Kidney Transplant

Kidney transplant is used to treat the following conditions:

• Chronic kidney disease (CKD)
• End-stage renal disease (ESRD)
• Diabetic nephropathy
• Polycystic kidney disease (PKD)
• Glomerulonephritis

Kidney transplant involves the surgical placement of a healthy donor kidney into the recipient’s body. The procedure can be performed using the following techniques:

• Plasmapheresis: It is used before transplantation for immunological optimisation in patients with high antibody levels and after completion of the transplant to manage rejection episodes.
• Laparoscopic donor nephrectomy: It is a minimally invasive surgery that is used to remove the donor kidney, reducing recovery time and surgical trauma.
• Robotic laparoscopic donor nephrectomy: It offers better outcomes with minimal scarring and reduced donor discomfort, as in this method, precision and accuracy are enhanced during kidney removal via robotic assistance.

Kidney transplantation surgery usually takes 3 to 5 hours, depending on the complexity and the surgical approach used.

• Laparoscopic donor nephrectomy typically reduces the operative time for the donor and speeds up recovery.
• Robotic-assisted nephrectomy may slightly increase the duration due to the time taken for the setup but offers greater precision and better outcomes.
• Plasmapheresis sessions, if needed for immunological optimisation, may take 2 to 3 hours per session and are usually done before or after the transplant.

Preparing for kidney transplantation involves several steps:

• Medical evaluation in preparation for kidney transplantation includes comprehensive blood tests, imaging studies, and heart/lung assessment.
• Donor screening is done to ensures the donor kidney is healthy. Laparoscopic or robotic techniques may require additional imaging for surgical planning.
• Plasmapheresis preparation involves blood typing and antibody testing when needed to optimise donor-recipient compatibility.
• Medication planning includes initiating immunosuppressive therapy to prevent transplant rejection.

Kidney transplantation is generally safe, but like all surgeries, there are potential risks:

• Surgical risks include bleeding, infection, or injury to surrounding organs. However, minimally invasive techniques (laparoscopic and robotic surgeries) are associated with markedly lower risks for the donor.
• Rejection is the most critical risk, where the body may reject the transplanted kidney. Plasmapheresis is performed in patients at high immunological risk.
• Immunosuppressive drugs can increase susceptibility to infections.
• Other complications include blood clots, delayed kidney function, or urinary tract problems.

Recovery after kidney transplantation involves close monitoring and lifestyle adjustments including the following:

• Hospital stay after kidney transplantation usually lasts 5–10 days for recipients, while donors generally stay 2–4 days following laparoscopic or robotic nephrectomy.
• Activity should be gradually resumed, with heavy lifting restricted for several weeks; minimally invasive donor surgeries enable faster recovery.
• Strict adherence to immunosuppressive medications is crucial to prevent rejection.
• Follow-up involves frequent blood tests, imaging, and clinic visits to monitor kidney function and detect complications early.
• Plasmapheresisfollow-up may include additional sessions if antibody levels remain high.