Kidney and Pancreas Transplant Step-by-Step Guide
If you or someone you love needs a transplant, understanding the following four steps will help:1. Pre-transplant Evaluation
After you have discussed transplantation with your doctor and decided you may need a transplant, your doctor may refer you to Baylor. Each patient referred for a transplant undergoes an evaluation including various physical examinations, diagnostic tests and educational meetings, usually performed on an outpatient basis. Together with your physician, a nephrologist (or kidney specialist) coordinates pre- and post-transplant care.
To be considered for a kidney transplant, you must have a diagnosis of end-stage renal disease without any conditions that would exclude you from getting a transplant. The following conditions may exclude some patients from kidney and kidney/pancreas transplantation:
- Heart disease. This could create unacceptable risks during the surgical procedure or immediate post-operative period.
- Age over 70 . Elderly patients with dialysis intolerance are considered on a case-by-case basis.
- Malignant disease. Patients with "cured" malignant disease must have a minimum of one year of follow-up.
- Active alcohol or other chemical abuse interfering with work or normal activities. Patients with a history of substance abuse must have a minimum of six months of follow-up.
- History of psychiatric disease or noncompliance with care that might jeopardize your post-operative compliance with treatment.
- Active liver disease.
- HIV-positive status.
- Obesity over 150 percent of ideal body weight.
- Active infection within six weeks before the date of the planned transplant.
- Refusal to allow the infusion of blood products as needed.
Dialysis and pre-dialysis patients may qualify. Pre-dialysis candidates should have a creatinine clearance of less than 15 before going on the transplant waiting list. You also can be considered for re-transplantation after a graft (transplanted organ) loss from chronic rejection or recurrent disease when your creatinine clearance is less than 12.
2. Patient Selection Process
If you are approved as a candidate for transplantation and reimbursement for the transplant has been cleared with your insurer, you will be placed on Baylor's transplant waiting list and registered with the United Network for Organ Sharing (UNOS), the national organ-donor system.
If you are waiting within the Dallas-Fort Worth area, you may choose to obtain a beeper to stay connected. You may stay outside the Dallas-Fort Worth area as long as you are within six hours of the hospital. During the waiting period your personal physician must keep the transplant team up-to-date on any medical changes.
3. Transplant
You may receive a kidney from:
- A family member, or living related donor. These are often the most successful transplants.
- A close friend, or living unrelated donor.
- A person who has recently died, or cadaveric donor.
Before a kidney from any donor can be used, it is tested to determine whether it matches your tissue type and blood type. This test helps reduce the likelihood that your body will reject the new kidney.
During kidney transplant surgery, a surgeon will place the healthy donor kidney into your body. The new kidney will do the work that your failing kidneys can no longer perform. Generally, your damaged kidneys will not be removed unless they are causing problems that cannot be treated with medication.
After placing the donor kidney in your body, the surgeon will connect blood vessels from the donor kidney to arteries and veins in your body. After the ureter--the tube that carries urine to the bladder--from the donor kidney is connected to your ureter, surgeons can allow blood to flow through the new kidney, and it can begin to function. Kidney transplant surgery may take three to six hours.
4. Post-transplant Care
You will typically stay in the hospital for approximately five days after you receive your new kidney. Hospital stays may vary from case to case. It may take some time for your new kidney to produce urine, so you may have to undergo dialysis and take such medications as diuretics, which help your new kidney eliminate excess water and salt from your body. However, many patients see immediate results with their new functioning kidney and typically only 20 percent require dialysis.
After the surgery, you will take immunosuppressive drugs for the rest of your life to help prevent your body from rejecting your new kidney.