1. General Information on Kidneys and Kidney Disease
2. What is the life expectancy of an LR kidney transplant?
3. Creatinine: What is it and why is it important?
4. Is it possible for a prune belly to have a successful kidney transplant?
5. How long is the waiting time for me to get transplant?
6. How long is the treatment period for kidney transplant?
Over 1,500 kidney transplants are performed in the UK every year and many more could be performed if more kidneys were available. The success rate for kidney transplants is excellent and higher than for other kinds of organ transplants.
The transplant kidney provides enough kidney function; remember some people are born with only one kidney and do not develop problems. After a successful transplant, there is no need for dialysis, provided the transplant continues to work well.
Patients who have a successful transplant should feel better and have more energy. There may still be a need to watch your diet to protect the kidney.
You will need to speak to your doctor to find out if you are medically suitable for a transplant (many patients are). If you wish to go ahead, you will be put on the waiting list for a donor kidney. In the UK, patients are on the waiting list for an average of two years before a suitable kidney becomes available.
If a transplant fails, you can go back to dialysis or have another transplant. Even a successful transplant may not last forever. You have to take a range of medication daily to prevent rejection of the new kidney.
1. General Information on Kidneys and Kidney Disease
The kidneys are organs in the body that play an important part in keeping people healthy. They are a pair of bean-shaped organs that lie toward the back of the body just above the waist. Each is about the size of a fist. Lying on either side, they are essentially mirror images of each other.
The kidneys function primarily as filters for the blood. Blood enters the kidney through the renal artery and circulates through the kidney into tiny structures called nephrons. (Nephros is the Greek word for kidney.) The nephrons clean the blood by filtering out excess fluid and waste. The cleansed blood leaves the kidney through the renal vein. The excess fluid and waste products leave the kidney through the ureter, pass into the bladder and are excreted from the body as urine. The entire process continues 24 hours a day, 7 days a week, so that the body's total blood supply is constantly being filtered. Here is an overview of the many functions of the kidneys:
- they remove waste products from your body through the urine
- they balance the fluids in the body
- they balance the body's chemicals
- they release hormones that are important in controlling blood pressure and forming red blood cells
The kidneys' functions are critical to sustain life. When a person's kidneys fail, that person's life can be maintained only by dialysis or by kidney transplant.
Kidney Disease
Another name for kidney disease is renal disease. End-stage renal disease, or ESRD, means that you must have some form of treatment in order to stay alive. You can be healthy with one kidney. However, when both kidneys do not work, waste materials and water stay in your body. Your body's chemical balance becomes upset. You become ill and need treatment to do the job your kidneys can no longer do. There are many diseases that can hurt your kidneys. Some of these are diabetes, high blood pressure, obstruction, and polycystic disease.
Acute kidney failure means your kidneys stopped working very quickly - within a few hours or days. Your kidneys may begin to work after a few weeks or after several months to a year.
Chronic kidney failure means your kidneys have been failing over a long time. As your kidneys stop working, your doctor may give you drugs or change your diet. But you may not have any warning signs to let you know you need treatment. Therefore by the time you see your doctor, you may have lost some kidney function. This kidney function does not return, even with treatment.If your kidney failure gets worse, you may not be able to live longer than a few weeks to months without dialysis or transplantation. End-stage renal disease (ESRD) happens when there is less than 5% to 10% of your kidney working. Healthy kidneys work at 80% to 100%.
A patient with kidney failure can choose among three forms of treatment: hemodialysis, peritoneal dialysis or kidney transplantation. Successful kidney transplantation makes dialysis unnecessary and helps restore a patient's energy level by correcting anemia and clearing the waste products better than can be done by dialysis.
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2. What is the life expectancy of an LR kidney transplant?
