Kidney transplants are a now familiar procedure. Individuals with kidney failure, often ESRD (end-stage renal disease), endure dialysis until a kidney becomes available. But what is involved in a transplant and what are some of the risks?
Kidney failure is defined roughly as a 10% reduction in renal function. That figure combines a number of dimensions, since the kidney itself performs a number of tasks. It regulates fluid level, electrolyte concentrations, influences blood pressure, and other vital activities. When their ability to do that fall outside an acceptable range, treatment is called for. When or if those fail or are not desirable, transplant is the next stage.
But there are several risks associated with kidney transplant, even apart from the normal ones that come with any serious surgical procedure. Bleeding during or after surgery is possible. Infection (though there are excellent drugs available) is still a common worry. Heart attack and stroke, though rare, are far from unknown.
Blood vessels in the kidney can clot or narrow, post surgery. That raises blood pressure and (in extreme cases) can lead to tissue death or even organ failure. Urine may leak into the body from a malfunctioning urinary tract. Or, clots may form in the ureters or bladder following a kidney transplant.
But, without doubt, the major ongoing risk is organ rejection.
The body’s immune system is ‘keyed’ to recognize foreign objects. That is how it can attack invading bacteria without harming surrounding native cells. When a kidney is transplanted, the body sees the organ’s cells as a foreign substance. In the absence of immuno-suppresive drugs, the immune system attacks the organ.
That risk can be lowered by using a donor organ from a close relative, because they are a relatively close genetic match, prompting a much less extreme immune system reaction. A living donor who is unrelated represents the next best choice. A viable option, but the least attractive from a rejection perspective, involves a donor organ from a recently deceased person.
Immuno-suppresant drugs are used to address the problem in each case.
There are actually two classes of drugs, corresponding to the two types of potential rejection: acute or chronic. Acute rejection would occur within the first few weeks after surgery and immuno-suppressants generally do a very good job of dealing with this. Chronic rejection occurs over a longer period, often despite the drugs and involves a slow, progressive level of kidney function.
Unfortunately, those immuno-suppressive drugs (required even in the best cases) themselves carry risks, both short term and long term. They can substantially increase the odds of diabetes, a disease which can be either cause or consequence of kidney disease. They can increase the odds of heart attack.
Some signs that the drugs are no longer working include fever, soreness in the kidney area (after the pain of surgery itself has subsided), or significant changes in urine production.
Only your physician (usually in conjunction with a specialist) can advise you properly on the full range of risks and benefits, and treatment options for kidney disease. But knowing some of the more common risks can help prepare you for that conversation.