Dialysis access & kidney transplant
Sydney Vascular Surgeon - Dr Mayo Theivendran
If you need kidney haemodialysis following kidney failure, you might wonder about the lifeline that makes this treatment possible — vascular access. Vascular access is a crucial part of haemodialysis, a process which does the job of your kidneys to safely and effectively remove wastes and excess fluids from your blood.
What is vascular access for kidney dialysis?
Vascular access for kidney haemodialysis is the bridge that connects your bloodstream to the dialysis machine. It's an essential gateway, allowing blood to flow from your body to the dialysis machine, where it gets cleaned, and then put back into your body. This process ensures that your blood is purified and balanced, compensating for your kidney's inability to perform these functions.
The 3 types of kidney dialysis surgery
1. Autologous fistula surgery
Dr Theivendran connects an artery and a vein, typically in your arm, to create an AV (artery-vein) fistula for renal dialysis. It takes time for the fistula to mature, which means you won't be able to use it for dialysis immediately. Once it's ready, you have a kidney port for dialysis. A needle can be inserted into the fistula to start and maintain each dialysis session.
2. Graft vascular access
Grafts are another option for vascular access. During graft surgery, a small, synthetic tube is inserted under your skin to connect an artery and a vein. Grafts typically mature more quickly than fistulas and can be used for dialysis sooner. However, they are more prone to complications and have a shorter lifespan.
3. Catheter vascular access
Catheters offer a temporary solution for dialysis access. They are inserted directly into a large vein, often in your neck, chest, or groin, without the need for surgery. Catheters can be used right away, making them a suitable choice for short-term dialysis. However, they come with a higher risk of infection and they’re not the best long-term option.
Aftercare following vascular access for kidney dialysis
Proper aftercare is essential to ensure the longevity and functionality of your vascular access port. Regular check-ups with your healthcare team are crucial.
They will monitor your access site for any signs of infection or complications. You should also keep the access site clean and dry and avoid tight clothing or anything that might put pressure on it.
Following your care team's instructions, taking prescribed medications, and maintaining a healthy lifestyle can significantly contribute to the success of your vascular access port.
Common complications of vascular access for kidney dialysis
While vascular access is essential for kidney dialysis, it can come with complications. They include:
Infection: Vascular access sites can become infected, particularly in the case of catheters and grafts. Signs of infection may include redness, swelling, pain, or fever.
Thrombosis: Blood clots can form in the access site, hindering blood flow. This is more common with grafts.
Aneurysm: Sometimes, the access site can develop a swelling due to weakened blood vessel walls, which may need treatment.
Stenosis: Stenosis, narrowing or blockage of the access site can occur, requiring interventions to maintain blood flow.
Haematoma: A haematoma is a collection of blood under the skin, often resulting from needle insertions during dialysis.
Kidney transplant: A second chance at life
A kidney transplant offers renewed hope and a brighter future for people who have endured the challenges of chronic kidney disease and dialysis.
Benefits of kidney transplant vs. dialysis
Improved quality of life
A successful transplant allows you to regain freedom from regular dialysis, offering a more normal and active life.
Better health outcomes
A transplanted kidney can perform the functions of a healthy kidney more effectively than dialysis. It helps maintain stable blood pressure, control anaemia, and manages mineral and bone disorders.
Longevity
On average, kidney transplant recipients live longer than people who rely solely on dialysis. It can significantly enhance life expectancy.
Dietary freedom
After a successful transplant you can enjoy a more flexible diet with fewer restrictions compared to when you’re on dialysis.
Less fatigue
Transplant recipients often experience less fatigue and weakness than people on dialysis.
How can I get a kidney transplant in Australia?
Obtaining a kidney transplant in Australia involves several steps which are managed by your kidney specialist:
- Evaluation: Your specialist will assess your eligibility for a transplant based on your medical history, overall health, and emotional readiness.
