Kidney Transplant

Hi! I am Dr. Suraj Gupta. I am a Nephrologist in Narayana Multisuperspeciality Hospital, Gurgaon. Today we would talk briefly about what is kidney transplant. See Kidney transplantation is modality of treatment when somebody loses almost all the kidney functions of the body. So what are the modalities in such a situation? either dialysis or transplantation. Obviously compared to dialysis, Transplantation is much better. The individual after transplantation regains almost the normal kind of kidney function. So one can perform almost all the day to day activities without any restrictions of dialysis. So how does somebody can undergo transplantation? What are the implications of it and what are the requirements of it?

Somebody to undergo transplantation, one person would need a matching donor in terms of blood group actually. Why there is matching is required because obviously the organ is taken from other individual and is put inside into the patient. So obviously these are two different individuals, so obviously there would be a barrier in between these two. So when we put the different organ into the body of the patient, so the body tries to reject it by producing lot of antibodies, by generating immunity against it. So to reduce these antibodies, to reduce this immunity, we give them immunosuppression, we give them drugs which are called immunosuppressive drugs.

So what are these drugs do? They reduce the immunosuppression of the body. So that leads to a lot of reduction in the immunity, a lot of susceptibility towards, a lot of infections which could be serious in nature. So, the first thing is to get a match donor. And the second thing is the use of drugs which are called immunosuppressive. So these are two very important things. Right now with a lot of advancements, we can in fact without even across the blood group transplantations are also done. So the blood group barrier is not there anymore. So patient with somebody with a different blood group can donate to an individual with a different blood group. So blood group barrier is also not present anymore. The most important issue is the immunosuppression to prevent the rejections to happen. So the most important thing would be how to live life with immunosuppression. Obviously, the initial 6 months is the period when the individual is more immunosuppressed. So, the precautions are most important. One should avoid contact to people who are very infected, or who have some viral diseases or infections.

One should avoid getting into close contact or getting into very crowded atmosphere and try to eat hygienic food, drink boiled water. All these things hygienic precautions should be taken. Beyond 6 months, if somebody’s kidney functions are ok, so we usually reduce the amount of drugs or immunosuppressions the patient would take so. Obviously, the level of immunosuppression would go down. So the restrictions are little less once the patient goes beyond 6 months to 1-year post-transplantation and the restrictions are little less than what it would be within the first 6 months and what should one do about the drugs? see there are major types of immunosuppression. There are three drugs which are called steroid, tacrolimus and mycophenolate. These three are the major immunosuppressant which almost transplant patients would be taking. So, it is very important to take these drugs on time. We would routine the monitor, the levels of the drugs. So the levels of the drugs should be monitored regularly. Initial 3 to 6 months are very crucial for these patients. These patients are at maximum risk for infections.

These patients have a lot of risk for rejections. So close monitoring with your nephrologist is required. So we routinely advise them to follow up with us regularly once a week or twice a week in the initial 2 to 3 months and to stay close to their transplant centers. Once these 6 months period is over, they can go back to their home, even if they are staying somewhere else they can go back there and can stay in communication with the nephrologist. In long term, the risk of infections would reduce but they still should take basic precautions and basic hygiene. Another thing is important is to maintain very good compliance with the immunosuppressions. Lot of times the rejections are quite common. In individuals who are already 4 years, 5 years transplant, they feel that the creatinine level is normal. So why not to switch off the drugs or stop taking the drugs?

That leads to a lot of severe rejections and patient would lose the function of the grafted kidney. So it is very important to maintain the compliance of the treatment. It is very important to maintain basic hygiene and it is very important to follow your nephrologist by directly or by any mode of communication. But following up is very important. So I would hope that this would clarify lot of doubts and if any issues are there you want to consult then always visit my website or contact me or make an appointment to meet me.

Thank you!