Kidney Transplantation – Risks & Complications

A kidney transplant is a surgery undertaken to replace an injured or diseased kidney with a healthy kidney from a donor. The kidney may come from a living donor or a deceased organ donor.

Family members or others who are suitable matches may be able to donate one of their kidneys. This type of transplant is known as a living transplant. People who donate a kidney can lead healthy lives with a single kidney.

A person who is going through a transplant most frequently gets just one kidney. In rare circumstances, they might get two kidneys from a deceased donor. The diseased kidneys are typically left in place. The transplanted kidney is placed in the lower belly on the front side of the body.

Risks and Complications of Kidney Transplantation

Rejection

The body’s immune system sees the kidney as a foreign object or tissue and initiates a reaction against it. This may result in massive damage to the new kidney functions. Early signs of rejection are soreness and fever at the site of the new kidney and decrease in the amount of urine production.

To prevent rejection reactions, immune-suppressing medications are used right after the operation.

Rejection may be of different types based on their timing.

Hyperacute

It happens within minutes of insertion. This is not common these days because the tissues are matched before donation. This implies that the donated kidney should be removed immediately.

Accelerated

This happens within a few days in patients antecedently sensitised. There can be fever, swollen new kidneys and an increase in the levels of creatinine in the blood. High-dose steroids are given to fight this; however, they may fail, and removal may be needed.

Acute cellular rejection

This happens in a quarter of all patients, typically in one to three weeks, but can occur up to 12 weeks. There may be fluid retention, increased blood pressure and a rapid rise in blood creatinine.

Chronic rejection

In this kind, there is a slow rise in serum creatinine and protein excretion in urine, along with high blood pressure. This type of rejection is not corrected by inflating immunosuppression therapy.

Side effects of Immunosuppressants

Complications are also linked with the use of immune-suppressing medications such as ciclosporin, mycophenolate mofetil, azathioprine, sirolimus, tacrolimus, or prednisolone.

Immunosuppressants work by lowering the ability of immune cells to function. They can weaken the immune system and expose people to infections.

Steroid drugs have various side effects like:

• bone disease
• cataracts
• stomach acidity
• skin changes
• puffiness of the face
• increase in weight
• high blood sugar and blood pressure
• acne
• facial hair, etc.

Over an extended period, immune suppressants may also increase the risk of specific cancers. When used over time, these drugs may also cause kidney or liver damage in a few patients.

Early Complications

Early complications are the risk of abscesses within the abdominal walls. This is more likely in obese, old and diabetic patients.

Bleeding is another frequent complication immediately post-surgery. Bleeding in urine may also be seen in a few patients.

A major abdominal surgery weakens the abdominal muscles and may result in the risk of abdominal hernias over the site of the incision, known as incisional hernia. Diabetics, obese, and those with rejection are more prone to risk.

Few patients may develop infectious tracts or canals known as urinary fistulae. There is a substantial risk of blood clot symptoms or arterial thrombosis forming postoperatively.

These may get dislodged from the operative site and move up to the lungs or brain, resulting in life-threatening complications.

Late Complications

Pyelonephritis or infection of the kidney post-surgery is another complication that needs to be considered.

Late complications include narrowing of the ureters and hindering the flow of urine from the kidney into the bladder, which is known as ureteric stenosis.

Certain infections are frequent, mainly due to the use of immunosuppressant medications. These are called opportunistic infections and include herpes simplex infection in the first four weeks & then cytomegalovirus infection. Fungal and bacterial infections are also seen.

Kidney stones may be transplanted with the donor’s kidney or may form later in the new kidney. There may be possibilities of infections, obstruction of blood in urine (hematuria).

Narrowing of the renal arteries is a late complication. Other blood vessel abnormalities, such as arteriovenous fistulae and pseudo aneurysms (balloon-like swelling of segments of the renal arteries), may develop. A few patients may also develop lymph channel abnormalities known as lymphoceles.

Over the long term, there can be a risk of skin or lymphoma cancers. This could be because of the usage of immunosuppressant medications. Common cancers include kidney cancer, Kaposi sarcoma, and, in women, cervical cancer.

Heart diseases, such as high blood cholesterol, high blood pressure,  etc., are common after kidney transplants.

Recurrence of the original kidney dysfunction that harms the new kidney is another complication of kidney transplant.

Summary

A kidney transplant is a significant operation. There are complications linked with most major operations that may happen with kidney transplants as well. These include bleeding, pain, delayed wound healing,  and risk of infections. One of the worst complications is a rejection reaction, or the body’s rejecting the newly donated kidney.

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