MEDICINE FOR ALL

WHAT HAPPENS DURING A KIDNEY TRANSPLANT?

After surgery

A physiotherapist may assist you with an exercise plan. You will probably be able to sit out of bed on the first day after your surgery. You should be able to go for a walk within a couple of days.

Reducing the risk of an infection is very important. For this reason, you may be looked after in a separate room or ward of the hospital, your visitor numbers may be limited,  and you may not be allowed to receive flowers from visitors.

The length of time that you will need to stay in hospital after the transplant surgery will depend on how well your body responds to the new kidney and wether you have any complications. Most people are in hospital between six and ten days. You may feel better immediately after your surgery or you may take longer to adjust.

WHAT HAPPENS DURING A KIDNEY TRANSPLANT?

After surgery

After the transplant surgery it is normal to feel some pain around your wound. You will be given medications to help with this.

Your transplanted kidney may start to make urine immediately, or you may need dialysis for a few days. If you need dialysis it does not mean that your transplanted kidney will not work. It just may need a bit of time to recover from the transplant procedure.

A catheter will be placed in your bladder for around five days to drain your urine into a bag. This helps your health care team to check that your kidney is working well. Often there are tubes from your wound draining away extra fluid. These are usually removed after a few days.

You will have blood tests every day to check the function of your transplanted kidney, to measure medication levels and to detect any problems early so they can be treated quickly.

The blood test for creatinine and eGFR measure how well your kidney is working. These may already be familiar to you. In many cases your creatinine and eGFR will go back to what they were before you first got kidney disease.

The amount of fluid you take in is important.The nurses may be asking you regularly how much you have had to drink, If your kidney is working you may find yourself having to drink lots of fluid.

WHAT HAPPENS DURING A KIDNEY TRANSPLANT?

During surgery

Surgery for a kidney transplant takes about two to three hours. A cut is made in your lower abdomen, on the right or left side. The new kidney is placed in your pelvis. The renal artery and vein of the tranplant kidney are connected to an artery and vein in your pelvis (usually the illiac artery and vein that lead down towards the leg). The ureter of the transplanted kidney is connected to your bladder so urine can flow.

Many people are surprised to learn that their own failed kidneys are not removed. They are left in your body to continue to provide whatever amount of function they may still have. Sometimes it may be necessary to remove your failed kidneys if they are very large (if you have polycystic kidney disease) or in the case of chronic infection. If this is needed, your failed kidneys will be removed in a separate surgical procedure before your transplant surgery.

WHAT HAPPENS DURING A KIDNEY TRANSPLANT?

Before surgery

You will admitted to the hospital where the transplant surgery will take place. You will have a physical examination, and you may need to have a dialysis session. If you have any active infections or other significant medical problems the transplant surgery may need to be cancelled.

You will be given anti-rejection medications before and after the surgery to control your immune system and stop your body from rejecting the new kidney.

Cross match

In the cross match test, your blood cells are added to blood cells taken from the donor. A positive reaction means that there is a high likelihood of severe rejection of the donor kidney. In the case of a deceased donor, the transplant will not go ahead if there is a positive cross match.

HLA proteins and cytotoxic antibodies

You have a combination of A,B and DR HLA proteins inherited from your parents. When you are exposed to other HLA proteins your immune  systems attacks them. Your body  then develops antibodies against these HLA proteins. If you have already have antibodies against a donor cell HLA protein then your body may attack those donor cells and reject the donor kidney.

When you are tissue typed, a blood test is taken to determine your HLA proteins and cytotoxic antibodies. This is usually one of the first  steps in your transplant work-up. Your HLA proteins and cytotoxic antibodies can also change overtime, so these test will be repeated every one to two months.

You will share some HLA proteins with other people and the more you share the more likely your body is to accept their kidney. How similar your tissue typing is with someone else’s refers your “HLA-match”. This is usually given as a number out of six as there were six groups of protein identified many years ago that were found to be important.

For many people, HLA-matching is less important than it was a few decades ago. This is because the anti-rejection medications have improved. We also understand more about tissue typing than we used to, and this has led to longer survival of transplanted kidney.

DONOR AND RECIPIENT MATCHING

Tissue type matching

Your immune system is designed to keep you safe from foreign invaders such as viruses and bacteria. Everyone has special proteins on their cells called HLA proteins. Your combination is unique to you and is recognised by your immune system so it will not attack your own cells.

Your immune system will recognise a combination of foreign proteins not belonging to you and will attack them. It will then develop cytotoxic antibodies against these HLA proteins. This is how your immune system defends your body against infections. This is also the underlying cause of your body rejecting a transplant and the reason you need to take anti-rejection medications.

Cytotoxic antibodies are called donor specific antibodies if they are shown to be against your potential donor’s HLA proteins. These can make it hard for you to be compatible with other donors. These antibodies may have developed because you have  previously been exposed to other people’s HLA proteins through a blood transfusion, through pregnancy, or from a previous transplant. Sometimes there is no clear reason found for the presence of these HLA-antibodies.

Your immune system remembers this exposure and is ready to attack cells with similar HLA-proteins on them. The cross match test also checks for this.