- Finding a donor: Kidneys for transplantation can come from two sources — living donors or deceased donors. If you have a willing and compatible living donor, the process may proceed more quickly. For a deceased donor kidney, you must be placed on the transplant waiting list.
- Going on the waitlist: If you don't have a living donor, you’ll be placed on the national transplant waiting list maintained by the Australian Organ and Tissue Authority. The waiting time varies and depends on factors like blood type, tissue match, and the availability of donors.
- Transplant assessment: When a kidney becomes available, you will be assessed to ensure that you are in good health for the procedure.
- Surgery: If you are deemed suitable, you will undergo transplant surgery. This can be a scheduled surgery if the donor is known in advance, or an emergency surgery if you have been allocated a deceased donor kidney.
Preparing for kidney transplant surgery
Before the transplant, you will go through a series of tests and preparations to ensure your body is ready for the procedure:
Medical evaluation: You will receive a comprehensive medical evaluation, including blood tests, imaging, and other assessments to determine your overall health and suitability for transplant.
Immunosuppressive medications: Your transplant team will discuss immunosuppressive medications, which you will need to take post-surgery to prevent rejection of the new kidney.
Emotional preparation: It's essential to prepare yourself mentally and emotionally for the transplant. Joining a kidney transplant support group or talking to a mental health professional can be helpful.
Legal and financial aspects: Ensure you have a clear understanding of the legal and financial aspects of the transplant process. Discuss insurance, work-related matters, and any legal documents needed.
What happens during kidney transplant surgery?
Kidney transplant surgery can be divided into two phases: the removal of the donor kidney and the implantation into the recipient.
Your donor’s kidney removal
In the case of a living donor, your surgeon removes the donor’s kidney. For deceased donors, the kidney is procured through organ donation procedures.
Your surgery
You have surgery to place the new kidney in the lower abdomen. The donor kidney's blood vessels are connected to your blood vessels, and the ureter (tube that carries urine) is attached to your bladder.
The surgery typically takes a few hours, and you will be under general anaesthesia. You'll wake up in the recovery room after the procedure.
Aftercare following kidney transplant surgery
Recovery and aftercare are critical for a successful kidney transplant:
- Immunosuppressive medications: You will need to take immunosuppressive medications as prescribed to prevent rejection. It's essential to adhere to the medication regimen and attend regular follow-up appointments.
- Monitoring: Your healthcare team will closely monitor your progress and kidney function through blood tests and other assessments. This is done to detect any signs of rejection or complications.
- Lifestyle changes: You may need to make some lifestyle adjustments, including eating a balanced diet, doing regular exercise, and avoiding smoking or drinking excessive alcohol.
- Emotional support: It's normal to experience emotional challenges after a kidney transplant. Support from mental health professionals and support groups can be valuable.
- Long-term care: You will require ongoing care and regular check-ups throughout your life to ensure the transplanted kidney's health and your overall well-being.
Common complications of kidney transplant surgery
While kidney transplant is a life-saving procedure, it's not without risks. Common complications may include:
Infection: Infection can occur after the surgery. It's crucial to follow proper hygiene and take medications as prescribed to minimise infection risks.
Rejection: Your immune system may recognise the new kidney as foreign and attempt to reject it. This can usually be managed with immunosuppressive medications.
Delayed graft function: Sometimes, the transplanted kidney takes time to function properly. This may require additional dialysis until the kidney starts working effectively.
Complications from medications: Immunosuppressive medications can have side effects, including increased risk of infection, high blood pressure, and weight gain.
Surgical complications: Surgical complications, such as bleeding, clot formation, or issues with the ureter, can occur.
How Dr Theivendran can help
If you need dialysis access, ask your treating doctor for a referral to Dr Theivendran, an experienced vascular and endovascular surgeon.
For a discussion about a kidney transplant, speak to your kidney specialist.
Explore kidney support groups
If you have any questions, please don't hesitate to contact our rooms on (02) 9066 6547
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Fax: (02) 9182 7533
