The kidney transplant program began in 1965 and plays a leading role in this field in Canada. In the past 40 years, our team has performed over 2500 kidney transplants and our services are continually improving to meet the needs of our patients. The MOT program currently follows over 1400 kidney transplant recipients through our Ambulatory Care department.

Indications

There are many causes of end-stage kidney disease. Patients under consideration for kidney transplant present with a variety of kidney diseases. There are many different kidney diseases, in fact more than 80 different ones. Some of these diseases are hereditary, some diseases take many years to develop while others develop quickly. Unfortunately, very few can be treated effectively, or cured. It is not until kidneys are very diseased that they are unable to perform their functions. Patients with end-stage kidney disease can live for many years supported by either hemodialysis or peritoneal dialysis. However, there are many advantages to kidney transplant, including:

• freedom from dialysis
• increased energy
• less restricted diet, and no fluid restrictions
• increased hemoglobin
• overall improved sense of well being.

One kidney is more than able to regulate, remove waste, and to produce hormones therefore only one kidney is needed in transplant surgery, and why in the case of living donor transplants, the donor is able to live a normal life with only one kidney.

Assessment

Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for kidney transplant. During the evaluation process the potential candidates and their family will be provided with information to assist them in making informed decisions about the operation and post-operative period. The patient and their family are encouraged to ask questions of the team members.

The workup process typically involves the following tests, but may require additional testing if other health issues are of concern:

• chest x-ray
• ECG
• 2D Echo
• persantine thallium scan
• barium swallow
• gastroscopy
• cystoscopy
• Blood Tests
• tissue typing
• cytotoxic antibody screen

The Transplant Team Members who consult on kidney transplant evaluation are:

• Nephrologist
• Anesthetist
• Transplant Coordinator
• Social Worker
• Psychiatrist / Psychiatric Nurse
• Physiotherapist
• Nutritionist

Waiting List

There are presently over 300 patients on the waiting list for kidney transplant within our program. The waiting period for a donor varies in length because the donor pool is limited and the selection criteria for a matching donor are strict. Patients can expect to wait a minimum of a few weeks up to 4 years.

Surgery

Kidney transplant surgery will take approximately two to three hours. During this operation the donor kidney is inserted and attached through an incision in either the right or left lower abdomen. The surgeon attaches the artery and vein of the new donor kidney to the iliac artery and vein, then attaches the ureter to the bladder. The recipient's own kidneys remain in place.

Recovery

Kidney transplant recipients can expect to be in the hospital for up to 2 weeks after surgery. After the transplant procedure, patients are stabilized within the recovery room, then transferred to the Step Down Unit on the Multi Organ Transplant Unit. Patient care following transplantation focuses on:

• Monitoring for Rejection
• Adjusting Immunosuppressive Therapy
• Education and Teaching
• Rehabilitation
• Support

Discharge & Follow-up

Discharge planning begins well in advance and patients meet with a social worker during their initial assessment to addressing these issues early. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete.

Patients will return to the Ambulatory Care regularly after the initial postoperative period, with the frequency of clinic visits reduced as the patient's condition permits. During clinic appointments, patients are seen by their Transplant Coordinator, Transplant Physician, and Primary Care Nurse Practitioner. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call.

The Multi Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.