Having a kidney transplant is often the last ditch effort to save the life of an individual whose kidneys have failed and no longer process waste products in the body. Statistics reveal that a total of about 9,000 kidney transplants occur every year from cadavers and about 3,000 transplants occur from living related donors. Living unrelated donors account for 9,000 transplants per year. Sadly, there are more than 56,000 individuals waiting for kidney transplants at any given period of time.
The first successful kidney transplant was done in 1954 in both Boston and Paris. These were kidney transplants done between identical twins which don’t have problems with rejection. The biggest problem was tissue typing–finding a suitable match for the recipient and making sure that rejection is kept to a minimum. This is why many donors are relatives who are a good match or living donors who are a good tissue typing match for the recipient.
Living donors are carefully evaluated to make sure they are medically and psychologically able to donate their kidneys for kidney transplant. The living donor transplant used to be done via an open procedure but it is now increasingly done through laparoscopic surgery, which is easier to tolerate. Kidneys from living donors have a better success rate than do kidneys from deceased donors.
Kidney transplant from deceased donors can come from those whose hearts are still beating but are brain dead, as well as from non-heartbeating donors. The kidney can survive on ice for several hours before transplant so that technically, a person can be deceased and still donate their kidneys. The kidney is then kept in a cold solution prior to donation. The best organs for kidney transplant come from the brain dead donors.
Doctors judge compatibility for kidney transplant by assessing the ABO blood type of the donor and recipient as well as the HLA and minor antigens. If many of these match, the risk of rejecting the transplant and further dialysis is much decreased. In addition, immunosuppressants are used to keep the immune system in check. In the US, only about 17% of transplants have no HLA mismatch whatsoever. This improves the success rate remarkably.
Because kidneys can be kept cold for several hours, the kidney transplant is usually done in a different place from where it was harvested. In addition, the kidney is also placed in a different place from where a normal kidney would be. The most common spot for kidney transplant is the iliac fossa in the lower abdomen. The blood supply must come from somewhere other than the renal artery.
In situations where the kidney transplant recipient is a diabetic, the pancreas is also sometimes transplanted at the same time in order to turn around some of the diabetes the individual has. This almost always requires a deceased donor although partial pancreas transplants in living donors has been done. The patient can also receive a kidney transplant first, followed by a pancreas transplant at a later date.
