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Kidney Transplants Explained


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Table of Contents

Foreword by Timothy Statham OBE xiAuthors' Acknowledgments xiiIntroduction 11 Suitable for transplant? 5Who can have a transplant? 5Fitness for transplantation 7Testing for infections 9Getting information early 10Getting onto the list 112 Matching a kidney to a patient 12Matching the blood group 12Matching the tissue type 14The performance of UK transplant centres 16New kidneys and old diseases 203 Deceased donor transplants 22Heartbeating donors 22Non-heartbeating donors 23The transplant list 24Average waiting time for a deceased donor kidney 27Being on the transplant list 29Do you have to be on dialysis first? 30Tests before the operation 31Physical examination 31The cross-match 32Kidney Transplants ExplainedBeing ready for a transplant 32You and your donor 34Contacting the donor family after transplantation 37How long will a deceased donor transplant last? 374 Living donor transplants 39Who can donate a kidney? 40Tests before living donor transplantation 42Risks to the donor 455 The donor's operation 47Open nephrectomy (open surgery) 47Laparoscopic nephrectomy (keyhole surgery) 47After the operation 506 Living donor transplantation: some considerations 54Rejection 54Some advantages of living donor transplants 54The Human Tissue Authority (HTA) 58Antibody incompatible transplants (AIT) 59'Exchange' or 'paired donor' transplantation 60Alternatives to antibody incompatible and exchangetransplantation 62Giving a kidney to someone you have never met 62Buying and selling organs 647 The transplant operation 68The operation 69After the operation 70Heading home 748 Medication 76How immunosuppressant drugs work 76Types of immunosuppressant drugs and their side effects 78Working out what is best for you 82Making sure you know what to expect 84Continuing your medication 85Other drugs after a transplant 869 The first three months 89Rejection 89The rejection process 89Acute rejection 90Tests to investigate reduced transplant function 91Treatment for acute rejection 93Infections 93Prevention of infection after a transplant 98If it all gets too much 98Three months out, and OK? 10010 Looking after yourself and your transplant over the years 102Stay in touch 103Take control 104Chronic rejection (or chronic allograft nephropathy) 105Circulation problems and high blood pressure 107Cholesterol 108Diabetes 110Cancer 114Problems with your bones 11711 Living with your transplant 121Social life 121Back to work 122Holidays 123Eating and drinking 126Enjoying your freedom while keeping your kidney healthy 126Keeping fit 12712 Relationships, sex and having children 129Drugs to help with erections 129Contraception 130Planning a pregnancy 13113 Transplant failure 135Success rate for second transplants 135Causes of transplant failure 135How does rejection cause transplant failure? 136Waiting for a kidney after transplant failure 137Coping with a failed transplant 138Stress for kidney transplant patients 139Factors affecting the ability to cope 14114 Research and future developments 144History of transplantation - a time of rapid change 144What is research and how does it apply to me? 145Possible future developments 148New therapies 149Glossary 151Appendix 1 Kidney disease - what do the numbers mean? 161Appendix 2 Useful addresses and websites 162Index 166

About the Author

Dr Andy Stein MD, FRCP, is Consultant Nephrologist and General Physician at the University Hospitals, Coventry and Warwickshire NHS Trust, and co-author of Kidney Failure Explained, now in its fourth edition. MD FRCP Consultant Nephrologist at University Hospitals, Coventry and Warwickshire NHS Trust Janet Wild, RGN is Clinical Education Manager at Baxter Healthcare Renal Division. She has been a Renal nurse since 1988.

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