Kidney transplant is the treatment of choice for End-Stage Renal Disease (ESRD) in eligible patients.
Chronic kidney disease is a major health concern in many countries affecting more than millions across the world and places a heavy burden on patients, their families and the nation’s healthcare system.
Sometimes, part of the solution for kidney failure is a kidney transplant. A kidney transplant is a surgical procedure where a healthy kidney from a live or deceased donor is placed into a person whose kidneys no longer work properly.
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Kidney transplant is the treatment of choice for End-Stage Renal Disease (ESRD) for eligible patients. Compared to dialysis, a kidney transplant is associated with:
Register Now or Make An Inquiry if you have any more questions.
Doing your own research.
Identify Island Hospital as your choice of hospital for kidney transplant (overseas recipient and donor travel to Island Hospital Penang, Malaysia).
3) 1st Consultation and Evaluation (3-5 Days)
4) Wait for Results (14 Days)
Patient and donor wait at home.
5) 2nd Consultation and Evaluation (2 Days)
Consultation with Nephrologist for the results.
6) Approval Process (30 Days)
7) Admission (1-2 Days)
Overseas recipient and donor travel to Island Hospital, Penang, Malaysia.
8) Surgery (Estimated 3 hours)
9) Hospitalisation (Estimated 7 days)
Overseas recipient and donor to remain in Penang, Malaysia.
10) Outpatient (Estimated 14 days)
Normal Kidney Functions
Most people are born with two kidneys on either side of the spine, behind the abdominal organs and below the rib cage. Kidneys are shaped like kidney beans. The kidneys perform several major functions to keep the body healthy and alive. Our kidneys:
When working well, it produces urine. Urine is then carried to the bladder through the ureter like pipes. It stays in the bladder until the body senses that it is full and thus releases the urine from the bladder through the urethra.
What is kidney failure?
When the kidneys stop working, waste products and metabolites start accumulating in the blood, leading to renal failure. If it persists (chronically), end-stage renal disease occurs and either dialysis or transplantation is required.
Common causes of end-stage renal disease
Treatments for End-stage Renal Disease
The treatments for end-stage renal disease are:
While none of these treatments cure end-stage renal disease, a transplant may offer the closest thing to a normal life because the transplanted kidney can replace the failed kidneys. However, it also involves a life-long dependence on medicine (which may have severe side effects) to ensure the transplanted kidney works well.
In some cases, dialysis patients who also have severe medical problems such as cancer or active infections may not be suitable candidates for a kidney transplant.
Types of kidney transplant done in Island Hospital
A kidney transplant is the transfer of a healthy kidney from one person into the body of a person who has little or no kidney function. Typically, kidney transplants can be done from a deceased donor or living donor. At Island Hospital, we perform only with living donors.
Living Donor Kidney Transplant
Living Donor Kidney Transplant vs. Deceased Donor Kidney Transplant
A living donor transplant has many advantages over a deceased donor, the most important being that it has a significantly higher success rate. Additional reasons may include:
|Living Donor Kidney Transplant||Deceased Donor Kidney Transplant|
|The transplanted kidney generally works immediately after the transplant.||The transplanted kidney could possibly take several days or weeks to function normally.|
|The transplant can be scheduled, giving the recipient and donor preparation time.||There is no way to know when a deceased donor kidney will be available, and surgery must be performed immediately after it is available.|
|A lower risk of rejection, especially if the kidney is donated by a blood relative.||A higher risk of rejection by the body.|
|Potentially reduces the waiting time to receive a kidney transplant.||The average wait time could be from three to five years or longer.|
Why are kidney transplants done?
There are pros and cons to both dialysis and kidney transplants.
|Kidney Transplant||Dialysis (Hemodialysis)|
|Less time and effort required to meet with doctor||Takes a lot of time
Frequent trips per week to a dialysis centre.
|Reduced long-term cost of dialysis||Labour-intensive
Requires medical professional assistance every visit
|A more active and normalised life with fewer dietary restrictions||Frequent discomfort
Requires patient to have needles inserted into them every visit. They have to sit there for hours and may feel tired after each visit.
Strict dietary restrictions.
|Lower risk of death||Higher risk of medical complications and death|
Although kidney transplant is the treatment of choice for End-Stage Renal Disease (ESRD), the procedure may not be suitable for everyone as there are a number of factors to consider. To ensure the safety and longevity of both the patient and the donor, the following conditions must be considered before the procedure can be carried out.
