CKD - Kidney Transplant For Chronic Kidney Disease

Chronic kidney disease, from diabetes, high blood pressure, inherited cysts or inflammation of the kidneys, can progress to kidney failure, when less than a sixth of normal function remains. Three treatments then keep a person alive.

1. Hemodialysis. The blood is cleaned by a machine, three times a week for four hours, in a center or at home.
2. Peritoneal dialysis. Fluid runs into the abdomen through a catheter and is drained several times a day or overnight by a machine.
3. Kidney transplant. One healthy kidney from a donor takes over the work of both failed kidneys.

Why a transplant does better than dialysis

In a study of 228,552 people on dialysis in the United States, researchers separated the effect of the transplant from the fact that healthier patients are chosen for one. Surgery carries its own risk. In the first two weeks after the operation, recipients were more likely to die than patients still on the list. By eighteen months their risk was a third of that on the list, and over the long term their death rate was 48 to 82 percent lower. A systematic review of 110 studies and 1.9 million people found the same pattern, with fewer heart attacks and strokes and a markedly better quality of life, and the advantage has grown over time.

1. Blood group and tissue typing of recipient and donor, and a crossmatch to check for antibodies against the donor.
2. Heart tests, and in older or diabetic patients a stress test or coronary angiography.
3. Screening for cancer, infections such as hepatitis, HIV and tuberculosis, and a dental check.
4. A pelvic scan.

Among patients with end-stage renal disease, healthier patients are placed on the waiting list for transplantation, and long-term survival is better among those on the waiting list who eventually undergo transplantation.

United States Renal Data System study, New England Journal of Medicine, 1999

Timing, before dialysis if possible

The time spent on dialysis before a transplant counts. An analysis of 73,103 transplants found that, compared with a transplant before any dialysis, six to twelve months of dialysis raised the risk of death after transplant by 21 percent, and more than four years raised it by 72 percent. Kidneys lasted longer, too. A patient whose function is falling toward failure should start the transplant assessment early, while there is still time to plan a transplant before the first dialysis session.

Who can donate

Living donors give one kidney, and the remaining kidney grows to take on most of the work. Turkish law allows donation by relatives, and any other donor needs the hospital ethics committee's approval. Donor and recipient travel together with official documents proving their relationship.

1. A healthy adult, with normal kidney function, blood pressure and blood sugar, and no kidney stones or cysts that threaten the remaining kidney.
2. A compatible blood group, or an incompatible one that the team can manage with special treatment before surgery.
3. A free decision, confirmed in private with an independent physician and a psychologist, which the donor can withdraw at any time.

Blood group need not stop a transplant.

When the donor's blood group does not match, the recipient can receive treatment before surgery to remove the antibodies that would attack the kidney, a process that adds one to two weeks and some cost, with results that approach those of matched transplants in experienced centers. Where two pairs are each incompatible, some programs arrange a paired exchange, with each donor giving to the other pair's recipient, within the same legal and ethical rules.

Risks for the donor