Kidney Transplantation

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Dialysis is only one of the renal replacement therapies but it doesn't provide complete replacement for kidney function. Other than removal of toxins (even the toxin removal function of dialysis is far inferior) there are other properties for kidneys which are hormonal functions like vitamin d-calcium metabolism and haemoglobin production which cannot be replaced by dialysis and need external supplementation.

The only permanent solution for complete replacement of kidney functions which includes hormonal functions as well is renal transplantation.

With transplantation from a healthy donor the new kidney can restore almost all the functions without any need for external supplementation and the quality of life also improves.

However the trade-off for this is the need for continued immunosuppression to prevent rejections and complications related to immunosuppression after transplantation. 

There is no need for dialysis after transplantation but there is a need for regular visits and monitoring to prevent complications related to transplantation.

The success of transplantation is very good in this era compared for the previous eras. 

When we say success we speak of graft survival and patient survival for 1st year, 5th and 10th years. 

The one year graft survival is 95% and patient survival is 98%.

By this we mean of 100 patients who undergo transplantation 98 of them would be alive and 95 of the grafts would be functioning.

This is excellent and there is further decline in 5 year and 10 year survival rates. 

For some you may be thinking why as to that 2 patients die and 5 grafts fail, it is mainly because of rejections and infections.

Now that you may ask as to who is prone for that and why? I would say it cannot be predicted in advance and if we could, we would not have transplanted them. 

So why should we get transplanted at all! What if we fall in the failing 5 or 2. For this you have to read the survival on dialysis given elsewhere in the page.

Their 1year survival is much much less on dialysis compared to transplantation and average life span is 5 to 10 years and when we compare this to transplantation, it is definitely more and quality of life is also appreciable. 

The only thing that can go wrong in transplantation is immediate postoperative morbidity and very rarely mortality. There is risk for life like with any surgery and risk of rejections or infections but once this phase goes off uneventfully everything will be a cake walk. If in fear of these immediate and other late complications someone doesn't undergo transplant, they may evade these for sometime but ultimately live less longer than transplanted patients. 

The success of transplantation in India is as good as in any other well developed nations. 

Yes there is risk of rejections and infections including threat to life in transplantation but evading this doesn't necessarily improve life span or give quality life on dialysis in comparison. 

Stop worrying about complications start thinking positively. There is nothing we or you can do but to think positively.

Patients with chronic kidney disease who undergo transplantation live longer and have a better quality of life than patients who are on dialysis.

When ever we speak of kidney dysfunction or dialysis people ask us about transplantation.

All kidney dysfunction don't need dialysis, like wise all dialysis patients don't need transplantation.

Acute renal dysfunction even if needing dialysis are expected to recover and there is no scope for discussing about transplantation. However some acute presentations or repeated acute dysfunctions may lead to chronic dysfunction who may have a high creatinine but can be managed like Chronic disease till the stage of dialysis.

Only Chronic dysfunction leading to dialysis will need transplantation.

There is something called preemptive transplantation where transplantation is done before dialysis is started in an end stage renal failure. There are many merits compared for transplantation after long term dialysis. 

After having discussed about transplantation I would like to emphasise that early transplantation is beneficial for patients with end stage renal disease, however the medical suitability to tolerate a transplant and available compatible related donor has to assessed before that influences the timing of transplant.