Kidney transplants may not be suitable for everyone. This includes people who have/are:
Risks and complications of kidney transplant
Kidney transplant surgery carries the risk of significant complications, including:
Also, kidney transplant is a major surgery. Therefore, it may have the surgical risks of:
Anti-rejection medication side effects
After a kidney transplant, patients need to take medications to help prevent their body from rejecting the donor kidney. However, these immunosuppressant drugs can lead to some unpleasant side effects such as:
It is best to discuss with your doctors these risks and complications which are generally low in a well-optimised patient.
If your doctor recommends that a kidney transplant be done, you will need to be referred to a licensed kidney transplant hospital, like Island Hospital. You can also find out if your insurance covers the transplant costs (pre-operation, operation and post-operation) and has a panel of hospitals to offer.
When you consult with our nephrologists at Island Hospital, we can share in-depth information on:
At Island Hospital, our facility, an integrated team of doctors trained in kidney diseases (nephrologists), renal transplant surgery (urologist), infectious disease management, and other specialties is focused on the needs of the patient and his family. Nephrologists, surgeons, doctors, transplant nurses, pharmacists, and others work together to manage every aspect of the patient’s kidney transplant, from planning through to post-surgical care.
Having all of this sub-specialised expertise solely focused on you means that you are getting care from the entire team and not just getting one opinion. At the same time, patient care is discussed among the team, test results are made available quickly, and appointments are scheduled in coordination so that the whole team can work together to determine what is best for the you.
Other medical professionals include:
Facilities at Island Hospital
Evaluation process and finding a match
After you have selected Island Hospital as the transplant centre of choice and your donor, you will be evaluated medically to determine whether you and your donor meet the eligibility requirements for a kidney transplant, which may take several days.
The team will assess whether you and your donor:
Medically speaking, a kidney donor can be alive, deceased, related, or unrelated to the patient. However, transplant laws may differ as certain countries may have different criteria on who can be a lawful donor. Our transplant team will consider several factors when evaluating whether a kidney donor will be a good match for you before submitting all test reports to the Unrelated Transplant Approval Committee (UTAC) of Malaysia for approval.
After your medical examination confirms that you are a suitable candidate for kidney transplant, the next step is to evaluate both you and your donor for compatibility.
It all begins with a blood test which will determine your donor’s blood type and whether it is compatible with yours. If it is compatible, two more blood tests will be done (tissue typing and cross-matching).
1. Blood Typing (ABO Compatibility)
A match is good if the donor and recipient have compatible blood types. This increases the chances of the recipient’s body accepting the new kidney.
Blood typing is the first blood test to check the blood type compatibility between the patient and donor.
If their blood type(s) does not match, the donor may not be able to donate his kidney to the patient.
A simple blood test is able to determine the blood type. The four basic blood types are A, B, AB and O. (Type O is the most common blood type and anyone of any blood type can accept type O.)
|Donor’s blood type||Blood types which can accept donor’s kidney|
|O||O, A, B, AB|
|A||A or AB|
|B||B or AB|
2. Tissue typing (or genetic typing)
Tissue typing (human leukocyte antigen (HLA) typing) is a blood test that matches the number of antigens that you and your recipient share. These antigens can recognise differences between their body tissues. This test also compares genetic markers which can tell how likely the transplanted kidney will last.
Each person has six basic tissue typing antigens (or markers) shared equally from their parents. A parent and child would have at least a 50 percent match while sibling can have a zero to 100 percent match.
The best tissue type for you, the recipient is to have a six out of six antigens match (a zero mismatch), something which is possible.
It is not necessary for all antigens to match in order to have a successful transplant. Sometimes, even one matched antigen could work.
Cross-matching is a blood test carried out at least twice you and your donor and recipient to see if there is any reaction to your donor’s kidney.
It involves mixing a small sample of your blood with your in the lab. The test determines whether antibodies in your blood will react against specific antigens in your donor’s blood.
If there is no reaction, the result is a negative cross-match, paving the way for a transplant surgery.
But even if you have passed all other tests, yet you are found to have a positive cross-match (your body would attack the new kidney), the surgery cannot be done unless you go through additional treatment before and after the transplant to reduce the risk of your antibodies reacting to your donor’s kidneys.
