Transplantation is not a cure
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Many years ago, when I first registered for a kidney transplant, a nurse told me: “Transplantation is not a cure” This struck me as odd. Having a new, healthy kidney filtering my blood sure seemed like a cure.
What Did This Transplant Nurse Mean?
Even if we do receive a healthy, new kidney, the conditions that brought about kidney failure haven’t necessarily changed. If someone loses their kidneys due to a pervasive condition like high blood sugar or lupus, they still have those conditions even after a transplant. And those conditions need to be managed on a continual basis.
People with high blood sugar who are lucky enough to have a transplant of both the kidney and the pancreas, certainly have a new lease on life. But they must still be aware of their weight and blood sugar to keep the new kidney healthy. This can be a challenge as transplant medications stimulate the appetite and raise blood sugar.
If someone lost their kidneys due to high blood pressure, they especially need to continually monitor the blood pressure after the transplant. High blood pressure is often called the silent killer because it’s so easy to ignore. But if we want the new kidney to last, it’s important to stay on top of our blood pressure readings.
Conditions like IgA nephropathy and Focal Segmental GlomeruloSclerosis (FSGS) don’t affect the whole body. These conditions involve inflammation of the kidneys. However, IgA nephropathy and FSGS can recur in the new kidney as well. Why some patients have a recurrence and others don’t is not well understood, especially since little is known about why these conditions occur in the first place. But we can reduce the inflammation and stress on the kidneys and work to preserve renal function. Personally, I worked through recurrent FSGS in my own transplant.
Besides the same challenges patients had with their health before transplantation, they should also anticipate new issues. While it is right after transplantation that we’re most likely to experience acute rejection, any transplant can reject at any time. Many people are under the impression that immunosuppressive medications are only needed in the short term, and that after a certain amount of time has passed, the kidney will “take” and the medications will no longer be necessary. This is not the case. With very few exceptions, patients need to take immunosuppressive medications for as long as they have their transplant.
Transplant patients should understand that the new kidney is not going to last forever. A patient may enjoy a decade or even two with their transplanted kidney functioning well. For older recipients, the new kidney may last for the rest of their lives, but for young people, it is a stop-gap measure until they need dialysis or another transplant. And a temporary measure is certainly not a cure.
The new kidney will face challenges from both the patient’s own immune system and the transplant medications. While transplant medications can turn down the immune response, they don’t turn off the immune system completely. Over time, minor pathways of the immune system can cause chronic rejection of the kidney with scarring and fibrosis.
Transplant medications are directly toxic to the kidneys. In fact, they are so nephrotoxic that transplant patients who receive an organ other than a kidney may develop further kidney problems due to transplant medications. There may come a time when nephrotoxicity is no longer an issue. Each new generation of transplant medications shows some improvement – from Imuran to Cyclosporine to Tacrolimus. But for now, nephrotoxicity is a necessary evil of transplantation.
Kidney transplant patients also need to be vigilant to new concerns with their health. Turning down the immune system increases the risk of cancer and infections. There are also issues with post-transplant blood sugar levels and gastrointestinal distress.
Transplant- The Next Chapter
Despite all of the issues that transplant patients face, nothing beats a working kidney. It’s a great relief on the body to be able to filter out waste again. After years of high creatinine levels, I never thought I’d see a creatinine of 1.3 again, but that’s exactly what I saw on my first blood test after the transplant. Living without a major organ is hard, and having a working kidney is a great blessing. A transplant may not be a cure, but it’s the next chapter in our journey.