As kidneys become diseased, they lose their ability to function, a
condition called end-stage renal disease (ESRD) or kidney failure.
Treatments for kidney failure are hemodialysis, a mechanical process to
clean the blood of waste products; peritoneal dialysis, in which toxins
are removed by passing chemical solutions through the abdomen; or kidney
transplant.
In 2017, UCSF's Kidney Transplant Program earned the highest score for risk adjusted outcomes based on data from the Scientific Registry of Transplant Recipients (SRTR) using SRTR's new "5-Tier Outcome Assessment" model. Among
those institutions receiving the highest ranking nationally, UCSF
ranked first in the number of adult kidney transplants performed.
Kidneys for transplant come from a living donor or a deceased
(cadaver) donor. When a kidney is transplanted from a living donor, the
donor's remaining kidney enlarges to take over the work of two. As with
any major operation, there is a chance of complication. But kidney
donors have the same life expectancy, general health and kidney function
as others.
Any healthy person can safely donate a kidney. The donor must be in
excellent health, well informed about transplantation and able to give
informed consent. Costs for living donor surgery, hospitalization,
diagnostic tests and evaluation usually are paid by the recipient's
insurance. Travel and living expenses are not covered. Insurance
coverage will be discussed during the transplant evaluation.
If you have a potential living donor, he or she will undergo an
evaluation and discuss the possibility of organ donation. Tests will be
performed to ensure that the donor and recipient are compatible. In some
families, several people are compatible donors. In other families, none
are suitable.
Since 1999, UCSF has been using a procedure, called laparoscopic
donor nephrectomy, to remove kidneys from living donors. We have
performed more than 850 of these procedures, making our program one of
the most experienced in the country. The procedure uses tiny incisions
and a scope or camera, similar to one used to remove a gall bladder. The
procedure has a shorter recovery period and the complication rate is
very low. In addition, the quality and function of the transplanted
kidneys are excellent.
The procedure will be described in detail by the surgeon prior to
surgery. The operation usually takes three hours. Most patients
undergoing laparoscopic surgery for kidney donation require a hospital
stay of only two to three days. After discharge from the hospital, the
donor is seen for follow-up care in the transplant clinic. If the donor
resides outside the San Francisco region, he or she should stay in the
area for at least a week after discharge. Donors who undergo
laparoscopic surgery often return to work within three to four weeks
after the procedure.
Living Donor Kidney Transplantation
Living donor kidney transplants are the best option for many patients for several reasons:
- Better long-term results
- No need to wait on the transplant waiting list for a kidney from a deceased donor
- Surgery can be planned at a time convenient for both the donor and recipient
- Lower risks of complications or rejection, and better early function of the transplanted kidney
Any healthy person can donate a kidney. When a living person donates
a kidney the remaining kidney will enlarge slightly as it takes over
the work of two kidneys. Donors do not need medication or special diets
once they recover from surgery. As with any major operation, there is a
chance of complications, but kidney donors have the same life
expectancy, general health, and kidney function as most other people.
The kidney loss does not interfere with a woman's ability to have
children.
Potential Barriers to Living Donation
- Age < 18 years unless an emancipated minor
- Uncontrollable hypertension
- History of pulmonary embolism or recurrent thrombosis
- Bleeding disorders
- Uncontrollable psychiatric illness
- Morbid obesity
- Uncontrollable cardiovascular disease
- Conronic lung disease with impairment of oxygenation or ventilation
- History of melanoma
- History of metastatic cancer
- Bilateral or recurrent nephrolithiasis (kidney stones)
- Chronic Kidney Disease (CKD) stage 3 or less
- Proteinuria > 300 mg/d excluding postural proteinuria
- HIV infection
If a person successfully completes a full medical, surgical, and
psychosocial evaluation they will undergo the removal of one kidney.
Most transplant centers in the United States use a laparoscopic surgical
technique for the kidney removal. This form of surgery, performed
under general anesthesia, uses very small incisions, a thin scope with a
camera to view inside of the body, and wand-like instruments to remove
the kidney. Compared with the large incision operation used in the
past, laparoscopic surgery has greatly improved the donor's recovery
process in several ways:
- Decreased need for strong pain medications
- Shorter recovery time in the hospital
- Quicker return to normal activities
- Very low complication rate
The operation takes 2-3 hours. Recovery time in the hospital is
typically 1-3 days. Donors often are able to return to work as soon as
2-3 weeks after the procedure.
