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Organ
Transplant » Kidney
Transplant
The Department
of Transplant and Immunology, a sub unit of the MIOT
INSTITUTE OF NEPHROLOGY has the expertise to provide the
best Kidney Transplant programme. The unit has experience in
handling transplants and problems arising from them, for
over many decades. The success rate of the kidney transplant
done here is comparable to the best in the world today.
Renal transplantation at MIOT
hospitals
So far 150 kidney transplantations have been done at MIOT
Hospitals, since June 2008.
MIOT’S renal transplantation team
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MIOT Institute of Nephrology has been founded by
a team of doctors headed by one of the leading
Nephrologists of the country Dr.Rajan
Ravichandran. Dr.Rajan Ravichandran has 25 years
of experience in treating patients with various
kidney ailments including general |
nephrology, dialysis and kidney transplants. He
has treated more than 15,000 patients from all over India
and neighboring countries like Maldives, Srilanka, Malaysia
and Bangladesh.
At the MIOT
hospitals, the director, Dr.Rajan Ravichandran, heads the
nephrology department. Dr.N.K.Ganesh Prasad and
Dr.A.Kanakaraj are consultants in nephrology. Dr.Ashok
Sakthivel is the urologist and Dr.Sairam is the vascular
surgeon performing transplantation surgery.
Dr.C.N.Srinivas, is the transplantation immunology and
molecular lab who
does the clinical tests of tissue typing and cross match, as
well as, highly specialized test such as donor specific
antibodies. Excellent, well – trained nurses, in
transplantation take care of these patients, in the
immediate pre and post transplantation period.
Facilities available for carrying
out renal transplantation at MIOT
The Nephrology Department is supported by the best
technology, like the
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Latest 4D USG
machine |
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MRI |
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750 HD CT Scan |
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Nuclear
Radiography |
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Immunology
Institute & Histopathology department |
MIOT Hospitals has
excellent biochemistry, haematology, and microbiology and
general pathology services available. All the tests required
for transplantation are done within the hospital.
State-of-the art radiology department and nuclear medicine
department, help in accurate imaging studies. The
transplantation immunology department has the latest hi-tech
equipments and expertise to perform advanced tests like HLA
typing (DNA PCR) and donor specific antibodies by Luminex
Fluoroanalyser, powered with fluoro-beads XMAP technology.
Superb operating theatres and postoperative wards are
available.
FAQ
1. What is
kidney transplantation?
One kidney from a
donor is surgically placed within the abdomen of a
recipient, who has irreversible kidney failure.
2. Is it
sufficient to live with one kidney?
Yes, it is
sufficient to live with one kidney.
3. Will the
patient’s own kidneys be removed during the transplantation?
Generally, the recipient’s native (own) kidneys are not
removed during the transplantation, unless there is a
specific problem.
4. Where is the
transplanted kidney placed in the abdomen?
The transplant
kidney is usually placed in the right or left side of the
lower abdomen.
5. Is it
necessary to take medications even after transplantation?
Yes, it is
absolutely essential to take medications after
transplantation, especially immunosuppressive drugs.
6. Why is it
necessary to take immunosuppressive drugs?
Our body perceives
any organ, which is from a different person, as “foreign”.
After transplantation, the body produces certain types of
antibodies and cells which would destroy the transplanted
organ. Hence immunosuppressive drugs that reduce the effect
of these antibodies and cells are required.
7. Can a person lead a normal life after transplantation?
Yes, a person can
lead a normal life after transplantation with the goal of
healthy life style. Certainly the quality of life is better
than on dialysis.
8. Are there
are any diet restrictions for kidney transplant patients?
Generally, there are no specific dietary restrictions,
if the transplanted kidney function is normal. Certain
precautions like eating cooked food, washed and peeled
fruits and drinking boiled and cooled water, will help to
avoid food poisoning.
TYPES OF DONOR
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Live donor |
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Cadaver donor |
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Dead or non breathing donors |
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Brain dead cadaver |
Live Donor
In case of a live donor any person from the age of 18 to
70 can donate their kidney. After the
organ
transplantation bill it is possible only for a near
relative like a parent/sibling/spouse to donate their
kidney. But in some cases an emotionally related person can
also be considered after getting an approval from the
government. The donor undergoes several tests where they are
checked on their health conditions and the functioning of
the kidneys.