Other tests on you and your donor in the donor evaluation which may take several days include:
After the evaluation, our kidney transplant team will discuss the results with you, and advise if you have been accepted as a kidney transplant candidate.
Living kidney donation
Getting a willing living kidney donor is an option other than waiting for a compatible deceased-donor kidney to be available.
Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants are also common with kidneys donated from emotionally related non-family donors such as friends. This is subject to approval from the ethics committee in the Unrelated Transplant Approval Committee (UTAC) of Malaysia, which takes about 14 days.
Staying healthy and active is vital whether you are waiting for a donated kidney or your transplant surgery is already planned. It may also help to speed up your recovery from surgery. Make effort to:
What to bring to the hospital
Here are some suggestions for your convenience during your hospital stay:
What you may want to think about if you live alone
For your convenience, there are certain things you would want to manage before getting admitted:
What to do on the day before surgery
Tell your doctor if you have any changes in your physical condition (fever, cold, dental problems, sore throat, urinating problem) or skin condition (rash, cuts). Surgery may need to be postponed.
(See instructions on pre-surgical food and drink guidelines )
What to do on the evening before surgery (admission may be 1 day or more before the surgery)
What to do on the morning of surgery
Directions on Food and Liquid Before Surgery
The following are based on your arrival time to the hospital, not your scheduled surgery time.
Smoking, Vaping or Chewing Tobacco: Do not smoke, vape, chew tobacco or use any other tobacco products up to 24 hours before your scheduled arrival time. This will reduce the risk of complications. If you do use tobacco products within 8 hours of your scheduled arrival time, your surgery may be delayed or canceled.
Alcohol: Do not drink alcohol up to 24 hours before your scheduled arrival time.
Solid Food: You may eat your regular meals up to 8 hours before your scheduled arrival time.
Solid Food: You may eat a light meal up to 6 hours before your scheduled arrival time.
A light meal is:
Clear Liquids: Drink clear liquids up to 2 hours before your scheduled arrival time.
Clear liquids are only these:
Drink 350ml – 600ml of electrolyte sports drink (Gatorade® or Powerade®) 2 hours before your scheduled arrival time.
Hard Candy and Gum:
Medicines: Take your medicines as directed with a small sip of water.
Details of procedure
Kidney transplants are done with you and your donor under general anesthesia, so that you are unconscious during the procedure. The surgical team also monitors the heart rate, blood pressure and blood oxygen level throughout the procedure.
After your kidney transplant, you can expect to:
1. Spend about a week in the hospital.
Our medical team will monitor your condition in the operation recovery area to monitor possible signs of complications. Your new kidney will produce urine just like how your own kidneys did when they were healthy and most often, it starts immediately. In other cases, it may take several days. You may expect aches or pain around the operation site while you’re healing.
Most kidney transplant patients can return to work and other normal activities within three to eight weeks after the procedure. Patients are not encouraged to lift objects weighing more than 5kg or do vigorous exercise other than walking until the wound has completely healed (usually about six weeks after surgery).
2. You need to go for frequent check-ups as you continue to recover.
Close monitoring is necessary for a few weeks. You may need blood tests several times a week and have your medications adjusted in the weeks after your transplant. If you live in another city or country, you may need to make arrangements to stay near the transplant centre.
3. Take medications the rest of your life.
You’ll need to take a number of medications after your kidney transplant. Drugs called immunosuppressants (anti-rejection medications) help keep your immune system from attacking and rejecting your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant.
After a successful kidney transplant, you will no longer need dialysis because the new kidney will filter your blood.
You’ll need medications to suppress your immune system to prevent your body from rejecting your donor kidney. Because these anti-rejection medications may make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.
After the transplant, skin check-ups with a dermatologist to screen for skin cancer are vital and it is recommended to keep your health screening (including cancer screening) up-to-date.
Depending on your health condition, ability to withstand surgery and expectations on the quality of life, there are several possible courses of actions for you if your new kidney fails:
Managing Your Life After Kidney Transplant
It is important to plan ahead these things for your life after kidney transplant as you adapt to the new lifestyle:
It is important to understand as much as possible as you manage chronic kidney diseases and consider kidney transplant as an option. Speak to us as soon as possible to understand more and be better prepared.