🧬 Renal Transplant (Kidney Transplant) Expertise of Dr. Yasir Iqbal

A renal transplant is a surgical procedure done by Dr. Yasir Iqbal where a healthy kidney from a donor is implanted into a patient with end-stage renal disease (ESRD) or chronic kidney failure. It’s considered the most effective long-term treatment for patients requiring renal replacement therapy.

🏥 Surgical Procedure

1. Duration: 2–4 hours

2. Location: The donor kidney is placed in the lower abdomen (iliac fossa).

3. Connection: Surgeon connects:

   • Renal artery and vein to the iliac vessels

   • Ureter to the bladder

4. The native (old) kidneys are usually left in place unless infected or enlarged (e.g., polycystic).

💊 Post-Transplant Care

Immunosuppressive Therapy:

To prevent rejection, lifelong use of medications is required:

• Tacrolimus or Cyclosporine

• Mycophenolate mofetil or Azathioprine

• Prednisolone (steroids)

Monitoring:

• Kidney function (Creatinine, GFR)

• Drug levels

• Urine output

• Blood pressure and glucose

💊 Anti-Rejection Medication Side Effects

After a kidney transplant, patients must take immunosuppressive drugs for life to prevent the body from rejecting the new organ. While these medications are essential, they can have significant short- and long-term side effects.

🧪 Main Classes of Anti-Rejection Drugs and Their Side Effects

1. Calcineurin Inhibitors (CNIs)

Examples: Tacrolimus, Cyclosporine

Common Side EffectsKidney toxicity (nephrotoxicity)High blood pressure (hypertension)Tremors or shakingIncreased blood sugar (can cause diabetes)HeadacheIncreased risk of infectionGum overgrowth (Cyclosporine)Excess hair growth (Cyclosporine)

2. Antimetabolites

Examples: Mycophenolate mofetil (MMF), Azathioprine

Common Side EffectsNausea, vomiting, diarrheaBone marrow suppression (low WBC, anemia, low platelets)Increased infection riskBirth defects (MMF – must be avoided in pregnancy)Liver toxicity (Azathioprine)

3. Corticosteroids

Examples: Prednisolone, Methylprednisolone

Common Side EffectsWeight gain, fluid retentionHigh blood sugar (diabetes)High blood pressureOsteoporosis (bone thinning)Mood changes, irritabilityAcne, thin skin, easy bruisingIncreased infection riskCataracts and glaucoma (with long-term use)

4. mTOR Inhibitors

Examples: Sirolimus, Everolimus

Common Side EffectsHigh cholesterol and triglyceridesMouth ulcers (sores)Poor wound healingDiarrheaAcne or rashLung toxicity (rare)Protein in urine (proteinuria)

5. Induction Agents (used immediately after transplant)

Examples: Basiliximab, Antithymocyte globulin (ATG)

Common Side EffectsFever, chillsLow blood countsIncreased infection riskAllergic reactions (rare)

⚠️ Long-Term Risks of Immunosuppressants

• Infections: Increased risk of bacterial, viral (e.g., CMV, BK virus), and fungal infections.

• Cancers: Higher risk of skin cancer, lymphoma (PTLD – post-transplant lymphoproliferative disorder).

• Metabolic Issues: Diabetes, obesity, lipid abnormalities.

• Kidney Damage: Ironically, some drugs (especially CNIs) can damage the transplanted kidney over time.

✅ Important Tips for Patients

• Never skip a dose — even one missed dose can lead to rejection.

• Regular monitoring is essential (blood levels, kidney function, blood pressure).

• Report any signs of infection or unusual symptoms to your doctor promptly.

• Practice sun protection to reduce skin cancer risk.

• Maintain a healthy lifestyle to counter metabolic side effects.

🤝 Types of Kidney Transplants

Kidney transplantation can be categorized based on the source of the donor, timing, and compatibility. Understanding these types helps patients and caregivers make informed decisions.

1. 🧬 Living Donor Kidney Transplant

• A kidney is donated by a living person, often a family member, spouse, or friend.

• Donors undergo medical and psychological screening to ensure safety.

Advantages:

• Better long-term outcomes

• Shorter waiting time

• Surgery can be planned electively

Subtypes:

• Related donor (biological relative)

• Unrelated donor (friend, spouse, altruistic donor)

2. ⚰️ Deceased Donor Kidney Transplant

• Kidney comes from a person who has recently died, and whose family consented to organ donation.

• The kidney is preserved and transplanted quickly after retrieval.

Types of deceased donors:

• Brain-dead donor (standard)

• Cardiac-dead donor (non-heart-beating)

Considerations:

• Longer wait time

• Slightly lower success rates than living donors, but still very effective

3. ⏳ Preemptive Kidney Transplant

• Transplant is done before the patient begins dialysis.

• Offers the best chance for long-term kidney function.

Benefits:

• Fewer complications

• Better quality of life

• Lower healthcare costs long-term

4. 🔁 Paired Kidney Exchange (Kidney Swap)

• Used when a donor and recipient are incompatible.

• Two (or more) donor-recipient pairs swap kidneys so that each patient gets a compatible kidney.

Example:
Donor A is incompatible with Patient A but matches Patient B — and vice versa.

5. 🩸 ABO-Incompatible Kidney Transplant

• A living donor with a different blood type donates to the recipient.

• Requires special protocols to reduce antibodies before transplant:

  • Plasmapheresis

  • Immunosuppressants

  • Rituximab

Used when:

• A compatible donor isn’t available

• Paired exchange is not feasible

6. 🧪 HLA-Incompatible Transplant (Desensitization Protocols)

• The donor and recipient are not a good tissue match (high panel reactive antibodies or cross-match positive).

• Recipient undergoes desensitization therapy to reduce rejection risk.

Complex but increasingly successful with modern immunotherapy.

📌 Indications for Kidney Transplant

A transplant is recommended when kidney function drops to <10–15%, and the patient is on or approaching the need for dialysis. Common causes include:

• Diabetes mellitus (diabetic nephropathy)

• Hypertension

• Glomerulonephritis

• Polycystic kidney disease

• Lupus nephritis

• Congenital anomalies

🧑‍⚕️ Eligibility Criteria

• ESRD or stage 5 chronic kidney disease

• Physically fit for major surgery

• No active infections, cancer, or severe heart/lung disease

• Psychologically stable and adherent to lifelong medications

• Compatible donor available (living or deceased)