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Kidney Transplant (3)


How are patients selected for cadaveric renal transplant?

Patients are selected on the basis of their tissue typing results. The best matched patients are the ones who will receive the kidneys provided they are medically fit.


What happens to the patient (recipient) after the operation?

After the operation, the patient is kept under intensive care. All the urine collected is measured and carefully charted to keep a record of his progress. Usually the transplanted kidney can function only after a few days or sometimes up to two weeks. A few may not work at all. During this period, the blood urea, creatinine and blood electrolytes are measured everyday. If there is poor urine production by the trans- planted kidney, the blood tests will still be abnormal and the patient will still require dialysis until the kidney can function properly.

The patient will need to be given anti-rejection medicine daily to prevent his body from rejecting the transplant. They are prednisolone, azathioprine and cyclosporin A.

Sometimes there may be problems such as obstruction or leakage of urine from the ureter of the transplant kidney. Special X-rays will have to be performed to determine the cause and site of the obstruction or urinary leakage and if necessary, the transplant surgeon will be called in to explore the kidney with a view of repairing the leakage or removing the obstruction.

What are the drugs patients have to take after a kidney transplant operation?

During and after the transplant operation, the patient has to take his transplant medication faithfully to prevent the kidney from being rejected. The medication consists of prednisolone, azathioprine and cyclosporin A. These drugs may predispose the patient to infection.


What are the main side-effects of azathioprine?

Apart from a predisposition to infection, the main side-effect of azathioprine is depression of the bone marrow, which results in a drop in the white cell count. When this happens the dosage of the drug is reduced for a few days. Occasionally the liver is affected and jaundice appears.


What are the side-effects of prednisolone?

Patients who are on prednisolone gain weight and may become obese. They may also develop high blood pressure, diabetes mellitus, ulcers in the stomach and a condition which causes pain in the hip bone called avascular necrosis. The pain can be relieved by pain relievers but if it gets worse, an operation will have to be performed to replace the hip with a metal one.


What is cyclosporin A?

Cyclosporin A is the most recent addition to the drugs used to prevent transplant rejection and though expensive, is increasingly being used in most countries because of the tremendous boost it confers on long term kidney transplant survival. In Europe, its use has contributed to an overall 20% increase in cadaver kidney survival rate within the first year, compared to patients on azathioprine and prednisolone. Among some of its disadvantages, apart from the prohibitive cost, are its 'toxicity to the kidney when too high a dose is given. Other side-effects of Cyclosporin A are increased hair growth ( hirsutism ), swollen gums, inflammation of the liver ( hepatitis ) but the worst, as mentioned earlier, is nephrotoxicity or toxicity to the kidneys which can cause kidney damage. Next >>>


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