Occasionally the kidney needs to be removed through an open incision
in the flank region. Prior to the use of the laparoscopic technique,
this surgery was the standard for the removal of the donated kidney. It
involves a 5-7 inch incision on the side, division of muscle and
removal of the tip of the twelfth rib. The operation typically lasts 3
hours and the recovery in the hospital averages 4-5 days with time out
of work of 6-8 weeks.
Although laparoscopy is increasingly used over open surgery, from
time to time, the surgeon may elect to do an open procedure when
individual anatomic differences in the donor suggest that this will be a
better surgical approach.
The quality and function of the kidneys recovered with either
technique work equally well. Regardless of technique all donors will
require lifelong monitoring of their overall health, blood pressure and
kidney function.
Special Programs For Living Donor Transplantation
Many patients have relatives or non-relatives who wish to donate a
kidney but are not able to because their blood type or tissue type does
not match. In such cases, the donor and recipient are said to be
"incompatible."
See also: National Kidney Registry
Live Donor to Deceased Donor Waiting List Exchange
This program is a way for a living donor to benefit a loved one, even
if their blood or tissue types do not match. The donor gives a kidney
to another patient who has a compatible blood type and is at the top of
the kidney waiting list for a "deceased donor" kidney. In exchange,
that donor's relative or friend would move to a higher position on the
deceased donor waiting list, a position equal to that of the patient who
received the donor's kidney.
For example, if the donor's kidney went to the fourth patient on the
deceased donor waiting list, the recipient would move to the fourth spot
on the list for his or her blood group and would receive kidney offers
once at the top of the list.
Paired Exchange Kidney Transplant (or "Family Swap")
This program is another way for a living donor to benefit a loved one
even if their blood or tissue types do not match. A "paired exchange"
allows patients who have willing but incompatible donors to "exchange"
kidneys with one another-the kidneys just go to different recipients
than usually expected.
An example of how this works would be if Mary wanted to give her
sister Susan a kidney, but differences in blood type made it impossible,
and Kevin wanted to give his sister Sarah a kidney, but differences in
blood type made that impossible (see picture below). A paired exchange
would be arranged so that Mary would donate to Sarah and Kevin would
donate to Susan. The two pairs can thus "exchange" kidneys so that both
donors give kidneys and both patients receive kidneys.
That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.
Blood Type Incompatible Kidney Transplant
This is a program that lets patients receive a kidney from a living
donor who has an incompatible blood type. To be able to receive such a
kidney, patients must undergo several treatments before and after the
transplant to remove the harmful antibodies that can lead to rejection
of the transplanted kidney.
A special process called plasmapheresis, which is similar to
dialysis, is used to remove these harmful antibodies from the patient's
blood.
Patients require multiple treatments with plasmapheresis before
transplant, and may require several more after transplant to keep their
antibody levels down. Some patients may also need to have their spleens
removed at the time of transplant surgery to lower the number of cells
that produce antibodies. The spleen, a spongy organ about as big as a
person's fist, produces blood cells. Located in the upper left part of
the abdomen under the rib cage, the spleen can be removed
laparoscopically.
Positive Crossmatch and Sensitized Patient Kidney Transplant
This program makes it possible to perform kidney transplants in
patients who have developed antibodies against their kidney donors-a
situation known as "positive crossmatch."
The process is similar to that for blood type-incompatible kidney
transplants. Patients receive medications to decrease their antibody
level or they may undergo plasmapheresis treatments to remove the
harmful antibodies from their blood. If their antibody levels to their
donors are successfully reduced, they can then go ahead with the
transplants.
Blood type-incompatible kidney transplants and positive
crossmatch/sensitized patient kidney transplants have been very
successful in the United States and internationally. Success rates are
close to those for transplants from compatible living donors and are
better than success rates for deceased donor transplants.
Source Link: https://transplant.surgery.ucsf.edu/conditions--procedures/living-donor-kidney-transplant.aspx
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