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Kidney Transplant (4)

 

What are the complications of kidney transplant?

Early complications are acute rejection, urinary leaks, infections, stomach ulcers and wound infection. Late complications include chronic rejection, pain in the hip ( avascular necrosis ), obstruction to the blood vessels of the kidney, cancer, infections and recurrence of kidney disease in the transplanted kidney which in some cases can lead to kidney failure again.

 

What is rejection?

Rejection is the process whereby the body of the transplant patient tries to get rid of the transplanted kidney. In the first 6 months, about 30% of cadaver kidneys are rejected, and 10 to 15% in related donor kidneys. The newer drug cyclosporin A has reduced this by 10 to 20%.

 

How many types of rejection are there and what happens during rejection?

There are 2 types of rejection, acute and chronic. Acute rejection usually occurs during the first 6 to 9 months after transplant. In the rejection process, a particular group of white blood cells called the lymphocytes attack the transplanted kidney. At the same time other lymphocytes produce antibodies which injure the transplanted kidney. As a result of these attacks, the kidney is damaged and does not function normally.

Chronic rejection occurs from about 3 to 6 months after the transplant. It is due to the production of antibodies by lymphocytes which attack the blood vessels within the transplanted kidney. This leads to decreased blood flow to the kidney, causing a gradual decrease in kidney function.

How is rejection diagnosed?

Early rejection is usually diagnosed by a raised serum creatinine level. Sometimes a rejection is accompanied by swelling and pain over the transplanted kidney. The patient may have fever and passes little urine. A kidney biopsy can confirm whether it is an acute or chronic rejection.

 

How is acute rejection treated?

The usual treatment of acute rejection is to give 3 daily high-dosage prednisolone injections. This injection has to be given very slowly, otherwise it may cause ringing of the ears and flushing.

 

Will sexual activity harm the transplanted kidney?

Sexual activity will not harm the transplanted kidney, but as with most major surgery it is advisable to wait for six weeks before having sexual intercourse. Most men regain their potency after a successful transplant. Women become fertile after transplant and can bear children. However it is advisable to wait for two years after a transplant as the kidney function must be good and the immunosuppressive drugs, at a low level.

 

What are the advantages of a kidney transplant?

The quality of life is much better for the patient who has undergone a transplant as opposed to one on regular hemodialysis. There is greater mobility as he is no longer tied to a kidney machine three times a week. The spouse or partner assisting him on dialysis is also freed of the burden of dialysis. Dialysis only rids the patient of waste products of protein metabolism but it does not help in the hormonal production of active vitamin D and erythropoietin which the transplanted kidney is capable of doing. The family life and the occupation of the patient, especially if he or she is the sole bread-winner, is also less disrupted with a transplant compared to the long hours, cost and monthly maintenance spent on dialysis. The male patient regains his potency and the female, her libido. They can also marry and bear children. However, these patients will have to continue taking their transplant medication - a minor inconvenience for someone who has been given a new lease of life.

 
 

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