Kidney transplant: Who’s eligible, how it’s done and after-care

If you are on dialysis and looking forward to undergoing a kidney transplant in the near future, it is important to familiarise yourself with what to expect. Kidney transplant is the most effective and best treatment option for patients with chronic kidney disease. When you get a transplant, a healthy kidney is placed inside your body to do the work your own kidneys can no longer do. The healthy kidney can come from someone who has died and chosen to donate —  a deceased donor — or from someone who has two healthy kidneys and chooses to donate one — living donor.

A successful kidney transplant can allow you to live longer and to live the kind of life you were living before you got kidney disease. Studies show that people with kidney transplants live longer than those who remain on dialysis.

Pre-emptive transplant v/s early transplant

Getting a transplant before you start dialysis is called a pre-emptive transplant. It allows you to avoid dialysis altogether. Getting a transplant not long after kidneys fail (but with some time on dialysis) is referred to as an early transplant. Both have benefits.

Research shows that a pre-emptive or early transplant, with little or no time spent on dialysis, can lead to better long-term health.

If your doctor has told you that your kidney disease is progressing or that you are in a later stage of the disease — Stage 3B, Stage 4, or Stage 5 — it could be a good time to talk about kidney transplant.

Who is eligible to receive a kidney transplant?

Although there is no fixed criteria for the age of a recipient, it is recommended for persons aged five to 65 years.

Who can donate a kidney?

In Kenya, the law only allows living related donors (blood relatives of the recipient up to the fourth degree of consanguinity —  being descended from the same ancestor).

Generally, donors should be between the age of 18 and 65 years and the recipient and donor must have either the same blood group or compatible groups. As with blood transfusions, a donor with blood group O is considered a universal donor.

What if I am older or have other health problems?

In many cases, people who are older or have other health conditions like diabetes can still have successful kidney transplants. Careful evaluation at a transplant centre is needed to understand and deal with any special risks. You may be asked to do some things that can lessen certain risks and improve the chances of a successful transplant. For example, you may be asked to lose weight or quit smoking. Only a transplant centre can decide if you are healthy enough to receive a kidney transplant.

How do I start the process of getting a kidney transplant?

Medical professionals will give you a complete physical exam, review your health records and order a series of tests and X-rays to learn about your overall health. Everything that can affect how well you can handle a transplant will be checked.

If someone you know would like to donate a kidney to you, they will also need to go through a screening evaluation to find out if they are healthy enough to donate.

What is involved in the transplant procedure?

The operation to place a donated kidney takes about four hours. The donated kidney is placed in the lower abdomen (belly), where it's easiest to connect it to the important blood vessels and bladder. You may be surprised to learn that your own kidneys generally aren't taken out when you get a transplant. The surgeon leaves them where they are unless there is a medical reason to remove them.

After surgery, you'll feel pain at first, but you should be out of bed in a day or so and go back home within a week. If the kidney came from a living donor, it should start to work quickly.

After surgery, you'll be taught about anti-rejection medications that you'll have to take and their side effects. You'll also learn about how your diet may change after the transplant. There are fewer restrictions on what you can eat and drink, which is one of the benefits of a transplant. You will want to eat a healthy diet and exercise to take good care of your body and your new kidney.

Is kidney transplant lifelong?

Although most transplants are successful and last for many years, how long they last can vary from one person to the next. Depending on your age, many people will need more than one kidney transplant during a lifetime.

What are anti-rejection medicines?

Normally, your body fights off anything that isn't part of itself, like germs and viruses. That system of protection is called the immune system. To stop your body from attacking or rejecting the donated kidney, you will have to take medicines to keep your immune system less active (called anti-rejection medicines or immunosuppressant medicines). You'll need to take them as long as your new kidney is working. Without them, your immune system would see the donated kidney as “foreign," and would attack and destroy it.

After transplant, what happens when I go home?

The most important work begins—the follow-up. For your transplant to be successful, you will have regular check-ups, especially during the first year. At first you may need blood tests several times a week, then once a week, then less often. As times passes, if you are doing well, you'll need fewer check-ups but enough to make sure that your kidney is working well and that you have the right amount of anti-rejection medication in your body.

How will a transplant affect my sex life? Can I still have children?

People who have not had satisfactory sexual relations due to kidney disease may notice an improvement as they begin to feel better. In addition, fertility (the ability to conceive and have children) tends to increase. Men who have had a kidney transplant have fathered healthy children, and women with kidney transplants have had successful pregnancies. Talk to your healthcare practitioner when considering to have a child. 

However, women should avoid becoming pregnant too soon after a transplant. At least you should wait for a year or more. All pregnancies should be planned together with your care team.

Certain medications can harm a developing baby, so they must be stopped at least six weeks before trying to get pregnant. Birth control or family planning counselling may be helpful.

It's important to protect yourself against sexually transmitted diseases .

Dr Joyce is a Consultant Nephrologist at Aga Khan University Hospital, Nairobi