Kidney Transplant

What is it?
Kidney transplant is a surgical procedure in which the damaged kidneys of a person are replaced with a functional kidney from a person who is alive or has recently died। Although a kidney transplant operation is a simpler procedure than most organ transplants, there are certain factors that are of paramount importance for the success of the procedure. To maintain the viability of the donor kidney, it has to be transported in a salt water solution and can only be preserved for a couple of days. During this time, the blood group of the donor and the recipient are matched.

Why is it done?

A kidney transplant operation is done when there is irreversible kidney failure and the patient is on dialysis। Chronic renal failure or CRF may be due to the following causes:

• Severe and uncontrollable high blood pressure
• Diabetes
• Polycystic kidney disease, when the kidney(s) are damaged due to presence of cysts
• Infection of the kidneys (pyelonephritis)
• Swelling of the filtering cells of the kidneys (glomerulonephritis).

When is the procedure NOT done?

A kidney transplant is not recommended in patients who have:

• Any disease of the heart, lung or liver
• Conditions like tuberculosis and osteomyelitis, which is an infection of the bones
• Recent history of cancer.

What happens during the procedure?

Before the operation, the patient’s blood and tissue typing is done। In all transplants there is a high risk of rejection by the recipient’s body, and therefore all patients need to be put on drugs like cyclosporin or steroids that depress the immune system।One kidney from a donor is removed under anaesthesia by making a cut in the abdomen। The kidney is removed with its blood vessels attached to it. The recipients abdomen is then opened and these blood vessels are then attached to the recipient’s blood vessels to ensure proper blood supply to the transplanted kidney. The tube that carries urine (ureter) is attached to the recipient’s bladder.

What happens after the procedure?

The donor’s urine for the first day after the surgery is drained by a catheter inside the urinary bladder। This is removed after the first day and the donor may be allowed to walk after 24 hours. No dietary modifications are needed and the patient can resume eating as soon as the anaesthesia wears off. The hospital stay is usually not more than 2-3 days.The recipient needs to stay in the hospital from 3-7 days depending on his condition. A bladder catheter is inserted which can be removed after a couple of days and the patient is generally able to eat and move about as soon as the anaesthesia wears off. The recipient is kept on medication to suppress any rejection reaction to the foreign kidney. Complete recovery usually takes a month.

What are the risks involved?

The risks in the surgical procedure are the same as they are in other kidney operations। There may be complications in the administration of anaesthesia। The patient may bleed during the surgery or may contract an infection. The biggest risk in a transplant operation is the risk of rejection of the foreign transplanted organ by the recipient’s body.

Are there any other complications?

Some of the complications of the procedure are:

• Infection happens in about 25% of the cases
• Major bleeding which may require blood transfusion
• Connections between the donor’s kidney and the recipient’s blood vessels that do not work properly
• Cancer which may develop in the cells of the kidney.

Long term care of the patient with a kidney transplant includes regular treatment with immunosuppressant drugs like prednisolone and cyclosporin। These may sometimes need to be given throughout life. However,kidney transplant is a better option than dialysis since it increases life expectancy. Donors can lead a normal life with one kidney and do not need to be on any special medication.

Bone marrow transplant

What is bone marrow transplant?

Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into a patient whose bone marrow is not functioning properly। Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer। This procedure can also be done to correct hereditary blood diseases। The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft)।

What is bone marrow?

Bone marrow is the soft, sponge-like material found inside bones। It contains immature cells called stem cells that produce blood cells. There are three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and tissues; and platelets, which enable the blood to clot.

Why is it done?

If a patient develops a disease of the blood cells, especially cancers such as leukaemia, he may require high doses of chemotherapy to destroy the cancer। However, this also destroys normal blood cells। Alternatively, hereditary or acquired disorders may cause abnormal blood cell production। In these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

What is the procedure?

Bone marrow transplant patients are usually treated in specialised centres and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding.Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing. Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow.Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone marrow (graft rejection).Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.

What are the indications?
Bone marrow transplant may be recommended for:

Bone marrow deficiency disease caused by:

• abnormal red blood cell production, such as thalassaemia or sickle cell disease
• aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or lymphoma
• lack of normal blood cell production (aplastic anaemia)
• Immune system disorders (immunodeficiency) such as: congenital neutropenia
• severe combined immunodeficiency syndrome

Bone marrow transplant is not recommended for:

• patients with heart, kidney, lungs, or liver disorders
• patients with other diseases that may limit survival

What are the risks?

The risks for any anaesthesia are:

• reactions to medications
• problems breathing

Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection as also bleeding.The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient) is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections.Other significant problems with a bone marrow transplant are those of all major organ transplants - finding a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient has, the more chances there are of finding a compatible donor.
What is the prognosis?
Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor. The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.