The kidneys are two bean-shaped organs located near the middle of the back, below the rib cage. Each kidney contains around a million tiny filtering units called nephrons. The kidneys filter waste and excess fluid from the blood to produce urine, which is stored in the bladder and expelled from the body when urinating. In addition to filtering the blood, the kidneys regulate fluid balance and blood pressure, encourage red blood cell production, and support bone health by producing vitamin D and regulating phosphate and calcium levels.
Reasons Why a Kidney Transplant May Be Needed
There are a few main reasons why someone may need a Kidney Transplant:
Kidney Failure: The kidneys can become damaged over time from conditions like diabetes, high blood pressure, glomerulonephritis (inflammation of the kidney's filtering units), and polycystic kidney disease. When the kidneys are severely damaged and can no longer perform their normal filtering functions sufficiently, it results in kidney failure or end-stage renal disease (ESRD). Dialysis then becomes necessary to replace kidney function and removal of waste from the blood.
Inherited/Genetic Disorders: Some disorders, like polycystic kidney disease, are caused by genetic mutations passed down from parents. These abnormalities impair kidney development and functionality from an early age and often progress to kidney failure.
Obstruction: Kidney stones, tumors, or other masses blocking urine flow out of the kidneys can damage their structures over time until failure occurs.
Trauma: Severe impacts, blows, or injury to the kidneys may rupture blood vessels or tear kidney tissues leading to scarring, loss of function, and eventual organ failure without a transplant.
Understanding Dialysis and Its Limitations
When the kidneys fail, dialysis is required as a replacement to filter the blood and remove waste. The two main types are hemodialysis and peritoneal dialysis. Hemodialysis uses an external machine and filter to clean blood outside the body during scheduled treatment sessions, usually three times per week for 3-4 hours each time. Peritoneal dialysis uses the inner lining of the abdomen (peritoneal membrane) as a natural filter, exchanging dialysis fluid into the abdominal cavity during the night or day to bathe the blood.
While it sustains life, dialysis has limitations. It is not as effective at waste removal as healthy kidneys and does not replace other kidney functions like hormone production and blood pressure regulation. Maintaining dialysis as a lifelong treatment is challenging and burdensome for patients with risks of infection, blood pressure issues, nutritional problems and anemia. Quality of life is significantly reduced. For all of these reasons, kidney transplant offers patients on dialysis improved health outcomes and a better quality of life compared to remaining reliant on long-term dialysis therapy.
Understanding the Kidney Transplant Process
When someone needs a kidney transplant, careful testing and evaluation is done to determine if they are a suitable candidate. Various medical factors related to overall health, other organ functions and risks are assessed. If approved as a candidate, the patient is placed on the national transplant waiting list.
The wait time for receiving a suitable deceased donor kidney often spans years due to the shortage of available organs. During this waiting period, dialysis continues as needed to sustain life. Some may elect to pursue a living donor transplant instead by asking family members or friends to donate a kidney. This is typically a faster option with lower waiting time than relying on a deceased donor kidney.
When a match is identified, the transplant surgery involves reconnecting the donor kidney's renal artery and vein to the recipient's blood vessels, and ureter to the bladder to allow urine drainage. Anti-rejection medications must then be taken lifelong to suppress the immune system from attacking the foreign organ. Close follow-up with transplant doctors is required for monitoring the new kidney, other health factors, medication adherence and screening for complications or rejection.
With proper medical and lifestyle management including medication compliance, most kidney transplant patients enjoy 10-15 year or longer average graft survival rates depending on individual factors. The new organ eliminates the need for dialysis, providing boosted energy, improved function and a better quality of life compared to remaining dialysis-dependent. However, there are also risks like infection and long-term medications side effects that patients must carefully balance.
Life After Transplant: Unique Considerations
Those who receive a lifesaving kidney transplant face new challenges adapting to their post-transplant routine. Some key considerations include:
- Strict medication schedule: Anti-rejection medications require punctual adherence to dosing schedules to prevent rejection. Non-adherence risks organ damage.
- Infection risks: Lifelong immunosuppression increases vulnerability to illnesses that a healthy person could fight off. Rigorous prevention methods lower risk.
- Dietary restrictions: Managing diet has new layers like monitoring protein, potassium, and phosphate intake to avoid overloading the transplant kidney.
- Follow-up appointments: Regular doctor visits promote monitoring transplant function, side effects, blood pressure, weight, and more. Complications are promptly addressed.
- Lifestyle adjustments: Care must be taken avoiding heavy impact exercise, concentrating herbal/drug interactions, and balancing activities with self-care needs. Travel requires thorough planning.
- Emotional shifts: Transitioning identities from patient to survivor brings psychological adjustments. Peer support aids the journey.
While transplant places ongoing demands, most recipients feel the benefits of resumed independence and an improved quality of life with fewer health limitations far outweigh ongoing transplant challenges. With diligent self-care, the majority are able to enjoy years of functional kidney allograft survival.
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