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Call our Transplant Center at 512-901-2880 and ask to start the transplant evaluation. The scheduling coordinator will get your demographic and insurance information. This is the beginning of your evaluation for transplant candidacy.
Office hours are 7:30 am to 5 pm, Monday through Friday
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1) Transplant Orientation – Educates the patient and family about the transplant process.
2) The transplant evaluation includes:
• Multiple blood and radiological tests
• Evaluation by a transplant physicians, social worker, financial coordinator and dietitian
• Clearances as needed by specialists like cardiologists, pulmonologists, gastroenterologists etc.
• Basic health screenings like Mammogram, PAP smear, Colonoscopy as applicable
3) Listing – Once the evaluation is completed, the patient records are presented to the Transplant Committee. The Transplant Committee will then decide if:
• The patient is an acceptable candidate and can be placed on the transplant list and, if applicable, the evaluation of the living donor candidates can be initiated, or
• Further testing is needed before a decision can be made, or
• Transplant is not the best option for this patient.
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There are two possible sources for a donated kidney for a transplant: a deceased donor kidney and a living donor kidney.
Deceased donor kidney: A deceased donor kidney comes from someone who has died from an accident in which the kidneys are not damaged and remain fully functional or from someone who has died from an illness or disease which does not compromise the kidneys.
Living donor kidney: A living donor kidney can come from a related family member such as a brother, sister, parent, or child. A living donor kidney can also come from an unrelated donor such as a spouse, friend or altruistic donor.
Advantages of living donor kidney
There are several advantages a living donor kidney has compared to a deceased donor kidney:
Closely Matched Donor: Living donation increases the possibility of obtaining a closely matched related donor kidney. In general, the better the match, the better the chances for long-term survival of the transplanted kidney.
Faster Transplants: A living donor evaluation can be completed in few weeks and the transplant surgery can be scheduled shortly thereafter. This allows the recipient to receive a kidney much sooner than a deceased donor kidney, which has an average wait time of 3 to 4 years.
Improved Outcomes: Research has shown that the less time spent on dialysis prior to transplantation, the better the outcome in terms of both short and long term function of the transplanted kidney.
Scheduled Surgery: Having a living donor allows the transplant center and the candidate to schedule the transplant surgery, allowing the patient to prepare for the surgery and post-transplant recovery time.
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At the time of surgery, patient can expect the following:
1. Placement of an intravenous needle, commonly called an IV, in the arm for administration of fluids and medications for relaxation before the anesthesia.
2. General anesthesia for sleep and prevention of discomfort or pain during the operation.
3. Once asleep:
a. Tube placement into the throat to assist breathing during surgery.
b. IV catheter placement in the neck area, called a central line. This makes it easier to administer IV medications and fluids during and after the surgery. The nurses can also take blood out of this line.
c. Shaving of abdomen and pubic area. This decreases skin bacteria which might cause infection.
d. Catheter placement into the bladder.
4. The new kidney is placed on either side of the lower abdomen. This location makes it easier to attach the kidney to a good blood supply and to the bladder. This placement also allows the kidney to be protected by the large hip bone behind it. The native kidneys will not be removed unless necessary.
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In the Hospital
The transplant recipient is taken to ICU after surgery where IV fluids and medications will be administered through the central line, vitals signs are monitored continuously and the bladder is kept empty by a catheter. There will be some pain in the surgery site and pain medication is normally administered through a patient controlled device to assure adequate pain control. Some patients may experience bladder spasms from the catheter and/or throat discomfort from the tube placed during surgery. These discomforts are only temporary and should disappear within a few days.
After the patient is settled, family and friends will be allowed to visit. Most patients are sleepy from the anesthesia and pain medication during this time.
Preventing complications after surgery is a major goal of nursing care. Lung infections, constipation, and risk of blood clots in the kidney, legs, heart, lungs and brain are potential complications after the operation. To decrease those risks, patients are asked to do the following:
• Begin deep breathing and coughing exercises once awake after surgery.
• Frequent use of the incentive spirometer (breathing exercise equipment) while awake.
• Get out of bed as early as the first day after surgery.
• Walk in the hallway, increasing the distance every day.
From the ICU, the transplant patient is moved to the Renal Unit between 24 to 48 hours after the surgery. Rehabilitation includes activities like walking in the hallway several times a day. Extensive instruction is provided for both patients and their families to ensure a smooth transmission from hospital to outpatient care. These instructions cover medications, signs and symptoms of rejection and other complications, as well as diet and exercises and what the patient can do to improve recovery.
The Daily Routine
DAILY BLOOD SAMPLES: Blood will be drawn daily to monitor progress and to adjust daily medicines.
1) Kidney function - BUN, creatinine, electrolytes, red blood count
2) Medication side effects - white blood count, liver panel, lipid panel
3) Medication levels - Cyclosporine, Prograf
DAILY WEIGHTS: Each patient is weighed daily before breakfast to monitor weight change. Increases in weight usually result from fluid retention.
MEASURING FLUID INTAKE AND OUTPUT: As soon as the patient arrives on the kidney floor, nurses will begin patient education. This includes how to keep track of all the liquids taken by mouth. At the same time the nurse will note all the fluids given by IV as well as the urine output. An appropriate fluid balance is important for the proper functioning of the transplanted kidney.
ULTRASOUND: During this procedure a jelly-like substance is placed on the lower abdomen. The kidney and bladder are then examined by passing a smooth hand-held device over them, allowing visualization of the kidney and its surrounding area. The purpose of this procedure is to observe the blood flow through the kidney and to find possible obstructions in the kidney or fluid collections around the kidney.
