What is kidney (renal) transplantation?

It is the best form of renal replacement therapy as it can provide the best clearance of solute (toxic substance of metabolism) and water; and allows the best quality of life (Fig. 13). However, availability of kidney is the main hurdle to it. In Hong Kong, on average, children with end stage renal diseases have to wait for 4-5 years before getting a cadaveric kidney. Kidneys from close relative is better than from cadavers as it results in better kidney graft survival and pre-emptive kidney transplantation (transplantation without previous dialysis) can be arranged. On average, the survival of a kidney graft is about 70-80% in ten year; and it is better in those from living donors. However, patients after transplantation have to take long-term immunosuppressive drug treatment to prevent rejection as the kidney is a foreign organ. Good drug compliance is needed and often supervision is necessary especially in adolescents who are notorious of poor drug compliance which may result in graft rejection. To have a better survival of the graft, it is important to prevent rejection. Better drugs will lead to lower risk of rejection. Infection remains the major concern as the child is always in an immunosuppressive state. When kidney graft fails, the child has to go back to dialysis therapy (PD or HD).

(Fig. 13) donated kidney transplanted into the patient (vein to vein, artery to artery and ureter to bladder of patient)