What to expect in kidney transplant

If you are on dialysis and looking forward to undergoing a kidney transplant in the near future, it is important to familiarize 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 kidney 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, called a deceased donor, or from someone who has two healthy kidneys and chooses to donate one, called a living donor.

A successful kidney transplant may allow you to live longer and to live the kind of life you were living before you got kidney disease. For many patients, there are fewer limits on what you can eat and drink, though you should follow a heart healthy diet and maintain a healthy weight to help your new kidney last. Your health and energy should also improve. Studies show that people with kidney live longer than those who remain on dialysis.

Pre-emptive Transplant v/s Early Transplant

Getting a transplant before you need to start dialysis is called a preemptive 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.

Some research shows that a pre-emptive or early transplant, with little or no time spent on dialysis, can lead to better long-term health. It may also allow you to keep working, save time and money, and have a better quality of life.

If your doctor has told you that your kidney disease is progressing or that you are in a later stage of kidney disease, called 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 kidney transplant recipient, it is usually recommended for persons from five to 65 years of age.

Who can donate a kidney?

In Kenya, the law only allows one source of kidneys for transplantation. These are living related donors (blood relatives of the recipient up to the fourth degree of consanguinity).

Generally, donors should be between the ages 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'm 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 center 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 center can decide if you are healthy enough to receive a kidney transplant.

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

Your healthcare team will need to know a lot about you to help them decide if a transplant is right for you. 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, that person will also need to go through a screening evaluation to find out if he or she is 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 into your lower abdomen (belly), where it's easiest to connect it to your 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 be sore at first, but you should be out of bed in a day or so, and home from the hospital within a week. If the kidney came from a living donor, it should start to work very 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 transplant. If you've been on dialysis, you'll find that 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 your 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?

Once you are home from the hospital, the most important work begins—the follow-up. For your transplant to be successful, you will have regular checkups, 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 checkups, 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 counseling may be helpful.

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

By Dr Joyce Bwombengi, Consultant Nephrologist at Aga Khan University Hospital, Nairobi

This article was first published in Daily Nation on October 31, 2023