RENAL SCAN: This is a special X-ray of the transplanted kidney. A radioactive substance is injected into a vein and pictures are taken of the kidney to see how it absorbs and excretes the substance. This procedure shows the blood flow and function of the kidney as well.
At Home
During the hospital stay and during the transplant clinic, members of the transplant team ensure that transplant patients have the knowledge and skills necessary to take an active role in maintaining a healthy lifestyle by providing extensive teaching and support. Transplant patients are required to:
1. Make lab and clinic visits as ordered by the transplant physician.
2. Measure vital signs, weight, fluid intake and urine output daily.
3. Note above results in a diary. This dairy is then reviewed in the clinic.
4. Take medications at regular intervals, mostly twice a day, 12 hours apart.
5. Be in charge of keeping an adequate supply of medications at all times.
6. Report any changes in their wellbeing.
7. Report any changes in their circumstances, such as phone number or address changes, to the transplant center to ensure a seamless collaboration between patient and transplant team.
Transplant patients will be followed in the transplant clinic for 6 months, then discharged to their nephrology office. They are expected to return to the transplant clinic annually around the time of their transplant anniversary. The transplant center keeps responsibility for all their patients as long as the transplant is still functioning and has to give regular update report to the United Network for Organ Sharing (UNOS).
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The immune system is the body’s defense mechanism. It is very complex but vital to maintaining overall health. It attacks any “foreign” substance that enters the body, including infectious organisms such as bacteria and viruses. By a series of steps, it finds the foreign material and attacks it.
There are two major genetic systems in the body that affect the immune system’s response to a transplant, ABO and HLA. Generally speaking, a close genetic match between the kidney donor and the kidney recipient reduces the risk of rejection.
ABO (blood type): All humans have one of four blood types, A, B, O, or AB. The first test of a “match” is to determine ABO compatibility. You do not necessarily have to have the exact same blood type to be compatible. There are so called “universal recipients” (AB) and “universal donors” (O) for blood.
HLA (human leukocyte antigen): This system is much more complex than the ABO system and involves the matching of antigens in the blood and tissues of the donor and candidate. Antigens recognize something as “foreign” to the body and produce antibodies, which then attack the foreign object. This process is called the immune response. This procedure is called “tissue typing.”
Both systems involve inherited traits, which is why parents, siblings, and offspring can make the best possible match. However, because we receive different genes from both parents, no relatives except identical twins (who have the same genes) will ever be a “perfect” match. There are infinite degrees of compatibility which influence the short and long term risks of rejection. The idea behind successful transplantation is to get the best possible match to reduce the chances of the immune response activating and attacking the donated kidney.
With transplantation, the new organ will be recognized as foreign by the immune system, and will react against it. This process is called rejection. In order to prevent and limit the immune system’s rejection to the new kidney, patients will take medications to suppress or reduce the normal immune responses. These drugs are called immunosuppressants. While immunosuppressants limit organ rejection, they also lower the body’s defense against infectious organisms, thereby increasing susceptibility to infections.
Current immunosuppressant drugs are: Cellcept, Neoral or Prograf, Prednisone, Rapamune, Solumedrol, Campath, Zenapax, Thymoglobulin and OKT3. In our transplant center we use an approach of in Induction and Maintenance therapy. Induction covers the medications given at the time of transplant surgery, while Maintenance includes the medications taken after the transplant for as long as the kidney is working. Each transplant recipient will be placed on a regimen best suited to that individual. Different combinations and dosages of the medications may be used at different times, but the goal is to prevent kidney rejection while minimizing the side effects to the patient. A significant amount of research is done to find immunosuppressive agents that prevent kidney rejection and produce fewer side effects.
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All humans have a built-in defense system that allows the body to protect itself against disease. Unfortunately, this defense system cannot always distinguish between what is good and what is bad for us. This can cause the body to reject the transplanted kidney.
Generally speaking, the best matches come from close relatives since they are most likely to share genetic characteristics which reduce the chances for rejection.
Typically, a biological parent, brother, sister, or child of the candidate will make a better match. Other relatives, such as aunts, uncles, or cousins, may be an acceptable match. Non-relatives, such as a spouse or friend, may be a compatible match, too. It is important to note that even poorly matched kidneys from living donors have better 10-year graft survival rates than closely matched or mismatched deceased donor kidneys.
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In general terms, either living or deceased donor kidney transplantation allows the patient a higher quality of life than is possible with dialysis.
The primary advantages experienced by most transplant patients include:
• The donated kidney works like a normal kidney
• There are fewer restrictions on diet
• Fluid intake does not need to be severely restricted
• Patients generally feel healthier because they do not experience the chemical imbalances and other side effects of hemodialysis
• Patients are not restricted by the dialysis routine and have greater freedom in their schedules
• Patients have greater mobility in traveling
• Patients have a greater range of physical activities available to them and greater freedom of movement
There are also a number of disadvantages to kidney transplantation. These may include:
• Taking anti-rejection drugs for as long as the transplanted kidney is working
• Undergoing major surgery
• Finding or waiting for an available donor
• Facing the possibility of kidney rejection, requiring additional transplants or returning to dialysis
• Dealing with the possible side effects of the medications
• Increased susceptibility to infections
• Increased incidence of cancer over the general population
• Weight gain
• Increased hair growth
These are all considerations which the kidney patient must take into account when making a decision about the most appropriate treatment.