Rashtriya Janata Dal (RJD) leader and former Bihar Chief minister Lalu Prasad Yadav has undergone a kidney transplant in Singapore’s Mount Elizabeth hospital, with his daughter Rohini Acharya donating the organ. As per updates from the family, the surgery was successful. “Father is in the ICU, he is conscious and is able to talk,” said his daughter Misa Bharti on Twitter. This has shed the spotlight on kidney donors and recipients and their well-being after the surgery. Dr HS Mohapatra, professor of nephrology at Dr Ram Manohar Lohia hospital, talks about the precautions that need to be taken by both after the surgery.
WHAT DONORS NEED TO DO?
With almost all medical centres now moving to laproscopic kidney donation – which is minimally invasive and leaves behind only three tiny scars on the abdomen – a donor can leave the hospital within two to three days of the surgery.
Dr Mohapatra says that a donor can live a completely normal life with one kidney. “Donors can start doing all their normal everyday work as soon as ten days after the surgery. It is uneventful for a majority of donors. However since it is a surgery there is a small percentage – less than one per cent – who might face complications and death. It is the same as the risk with, say, a simple gallbladder surgery.”
To keep a check on their condition, however, it is suggested that “donors get their blood pressure and urine creatinine level tested every six months,” he added.
PROTOCOL FOR RECIPIENTS
With kidney recipients already being ill before the surgery and vulnerable to infections due to the immunosuppressants prescribed, they have to take more precautions. Mid-term, they may face the threat of rejection and in the long term, they may develop cancers. “Although the doses of immunosuppressants are reduced over time, they have to be taken life-long. The long term consequence of that is it may allow the unchecked growth of certain cells leading to cancers. “Transplant patients are at a higher risk of lymphoma and other cancers. But they happen after years and years of taking the medicines and are treatable,” said Dr Mohapatra. There is also a loss of libido. “Whereas patients who have undergone transplants can eat almost anything – of course burgers and pizzas are not advisable – they have to ensure that it is clean. Sexual activity is not a problem, and women who have undergone kidney transplant can also give birth,” said he.
As for survival after the transplants surgery, although no concrete data exists from all centres across the country, Dr Mohapatra added that an estimated 90 per cent survive past the one-year mark, 70 to 80 per cent past the five-year mark, and 50 to 60 per cent past the ten year mark.
He said, “In the short term, infections are the worry. Those who have undergone transplant are at a risk of bacterial infections up to three months after the surgery, and viral and fungal infections after that. That is why it is crucial that they maintain personal hygiene, drink very clean water, and eat hygienic foods during this period. The rate of infection may vary from hospital to hospital – at my centre we see around 30 to 40 per cent of patients coming in with infections but all of them get better after treatment.” Although transplant patients always remain at a slightly higher risk of infections, the risk goes down in later years with doses of their immunosuppressant medicines being tapered.
To keep an eye for any complications, transplant patients need to visit their doctor weekly for the first month, fortnightly for the next two months, monthly for the next three or four months, and every three months life-long. “They should also reach out to their doctors if they have any symptoms of an infection, difficulty breathing and so on. Barring the preventative check-ups, the patient leads a 100 per cent normal life,” said Dr Mohapatra.
HOW A TRANSPLANT IMPROVES THE QUALITY OF LIFE
“A kidney transplant immensely improves the quality of life of people with chronic kidney disease who are under dialysis,” he said. Patients on dialysis (an out-patient procedure where the machine takes over the function of filtering waste instead of the kidneys) have to follow a strict treatment schedule in order to avoid build-up of waste in the body. They might face fluctuations in blood pressure, electrolyte imbalance, fluid accumulation and later problems finding an access site for the port from where the blood is taken out and sent in.
Not to mention the long-term repeated costs for the dialysis treatment – one dialysis session might cost anywhere between Rs 2,500 to 4,000 with patients needing it two to three times a week, whereas kidney transplants may cost between 5 and 10 lakh.
“Patients on dialysis need to follow a very strict diet – restrict the intake of water and salt. The amount of protein also has to be decided depending on the kidney function. They may face electrolyte imbalance,” said Dr Mohapatra.
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