Cadaver Donor
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Dead or non
breathing heart donor: It is very difficult to carry out
from a dead person since the kidney has to be per fused and
preserved within 10minutes of death. A very small percentage
of transplantation is carried out in this manner. |
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Brain dead
cadaver: once a person is brain dead it is possible to
harvest kidneys according to legal provisions. In such cases
the kidneys can be used with in 24 hours if it’s preserved
properly. Majority of the transplantation is done this way
where the list of patients is maintained and suitable match
can be found with the cadaver. |
Precautions to take before kidney transplantation
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First it is very
essential to make certain that the patient has irreversible
kidney failure and requires kidney transplantation. Normally
this is judged by the blood reports, the size of the kidneys
and the duration of kidney failure. |
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Secondly, it is
important to see that the patient is fit to undergo kidney
transplantation. |
Transplantation can easily be done up to the age of 70
years, but the procedure could be difficult in a child less
than 10kg’s of body weight.
How is the kidney transplant done?
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First the
patient and donor are admitted a day prior to the surgery
where they have to go through several tests and make sure
they are ready for transplantation, this is called induction
therapy. |
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The donor is not
given any special drugs and is only hydrated with IV fluids
so that the kidney is function is optimum during the
operation. |
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The donors left
kidney is preferred since it is easier to get a good segment
of the vein in the left side. Some times the right kidney is
chosen if the left kidney has multiple arteries. |
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Once the kidney
is harvested it is per fused with cold organ preserving
fluid. The perfusion is done for about 10 to 15 minutes till
all the blood removed from the kidney and the core
temperature of the kidney is brought down. |
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The kidney is
also kept in mashed ice to lower external temperature. This
way the kidney can live without blood supply till it is put
in the patient. |
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The advantage of
the perfusion is both cooling and washing out of antigenic
blood cells. The patient is also simultaneously operated and
an incision is made in the right lower abdomen and the area
is dissected so as to expose suitable artery and vein (iliac
vessels) to which the donor’s kidney can be attached. |
Life after donation
The donor can lead
a normal life with a single kidney. Donor requires checking
his blood pressure, urine for protein loss and blood test
for kidney function once a year. The risk for a donor is
extremely low but he can develop high blood pressure or
protein loss in future. Hence it is essential to monitor the
donor.
Life after kidney transplantation
For the recipient
it is a new life and he rapidly recovers to a normal state.
He can do all activities and all body functions improve from
head to toe. Patient has to be careful in taking medications
regularly and not to skip even a single dose. He should
avoid infections by not taking contaminated food or drinks.
He should also follow-up in the transplant centre so that
his immunosuppressive drugs can be tapered over a period of
time. He has to be on life long medications.
Results of kidney transplantation
The success rate
of kidney transplantation has increased tremendously in the
last decade due to newer immunosuppressive drugs and better
management of infections. The first year success rate is
about 95%. The 5 years graft survival (that is functional
kidney) is around 85%. But in 10 years graft, survival drops
to around 60%. The cadaver transplant results are somewhat
inferior to the live donor transplantations. There are
several patients in our country who have crossed 20 years of
good quality life after transplantation. It is also possible
to conceive and have a successful pregnancy after
transplantation.
Future in kidney transplantation
Tremendous research is being carried out in the area of
immune tolerance. Once this becomes practical the patient
will not require life long drugs and will be less
susceptible to infections. Then next area of research is
xeno transplants where kidneys are removed from genetically
modified animals. Lastly the area of greatest interest is
the development of full kidney from the basic stem.
Statistics regarding chronic kidney disease and renal
transplantation in India
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3584
transplantations were done in 2008. |
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160 cadaver
transplantations were done. |
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Approximately,
7, 00,000 patients had chronic kidney disease. |
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35,000 patients
were on Haemodialysis. |
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6500 patients
were on continuous ambulatory peritoneal dialysis (CAPD) |
History of kidney transplantation
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The first kidney
transplantation was done in 1954 in US, and in India it was
done in the late 1960’s |
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In 1994 a bill
was passed in the parliament to regulate organ
transplantation, this happened because of the illegal
increasing purchase of kidneys by foreigners. |
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Subsequently
this bill was passed in several states which made organ
transplantation fairly well regulated all over the country. |
As per the present
law only direct relatives like parents/siblings can donate
kidney. There are exceptions that also allow spouse and
emotionally related person to donate kidneys.
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