If you don’t want to undergo dialysis for life and want to choose kidney transplantation treatment but still have doubts and concerns that you want answers to, today Phyathai 3 is here to clear up all your questions about kidney transplantation that you need to know with Assoc. Prof. Dr. Nuttapon Apornsujaritkun . Just one click, get answers, complete and definite.
Q: What is kidney failure?
A: Kidney failure is a condition where the kidneys’ efficiency in functioning decreases, causing accumulation of water and waste in the body. Kidney failure can be divided into 2 types: acute kidney failure and chronic kidney failure.
Acute kidney failure mostly occurs over a short period and is temporary, caused by various reasons. However, after treating and correcting the cause, kidney function can return to normal on its own.
Chronic kidney failure patients experience a gradual decline in kidney function over a long period until the kidneys can no longer function.
Q: At what severity of kidney failure should kidney transplantation be considered?
A: Chronic kidney failure is classified by severity based on kidney function levels, divided into 5 stages. Kidney failure stages 1 – 4 are treated with medication. For stage 5, patients receive renal replacement therapy, which includes the following methods:
- Hemodialysis
- Continuous ambulatory peritoneal dialysis (CAPD)
- Kidney transplant
Therefore, kidney transplantation is the recommended treatment for patients with end-stage chronic kidney failure (stage 5).
“Doctors recommend that once chronic kidney failure reaches stage 4, patients should consult a doctor to evaluate kidney transplantation early for the greatest benefit in preparing for renal replacement therapy and kidney transplantation.”
Q: Can kidney transplantation be done for all patients with end-stage kidney failure?
A: Before kidney transplantation, patients must be evaluated by a kidney transplant specialist to consider contraindications for transplantation, which include several conditions such as active cancer, severe infections, severe heart or lung diseases that cannot be corrected, etc., for the patient’s safety.
Therefore, “all end-stage chronic kidney failure patients who have been evaluated and found to have no contraindications can undergo kidney transplantation.”
Q: How many methods are there for kidney transplantation?
A: Currently, kidney transplantation surgery is divided into 2 types:
- Open kidney transplant surgery involves placing the transplanted kidney in the recipient’s pelvis on either side. The surgical incision is generally about 15 – 30 cm, depending on the patient’s weight and height.
- Robot-assisted kidney transplant surgery is a new kidney transplant technology first performed in 2010. It is still limited to certain countries. In Thailand, it is available only in some government hospitals. The surgical incision is generally about 7 cm, with four additional 8 mm incisions for robotic arms.
Advantages of robot-assisted kidney transplantation
- Smaller incisions
- Less pain at the incision site
- Fewer postoperative wound complications
Limitations of robot-assisted kidney transplantation
- High cost
- Must be performed by a specialist in robot-assisted kidney transplantation
Q: Does kidney transplantation cure kidney disease?
A: Kidney transplantation is currently the best renal replacement therapy for patients with chronic kidney failure. It helps patients return to a life as close to normal as possible.
Q: How long can a person live a normal life after kidney transplantation?
A: It mainly depends on the patient’s care. Kidney transplant recipients must take medication regularly and monitor for infections. However, most patients who take good care of themselves can have a transplanted kidney that functions well for a long time. Data from kidney transplant centers show that 85-90% of patients still have good kidney function 5 years after transplantation, and some can live nearly normal lives for over 20 years.
Q: Is there a chance of needing a repeat kidney transplant?
A: Repeat kidney transplantation usually occurs if the first transplant fails or is unsuccessful after transplantation. This can happen for various reasons, some preventable and some difficult to prevent. It also depends on the patient’s self-care after transplantation.
Therefore, it is advisable to consult a specialized kidney transplant medical team for risk assessment before deciding on treatment.
Q: How much does kidney transplantation cost?
A: The cost of kidney transplantation depends on the patient’s physical condition and can be quite high. However, in the long term, compared to lifelong dialysis, research shows that the overall average cost and effectiveness of kidney transplantation are lower than dialysis.
Q: How should one prepare before kidney transplantation?
A: It is recommended to consult a kidney transplant specialist team for advice and early preparation before transplantation. Basic preparation includes:
- Fasting from food and drink for at least 6 hours before transplantation
- Bring all regularly taken medications
- If taking blood thinners, inform the doctor or nurse
- If undergoing hemodialysis, have dialysis 24-48 hours before transplantation
- If undergoing peritoneal dialysis, bring all dialysis fluids and equipment to the hospital
Q: How should one take care of themselves after kidney transplantation?
A: Post-transplant care involves detailed instructions. Patients will receive training during recovery before discharge. Generally, it includes:
- Regular follow-up appointments for evaluation and immunosuppressive medication adjustment
- Taking immunosuppressive drugs on time, understanding how to manage missed doses, and avoiding foods that affect drug levels
- Exercise is allowed initially but should not be too strenuous
- Maintain genital hygiene before and after sexual intercourse
- Consult a doctor before planning pregnancy
- Proper diet
- Avoid crowded places
- Frequent hand washing
Q: How to donate a kidney?
A: Living kidney donors who want to donate to a relative are advised to contact the kidney transplant center for donor and recipient evaluation. The main steps are as follows:
Step 1 Initial screening and risk information
This involves screening for donation contraindications such as underlying diseases, evaluating familial relationships, and blood type compatibility.
Step 2 Evaluation of blood tests and kidney anatomy
Step 3 Summary of evaluation results and explanation of donation risks
Q: How should kidney donors take care of themselves after donation?
A: Once donors pass evaluation and proceed with donation, it means they have healthy kidneys sufficient for donation. Post-donation care involves normal health maintenance, avoiding salty foods, seeing a doctor when ill instead of self-medicating, and regular follow-up check-ups.
Q: Is it true that pig kidneys can be transplanted into humans?
A: Yes, pig kidneys that have been genetically modified have been successfully transplanted into patients with end-stage chronic kidney failure in the United States in March 2024. In Thailand, this technology is not yet in use as it is still under long-term follow-up. However, it is expected to be introduced in Thailand in the future.