Living Donor Kidney Transplant

What is a living donor kidney transplant?

A living donor kidney transplant (LDKT) is an operation where a kidney from a healthy living person (the donor) is removed and placed into someone with end-stage kidney disease (the recipient).

This is usually done without the removal of the recipient's own kidneys.

Why do you need a living donor kidney transplant?

A successful living donor kidney transplant (LDKT) could save your life if you are suffering from end-stage kidney disease. The new kidney can take over the function of the diseased kidneys, and allow your body to self-regulate fluid and electrolyte balance, as well as produce hormones necessary for good bone health and red blood cell production.

The 5 and 10-year survival rates of dialysis vs transplant patients in Singapore are 57.2% vs 93.6%, and 32.7% vs 85.3%, respectively*. This is due to increased cardiovascular complications present in dialysis patients.

_{(Source: Singapore Renal Registry Annual Report 2019)}

Kidney dialysis vs kidney transplant

Compared with dialysis, kidney transplantation offers the following benefits:

• Better survival outcomes, with at least 90% of transplanted patients doing well after surgery
• Better quality of life after receiving a new kidney
  • Patients can resume work and normal daily activities
  • Patients are free from the pain and complications related to dialysis
• Fewer dietary restrictions
• (For female patients) Higher chances of successfully getting pregnant

Discover the additional benefits of kidney transplantation compared with dialysis, and delve deeper into its viability as a treatment option for end-stage kidney disease.

Deceased donor transplant vs living donor kidney transplant (LDKT)

Compared with a deceased donor transplant, LDKT offers the following advantages:

• Shorter waiting times, with less time spent undergoing dialysis, and even potential avoidance of dialysis in pre-emptive kidney transplantation
• Better graft and patient survival rates
• Ability to schedule your transplant in advance compared to an emergency transplant procedure with a deceased donor kidney
• Blood group incompatible kidney transplantation can be done for some patients

Who should not undergo a living donor kidney transplant?

An LDKT is not recommended if you have any of the following:

• An ongoing infection, which must be treated first
• Severe heart disease
• Cancer that is not in clinical remission
• Active AIDS

What are the risks and complications of a living donor kidney transplant?

For the recipient, an LDKT carries the following potential risks:

• Decreased immunity as a result of the use of immunosuppressants
• Other side effects of immunosuppressants e.g. new-onset diabetes after transplantation, high blood pressure
• Acute rejection, where the immune system recognises the transplanted kidney to be foreign, and begins to ‘attack’ it. This is usually treated with stronger immunosuppressant medications.
• Increased risk of developing cancers, especially certain virus-associated cancers

For the donor, an LDKT carries the following potential risks:

• Risk of death, which affects around 3 – 5 in 1,000 living donors
• Chance of premature kidney failure
• Increased risk of hypertension and/or having protein in the urine later on in life

How do you prepare for a living donor kidney transplant?

Before an LDKT can proceed, your transplant team will conduct a thorough pre-transplant evaluation to assess the risks to both the donor and recipient.

This evaluation seeks to confirm whether the donor is mentally and physically fit. The Transplant Ethics Committee (TEC) must be satisfied that your donor is willing to donate his / her kidney voluntarily and is not acting under any form of emotional coercion or financial motivation.

In preparation for the procedure, your donor must:

• Undergo assessments conducted by an independent team of doctors, which includes blood and urine tests, to ascertain his/her medical fitness to be a kidney donor.
• Be interviewed by the transplant coordinator and social worker to confirm their socioeconomic background and motivation for kidney donation.

The TEC consists of 3 members appointed by the Ministry of Health, and includes:

• A medical practitioner practising in the hospital
• A medical practitioner not practising in the hospital, and
• A layperson

TEC members are not part of the potential donor’s or recipient’s primary care team.

After your application is approved by the TEC, there is a compulsory 1-week cooling off period. The earliest the transplant can happen is 1 week after the approval date.

If you are undergoing dialysis, you will continue with it until your surgery date.

What can you expect in a living donor kidney transplant?

A living donor kidney transplant is a complex and demanding procedure.

Estimated duration

Each surgery for the donor and recipient takes about 3 – 4 hours.

After the procedure

The recipient will remain in the hospital for around 10 days and the donor will remain in hospital for around 5 – 7 days for close monitoring after the surgery.

Care and recovery period for a living donor kidney transplant

You should begin to experience an improved quality of life especially after the first month from your LDKT. Provided your recovery goes well, you can look forward to returning to work and resuming your normal activities within a few months.

Your doctor may schedule 2 – 3 appointments a week to check on your recovery in the first month after surgery. They will continue monitoring you closely and will schedule regular appointments to check on your kidney function. The frequency of clinic reviews will decrease over time.

To minimise the risk of complications after a kidney transplant, it is recommended that you strive towards a healthy lifestyle by:

• Eating a healthy diet
• Increasing physical activity (about 2 weeks after the surgery)
• Losing weight, if you are overweight or obese
• Not smoking