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
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
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
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.