation time may vary from patient to patient. Those who are not able to find a living donor for transplant must register themselves for a cadaver donor, the waiting list for which may vary.

Pre-surgery Blood Tests

Whether the donor's kidney is from a living or a deceased donor, there are a few sets of special blood tests that are conducted to know the type of tissue and blood compatibility required for successful transplantation. The kidney transplant success rate depends hugely on compatibility with the donor.

Among the four kinds of blood groups, the donor and recipient should have the same blood group or compatible blood groups. The following combinations are allowed for kidney transplantation unless participating in any special program that allows blood type donations across groups.

 While AB recipient has the benefit of receiving from all the donor blood type groups, the O type recipient, on the other hand, finds it difficult to get donor since it can only receive from a donor with O blood group.

Tissue typing

In this test, the human leukocyte antigens (HLA) are checked in the blood. Antigens make each individual unique and are inherited from parents. During the evaluation check before kidney transplantation surgery, tissue typing is performed. It is considered as a perfect match when markers of donors and recipients match completely, which usually happens in case of siblings.

A crossmatch test is conducted to ensure that the recipient does not already have pre-formed antibodies in the body. If these antibodies treat the transplanted kidney as a foreign matter, it will try to destroy the kidney by treating it as an infection.

In several cases, a crossmatch is done before the transplant. At least 48 hours prior to the surgery, a final crossmatch is done.

Serology

Testing is also conducted for hepatitis, cytomegalovirus, or HIV in case of the donor. These viruses must be checked to protect the recipient against any infection from the donor.

The anti-rejection medication regime for the recipient is decided prior to the surgery. Tests are conducted on the recipient based on the cause of disease, gender, age and concomitant medical status. The tests may include coagulation studies, colonoscopy, blood count, pap smear and mammogram tests (applicable for women), prostate (for men), stress test, cardiac catheterization, pulmonary evaluation, spirometry, chest X-ray, electrocardiogram, and echocardiogram.

The kidney transplant surgery is performed under the influence of general anesthesia. The operation can range from two to four hours. Since the kidney is placed in a different location than where it naturally exists, this kind of procedure is called a heterotypic transplant.

Kidney Transplant vs Other Organ Transplants

This is unlike liver and heart transplant surgeries during which the organ is placed in the same location after removing the diseased organ. Thus, in the case of a kidney transplant, diseased kidneys are left in its original position.

During the kidney transplant procedure, an intravenous line is initiated in the hand or arm and catheters are connected to the wrist and neck to check the blood pressure, heart status and take samples of blood. Groin or region below the collarbone can also be used for insertion of catheters.

The hair is shaved off or cleared in the region of the surgical site and a urinary catheter is inserted into the bladder. The patient is positioned on the operating table lying on their back. After the administration of general anesthesia, a tube is positioned into the lungs through the mouth. This tube is attached to a ventilator so that the patient can breathe during the surgery.

Anesthesia and Kidney Donor

The anesthesiologist closely monitors the blood oxygen level, breathing, heart rate and blood pressure. The site of the incision is cleaned with an antiseptic solution. A long incision is made by the doctor on one side of the lower abdomen. The donor's kidney is visually inspected before implantation.

Now the donor's kidney is placed in the abdomen. Usually, the left donor kidney is implanted on the right side and vice versa. This leaves scope to connect ureters with the bladder. To the external iliac artery and vein, the renal artery and vein of the donor's kidney are sewn.

The donor ureter is then connected to the urinary bladder of the patient. With surgical staples and stitches, the incision is closed and a drain is positioned at the incision site to prevent swelling. Lastly, a sterile bandage or dressing is placed.

After the surgery, close monitoring of the functioning of transplanted kidney and signs of adjustment, rejection, infection, and immunosuppression is done. Almost 30 percent of the cases experience a few side effects related to organ rejection and it usually happens within a period of 6 months. In some cases, it can even happen years later. Quick treatment can negate and fight rejection in such cases.

Recovery post Kidney Transplant Procedure

Immunosuppressive agents that fight rejection prevent this from happening. These medications have advised to the transplant patients for their lifetime. The kidney transplant success rate is challenged if these medications are stopped. A combination of drugs is usually recommended

It takes around two to three days for the recipient to be discharged from the hospital after the surgery. The patient is encouraged to take small steps and start walking and moving a bit. Kidney transplant recovery period lasts for around two to three weeks of the surgery, after which the patient may return back to normal life.

Pros and Cons of Kidney transplant

Pros

• It improves life and is better than most other alternatives
• Little restriction on diet
• Mostly covered by insurance

Cons

• Rejection of the transplanted kidney
• Medications have to be followed religiously
• Medications may have side effects

Cost of Kidney Transplant in India

Cost of kidney transplant operation in India is quite cheap as compared to the Western countries and other popular medical tourism destinations. Kidney transplant cost in India differs from hospital to hospital and city to city.

Some of the additional factors that decide the total cost of a kidney transplant in India include the following:

• The fees of the kidney transplant surgeons
• The number of kidney transplant specialists and other surgeons conducting the procedure
• The number and type of compatibility tests conducted
• The need to conduct any side procedures
• Total duration of hospital stay
• Number of days spent in the ICU
• Cost of dialysis (if needed before surgery) and post-surgery visits

The following table highlights the approximate cost of kidney transplant operation in India and a few other popular medical tourism destinations: