With over 1000 kidney transplant recipients and living donors under its follow-up, the kidney transplant programme is equipped with the state of the art facilities and multidisciplinary staff to provide advanced and team-based care, putting patients at the hearts of all we do.
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Kidney transplantation is a major surgery conducted under general anaesthesia. During the surgery, a cut will be made in the lower part of the abdomen to place the donor kidney(s) into the patient’s body. The blood vessels from the donor kidney(s) are then connected to the patient’s blood vessels that supply blood to the legs. The ureter from the donor kidney(s) is/are connected to the bladder.
The patient’s own kidneys will not be removed unless there is a specific reason requiring such removal, such as an infection, or if it is necessary to make room for the new kidney(s) to be placed into the body. Besides the surgical operation, other tubes may be inserted for various purposes such as a central venous pressure (CVP) catheter into the vein of the neck to allow monitoring of fluid balance and the administration of fluids or medication, a urinary catheter into the bladder to monitor urine production, and a tube to drain fluid and blood from the operation site.
Finally, a small plastic tube (called a stent) is usually inserted into the connection between the ureter and bladder. This is removed 2 to 4 weeks after the transplant by an outpatient procedure called a cystoscopy under local anaesthesia.
Kidney transplant surgery has no higher risk than other major surgery. However, as with all surgical procedures, complications can occur. The risk of death is less than 1%. Other possible risks of surgery include reactions to anesthetic drug, blood clots, rejection of new kidney, bleeding and infection. It is our priority in ensuring patient’s safety and reducing these risks.
Patients who do not have a living donor can be registered on the National Transplant Registry System (NTRS) if he/she fulfils the eligibility criteria to receive a DDKT.
Your kidney doctor will recommend registration on NTRS if you are medially eligible and willing. You are also encouraged to initiate and check with your doctor on your suitability for registration. A referral will be sent to the transplant team; after which you will be contacted by transplant coordinators to proceed with further screening tests to confirm your eligibility for registration.
Before you return home, the ward clerk would have arranged for your follow-up appointment to see your kidney specialist. In the first year after transplant, you will need to attend frequent clinic visits so that your kidney specialist can review your tests results, adjust your medications and monitor for signs and symptoms of rejection and infection.
Your blood and urine tests should be done at least 1 – 3 days before the clinic visit for timely processing of tests. This is done at the Transplant Center (Singapore General Hospital Block 7, level 1) or Specialist Outpatient Clinic Laboratory (Singapore General Hospital Block 3, level 1).
Bring along the laboratory request forms given to you in the ward and hand these to the laboratory technician.
Avoid doing your tests on the day of your clinic appointment as the results may not be ready for the kidney specialist to review.
Remember to bring your medications when you get your blood tests done. Some tests, such as those testing for immunosuppressive drug levels (e.g. Prograf), will require bloods to be drawn before the morning dose of medication. Take your medications once these tests are drawn and do not omit your medications.
After registering with the clinic receptionist, a transplant coordinator will review your home records and counsel you on post-transplant care.
The transplant pharmacist may see you especially if you have just received a transplant or are receiving complex treatment or are participating in a research study. He/She will check your laboratory results and medications so that recommendations on the doses of your medications can be made to your kidney specialist.
When you see your kidney specialist, please clarify your concerns and the management plan. In particular, you should understand what adjustments are being made to your drug therapy.
In order for your kidney transplant to be successful, you will need to take a combination of medications. There are two important groups of medications:
It is important to take these medications every day, according to your doctor’s instructions.
Immunosuppressive Drugs (Anti-rejection drugs)
The immune system comprises of cells and proteins (antibodies) that help us fight off infections from foreign microorganisms (bacteria/viruses/fungi).
However, the transplanted kidney is also recognized by the immune system as an object foreign to the body. If unchecked, the implanted kidney will be attacked and destroyed by the immune system in a process termed “rejection”.
Fortunately, the use of immunosuppressive drugs has allowed us to put the immune system into a partial sleep, thereby dampening the immune system’s response to allow a transplant to take place. These immunosuppressive drugs prevent the body from rejecting the kidney.
If you stop taking your immunosuppressive drugs, the immune system will wake up and attack your kidney transplant. Rejections may be severe enough for you to go back on dialysis due to kidney failure or die. It is therefore important to take your immunosuppressive drugs every day.
