Performing renal transplantation is a team effort. Transplant centers need to develop a network of specialists, such as a psychologist, psychiatrist, urologist, gastroenterologist, cardiologist, infectious diseases, and other specialists who become familiar with the transplant evaluation process.
The common causes of end-stage kidney disease include:
- Uncontrolled high blood pressure
- Chronic glomerulonephritis (inflammation of renal parenchyma)
- Polycystic kidney disease.
Regular kidney dialysis is a short-term solution to kidney failure: the blood is artificially filtered through a machine or by diverting the bloodstream through another permeable membrane in the body itself. The ideal treatment for total kidney failure is kidney transplantation.
Kidneys come from live related donors, brain dead or recently deceased donors and are implanted in the right or left iliac fossa. The renal artery is sutured to the external or internal iliac artery and the renal vein to the external iliac vein, and the ureter is implanted in the bladder wall. The immune system attacks foreign material, including transplanted organs. Humans have many polymorphic genes which cause differences between individuals, identifying transplant as foreign.
Following the transplant, you will need to remain on transplant medicines like Steroids, Tacrolimus, Mycophenolate mofetil, etc. for the rest of your life. If you ever stop taking the transplant medicines, you will lose your transplant kidney through rejection.
Dr. R.H. Lawler performed the first homo-transplantation of kidney in 1950 at Harvard Medical University, US. In India, the first kidney transplant was done in 1971 at CMC, Vellore (Tamil Nadu) on Mr. Shanmugham. The living kidney transplantation program in India has evolved in the past 45 years and is currently the second largest program in numbers after the USA.
Presently, approximately 3,200 renal transplants are done in India every year, a majority of which are living donor transplants. Barely 5% of all renal transplants come from cadaveric organ donors. A kidney transplant costs about US$ 6000, with a lifetime monthly postoperative care costing approximately US$ 250.
In the book “The story of the first kidney transplant in Guyana, South America”, the minister Ramsammy mentions that foreigners travelling to India may become victims of fraud. In Toronto, a refugee who paid for a transplant in India ended up in Zaltzman’s office with poor kidney function. Despite a 6-inch scar on his abdomen, an ultrasound revealed there was no transplanted kidney and he was the victim of a con. Probably, more such cases of fraud may have gone unreported. He also mentions that there is no quality control outside of major hospitals. You can find a good kidney hospital in Delhi.
However, a kidney transplant does not last forever. Overall, average kidney survival times are:
- 1 year – about 95%
- 5 years – about 85-90%
- 10 years – about 75%
Risk of mortality during kidney transplantation is around 3%.Infection, cardiovascular disease and cancer are the feared complications following the procedure of kidney transplantation.