By NBF News
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Renal failure is becoming a frequent occurrence among many Nigerians. It exerts much toll on the affected persons, both emotionally and financially. Since there are no better ways to treat the sickness except through kidney transplant, many patients go through hell before and after the operation.

Dr Toyin Amira, a consultant nephrologists, in this interview, speaks on what life after a transplant is like. Also, Nzoputa Chimere, a kidney recipient, narrates his experience.

What is a kidney transplant?
Kidney transplant is the best form of treatment for end stage renal failure, because it affords the recipient an opportunity to have a second chance at life and to live a near normal life, but not without problems. It refers to the surgical operation of grafting an organ (kidney in this case), which has been removed from a cadaver that has been declared brain-dead or from a living relative.

What happens to a kidney donor and what are the criteria for accepting a kidney from a donor?

Nothing happens, so long they are healthy and maintain a healthy lifestyle; life goes on. Donating a kidney doesn't shorten one's lifespan and it doesn't put the donor at risk of developing kidney failure, that is why we ensure that the donor is completely normal and not at risk of developing kidney failure. So, we accept a kidney from a donor, who, most importantly, is healthy and free from any viral infection like HIV or hepatitis B; is neither hypertensive nor diabetic; has two normal functioning kidneys and lastly, must donate out of free will. We also have a yearly programme in place where the donors go for routine check-up.

What does it require to survive after a transplant?

First, a kidney transplant recipient must be well-motivated to receive the organ because someone is laying down his life; must be disciplined, post-transplant, in taking regularly and specifically medication prescribed and taking special interest in the treatment because the transplanted kidney is very precious and can still be lost. So, it is not as where patients are careless and non-compliant because post-transplant has zero tolerance for non-compliance.

Why is there so much attention to detail?
What you should know is that there are two major problems a kidney recipient faces post-transplant: it could be rejection where the body of the recipient sees the grafted kidney as foreign and continuously tries to attack and destroy it, or infection where it is vulnerable to even simple infection like cold. Three types of rejection exist: the commonest are acute and chronic, while the last is hyper-acute rejection.

With some treatment, acute rejection is reversible while chronic rejection is irreversible; you see it develop over months/years with an inexonerable loss of the kidney. In order to prevent rejection, patients are given very powerful anti-rejection drugs or immunosuppressive agents that have been properly titrated in the right dosage, which should be taken as prescribed although, these drugs are very expensive, that is why the patient must be well-motivated.

So, there is a balance between trying to prevent rejection and over-immunosuppressing the recipient and that requires partnership between the patient and the nephrologist/physician; it therefore means the patient must go for regular check-up, drug monitoring and make complaints whenever there is an observation and this requires discipline.

Is there a lifestyle change for a transplant recipient?

If the grafted kidney is well-looked after, the patient can go back to a near normal life that is productive and of better quality with fewer restrictions compared to when placed on dialysis and restrained from eating a normal diet.

Except medications, with a lot of them to take and probably during the immediate transplant period where patients are isolated from crowded areas because they are prone to infections like simple cold that could be a serious problem and then for contact sports like judo or boxing, because of the graft/kidney transplant, which they try to avoid, but can take part in swimming, jogging and aerobics; the females can get pregnant, there isn't much modification in lifestyle.

You said the drugs are expensive, what are they worth and how long are they to be used?

That depends on the combination, they could be in the range of N150,000 monthly especially during the immediate post-transplant period and these drugs are for as long as the kidney is there. If they are not taken, the body would try to destroy that kidney and rejection sets in. Moreover, the transplanted kidney has an average lifespan of 10 years if well taken care of, so it is not just putting the kidney that is the problem, but the after-care that determines how long that kidney will last and function well.

That is why a lot of patients start up normally, but because of inadequate funds to buy these drugs they start cutting corners and in the process lose the kidney. By the term 'losing the kidney', I mean the kidney is rejected and does not function again, so the patient is back to where it all started. So, the huge problem of post-transplant is preventing rejection and by taking anti-rejection drugs that is carefully titrated to maintain between preventing rejection and infection, that is why these drugs are very important and must be taken as prescribed with 100 per cent compliance.

What are the pains of a transplant patient?
There are no pains except gains; prior to transplant, getting a donor, getting enough funds for the procedure and also the pains of being on dialysis with so many dietary restrictions and poor quality of life. But the gain of transplant is a new lease of life; an opportunity to live a near normal life and an opportunity to be productive; to have a better quality of life, but it is at a cost. However, in all, the gains far outweigh the pain. The pain in post-transplant is the cost of anti-rejection drugs and another pain, if you regard it as pain, is living a complex treatment regimen.

What should the recipient do to avoid failure of a transplant kidney?

The best way to manage a kidney transplant is partnership between the patient and physician. The patient has a lot of responsibility to carry out such as: patient must be compliant with clinic visit and medication; if changes are observed in the body, it should be reported promptly to the doctor; should not self-medicate; avoid herbal medications; eat normally but avoid high fat and salt diet; take anti-hypertensive and diabetic drugs as prescribed; live healthy lifestyles; avoid alcohol; avoid smoking and maintain ideal body weight. A transplant recipient has a new and second chance to life, so the patient must do all these to keep and enjoy it.

What should one do to avoid having a transplant?
One should live a healthy lifestyle by keeping the weight in check, using the Body Mass Index (BMI), which is calculated by dividing one's weight by the square of height; it varies for individuals, but should be between 20 and 25; don't smoke; take alcohol in moderation; eat more fruits and vegetables and go for a routine check-up. A lot of people have high blood pressure but don't know, and those who know, about 50 per cent of them are not on treatment and those who are on treatment, about another one-third, are not controlled, so you see the complexity of the problem.

Hypertension has been rightly tagged 'silent killer' and is about the leading cause of kidney failure in Nigeria, because you don't know it is there, because it doesn't give signs and maybe the first symptoms might be a stroke, heart failure or even kidney damage, so people must go for blood pressure checks, which takes about five minutes. The routine check also involves having your urine tested to make sure there is no protein or blood in it and the urine should be crystal clear and not cloudy, blood-like or coke-like; if there is a problem, you are investigated on time.

A lot of people are becoming diabetic because we have adopted the western lifestyle by taking energy dense drinks and eating a lot of fatty foods and no longer exercise, so we are becoming obese. Along with obesity is an increase in type II diabetes; for every one diagnosed of diabetes there is one that is not diagnosed and the projection is that there is going to be an epidemic of diabetes and the worst hit countries are developing countries like Nigeria. So, we all have to watch what we eat, that is why vegetarian diet is the best.