Special instructions on taking immunosuppressive drugs
Prophylaxis Drugs
Because immunosuppressive drugs dampen the immune system’s response, transplant patient are vulnerable to infections. Your kidney specialist will put you on medications to try to prevent infections (prophylaxis).
These medications include:
Take your prophylaxis drugs as prescribed and do not omit them – this would help keep you safe from infections.
Before your kidney transplant, you were restricted to certain types of foods and drinks because of your kidney disease. However, this changes after transplant.
Before discharge, a dietitian will advise you of a nutritional plan. This plan will be tailored to your eating habits, weight, laboratory tests, kidney function and medications.
To promote healing after transplant surgery, you should eat adequate protein-rich foods such as lean meat, poultry, fish, eggs, milk, beans and legumes, and its products. You should also include a variety of grains, fruits and vegetables for adequate calories, vitamins and minerals.
Fad diets, diet supplements and herbal products should be avoided.
Renal failure and dialysis can affect the renal patient’s physical function.
Before transplantation, there is a window of opportunity to increase the success rate of their renal transplantation through prehabilitation.
If the doctor assesses a patient to be frail or to have problems with mobility, they may require an assessment by a physiotherapist. The physiotherapist will work closely with the patient to prescribe an individualized exercise programme to improve their function to help with their recovery after surgery.
During the immediate post-surgical period, you may feel tired easily, loss of appetite, swelling around the ankles and legs, difficulty in breathing and shortness of breath which could lead to physical inactivity. In addition, side effects of medications such as steroids may include weight gain, osteoporosis (loss of bone mass/decrease bone strength) and sarcopenia (loss of muscle mass).
Physical activity is important to mitigate many of these risk factors - if left untreated, this can lead to strokes and heart attacks.
Live On: Support Organ Donation
Live On is a webpage maintained by the National Organ Transplant Unit that provides education and support on organ transplantation in Singapore.
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After your transplant, you will be given medications to suppress the immune system - these medicines are critical to prevent your body from rejecting (fighting) the transplanted kidney. However, body's immune system not only defends the body from infections, it also helps prevent cancer. Abnormal cells are constantly being produced in our bodies - they are identified by our immune system and destroyed. The suppression of the immune system compromises this clearance of abnormal cells and puts transplant recipients at higher risk for development of certain cancers.
Cancer is a common problem in Singapore with 1 in 4 people developing cancer in their lifetime even without a transplant. Colorectal, lung and breast cancer are the commonest cancers diagnosed*.
Transplant recipients are at particularly high risk of cancers of the skin, lymph nodes and cervix (neck of the womb) compared to people without a transplant. Whilst cancer is treatable if detected early, cancer is among the top 3 causes of death in transplant recipients and we should be vigilant.
Infections are diseases caused when microorganisms such as viruses, bacteria, or fungi invade the human body.
Infections can occur when germs are passed onto a person from another person (e.g. cough droplets), animals or the environment (e.g. soil, water, the food we eat). Infections may also occur when germs that are usually in our own body get out of control or reactivate.
Common infections that can develop in kidney transplant recipients include infection of the lungs (pneumonia), urine (urinary tract infection), food poisoning (gastroenteritis) and soft tissues. Kidney transplant recipients may also acquire unusual infections that do not usually affect healthy people (opportunistic infections).
Because of the kidney disease and anti-rejection medications which suppress the immune system, kidney transplant recipients are more susceptible to infections and are at risk of developing more severe or complicated infections.
Infections can cause symptoms such as fever, breathlessness, diarrhea and serious complications such as organ injury (e.g., kidney, lung) and even death. Therefore, it is important for kidney transplant recipients to learn how to recognize infections and take steps to prevent them.
If you are unwell, please speak to our Transplant Coordinator for advice. Depending on the situation, you may be advised to seek medical attention from a general practitioner, to see us in clinic, be admitted into hospital or to present at the Emergency Department. Many infections are contagious and can be dangerous for your fellow transplant recipients. Therefore, you should avoid walking into the Transplant Center without prior arrangement.
These restrictions may cause inconveniences and impede your newfound freedom and independence after being dialysis-free. However, it is important to prevent infection in an immunocompromised state to maintain your health and avoid complications.