Each of us inherits half of our genes from our mother and half from our father. The genes responsible for immunological reactions to transplanted organs are close to each other on a single chromosome; so, for the most part, they are inherited as a single group, called a haplotype. If siblings recieve the same group of genes from each parent, they are a two-haplotype (full or complete) match. If they receive one group that is the same and one group that is different, they are a one-haplotype (half) match. If both groups of genes are different they are a zero haplotype match.
In general, two-haplotyped matched living related donor kidney transplants have a 50% chance of achieving 24 years of function, one-haplotyped matched living related donor kidney transplants have a 50% chance of achieving 12 years of function, and cadaver donor kidney transplants have a 50% chance of achieving 9 years of function (Cecka and Terasaki, "The UNOS Scientific Renal Transplant Registry", Clinical Transplants 1993, Paul I Terasaki and JM Cecka, eds., UCLA Tissue Typing Registry, 1993:1-18). This does not mean, for example, that a two-haplotype matched living related transplant will function for 25 years and then fail, or that a cadaveric donor transplant will last 9 years and fail. Any individual transplant, if well cared for, may last much longer.
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3. Creatinine: What is it and why is it important?
Serum creatinine level and "creatinine clearance" are different ways of determining kidney function. Here is a technical explanation for those that are interested:
Creatinine is a protein produced by muscle and released into the blood. The amount produced is relatively stable in a given person. The creatinine level in the serum is therefore determined by the rate it is being removed, which is roughly a measure of kidney function. If kidney function falls (say a kidney is removed to donate to a relative), the creatinine level will rise. Normal is about 1 for an average adult. Infants that have little muscle will have lower normal levels (0.2). Muscle bound weight lifters may have a higher normal creatinine. Serum creatinine only reflects renal function in a steady state. After removing a kidney, if the donor's blood is checked right away the serum creatinine will still be 1. In the next day the creatinine will rise to a new steady state (usually about 1.8). If both kidneys were removed (say for cancer) the creatinine would continue to rise daily until dialysis is begun. How fast it rises depends on creatinine production, which is again related to how much muscle one has. A baby may need dialysis when the creatinine reaches 2, whereas a normal adult may be able to hold off until 10, or higher.
Creatinine clearance is technically the amount of blood that is "cleared" of creatinine per time period. It is usually expressed in ml per minute. Normal is 120 ml/min for an adult. It is roughly, inversely related to serum creatinine: If the clearance drops to one half of the old level, the serum creatinine doubles (in the steady state). So for an adult, serum creatinine of 2 is roughly a creatinine clearance of 60 ml/min; creatinine 3 is roughly a clearance of 30; creatinine of 4 is roughly a clearance of 15, etc. So why didn't the creatinine rise to only 2 when a kidney was removed? (I said it would rise to 1.8) The answer is that the remaining kidney "hyperfilters" and seems to work harder, therefore kidney function is not quite halved.
Usually, an adult will need dialysis because symptoms of kidney failure appear at a clearance of less than 10 ml/min. Creatinine clearance has to be measured by urine collection (usually 12 or 24 hours). It is a more precise estimate of kidney function than serum creatinine since it does not depend on the amount of muscle one has.
Note that the units used in the United States are milligrams per deciliter (mg/dl). To convert to international units (micromoles per liter) multiply the creatinine (in mg/dl) by 88. Thus a serum creatinine of 2mg/dl is the same as 176 micromoles per liter.
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4. Is it possible for a prune belly to have a successful kidney transplant?
The prune belly syndrome is a congenital abnormality that consists of deficient abdominal wall muscles, urinary tract abnormalities, and undescended testicles.
The prune belly syndrome does not exclude the possibility of successful kidney transplantation. The first kidney transplant in a patient with prune belly syndrome was reported in 1977 (Schenasky and Whelchel, Journal of Urology, Jan 1976, p112).
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5. How long is the waiting time for me to get transplant?
It may take from 2 days to 2 weeks, depends on if the suitable donor organ is available at time.
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6. How long is the treatment period for kidney transplant?
It takes about 4 weeks to complete our treatment cycle, where patient is capable to take flight home.
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