Chronic Kidney Disease stage 5 (or irreversible kidney failure requiring dialysis) is a life-threatening problem. The options before a patient are life-long dialysis (hemodialysis or peritoneal dialysis). While dialysis is a lifesaving option, it entails undergoing hemodialysis three times a week for 4 hours each time. Even with the best dialysis the patient's creatinine stays at around 5 – 10 mg/dl, which means the patient is never free of toxins. Dialysis is thus capable of replacing lost kidney function by only about 25%. This means there is continuing damage to the vital organs and the blood vessels. Almost 50 percent patients on dialysis die in three years and about 90 percent in five years. If a 100 patients undergo transplant today, 85 of them would be alive 10 years and beyond. Added to this, the high chance of HCV+ infection, which is not easily curable, and the loss of a job (patient comes to hospital three times a week!), dialysis paints a dismal picture.
The definitive treatment for chronic kidney failure is Kidney Transplantation. Transplantation treats and normalizes all the biochemical, hemodynamic and metabolic abnormalities of kidney failure. A transplanted individual's creatinine becomes normal (around 1mg/dl) and replaces lost kidney function by 80 – 100%. Transplantation bestows full functionality to the patient, who can now work, play and even procreate. After 10 years of transplantation, more than 85% of patients are alive and well. Thus transplantation is the best option for chronic kidney failure.
Only one donated kidney is needed to replace two failed kidneys. The donor kidney is usually placed in the groin of the patient and connections are made between the graft and patient's arteries, veins and the ureter is connected to the bladder. The diseased kidneys are not removed in the majority and so the patient now will have 3 kidneys though only one is functional. For a transplant to succeed, two factors are desirable, although they were earlier thought to be absolutely essential. Blood group compatibility between recipient and donor was (for compatible blood groups click here) hitherto considered a must, but is now not a barrier anymore. Likewise, the recipient must not exhibit any antibodies against the donor tissue, termed a positive cross-match. Even though this is not a contraindication anymore, it definitely carries more risk.
Kidney transplants are of two types. Live (from 1st or 2nd degree relatives) or cadaver (brain-dead donors). Donation from unrelated or commercial donation is not acceptable and is illegal. You cannot buy a kidney. 1st degree relatives are parents, siblings, children and spouse. 2nd degree relatives are uncle, aunts, cousins, in-laws etc where the relationship can be proven by tissue-matching, DNA finger-printing or other means.
Transplantation of an organ from a different individual incites immunological attack from the recipient, which is termed as rejection. Transplantation is possible only because of medications called Immunosuppressants. These medications work by reducing the immunological resistance of the recipient and prevent rejection. These medicines are to be taken life-long. The type of immunosuppression depends on the matching between recipient and donor.
Kidney transplantation involves the donation of a single kidney from a donor. The donor is a medically normal individual, is expected to live a fully normal life after donation and will have no problems. Donors have to be aged above 18 years and preferably below 60 years and should have no medical disorders that can affect the remaining normal functioning kidney later on. So those with diabetes, kidney stones, cardiac disorders, cancers are not accepted as donors. Donors are allowed to donate only after a thorough counseling and medical check-up including kidney function tests. After donation, the donor's kidney function does not decrease and remains the same as prior to donation due to the immense reserve capacity of the kidneys. After donation the donor can continue to work, play and live as before.
Transplantation is a modern medical miracle, which is saving countless number of lives and bestows a great quality of life. For patients with Chronic Kidney Disease stage 5 the first option is to get a transplant. Those who cannot undergo a transplant are condemned to stay on dialysis. The question is not whether transplantation will succeed. Transplants have a success rate 95 – 98% in the modern era. It is dialysis which has a high rate of failure from which there is no return.
