Kidney transplantation: when, where, complications, prognosis, behavior after surgery

To kidney transplantation is used in end-stage chronic renal failure (CRF). The criterion is a decrease in glomerular filtration rate less than 15 ml/min, in this case, the condition is characterized by uremia, require long-term hemodialysis or kidney transplantation.

A little history: the first attempts to transplant the kidney was performed in animals at the beginning of the 20th century. A successful operation was performed by D. Murray in 1954, was made related liver transplantation terminally ill patient with chronic renal failure, after which he lived for 9 years. Further transplantation, as science was rapidly developing: this was facilitated by the invention of preservatives, the discovery of new drugs with cytostatic effect, the accumulation of knowledge about the parameters of blood compatibility and the use of artificial methods of treatment – hemodialysis and peritoneal dialysis.

Kidney transplant necessary measure, without the purification of blood, amid uremia, comes death. Hemodialysis – an artificial blood purification may be considered as palliative therapy for patients waiting for transplantation of the donor organ.

List diseases that lead to the development of end-stage renal failure:

Indications for kidney transplantation

The indication for transplantation of the donor organ is end-stage renal failure. Let us consider the impact of the loss of renal function.

Characteristic symptoms and signs of ESRD:

For children suffering from disease, which led to the complication of loss of renal function, characterized by the retarded growth and psychomotor development.

Unfortunately, donor organ transplantation not feasible for all patients suffering from end-stage chronic renal failure.

The fact is that not every kidney is suitable to a specific person. In addition to compatibility issues, there are a number of contraindications to transplantation of the donor kidney.

These include:

• Severe forms of cardiac and pulmonary insufficiency, with the implementation of anesthesia (anesthesia).
• TB.
• Liver disease decompensation.
• Cancer (some types).
• Significant cardiovascular disease (heart attacks, strokes in acute form).
• Autoimmune disease.
• Psychiatric illness.

HIV infection of the recipient – a relative contraindication to transplantation, donor kidney, as there is a risk of progression of chronic renal failure in patients receiving specific therapy.

In recent kidney transplants to HIV patients comply with the mandatory consideration of the compatibility of immunosuppressive and antiviral therapy.

It should be noted that rare cancer after treatment and the lack of progression is not a contraindication for kidney transplantation. The question in each case is solved individually.

How is the operation

In the operating room under General anesthesia by one of the standard approaches, the incision is performed, compressed vessels supplying the kidney, and the organ removal of the donor along with blood vessels and ureter. On average, the surgery lasts about 3-4 hours.

Another team of surgeons performed a kidney transplant recipient. Distinguish between orthotopic and heterotopic transplantation. Orthotopic transplant is used less frequently because of complications after transplantation of a donor kidney to replace a remote “native” more often.

Heterotopic transplantation does not imply removal of the kidney recipient, donor organ sits in the pelvic region, vessels of the transplanted kidney are stapled with the iliac vessels of the recipient, after the restoration of blood supply to the ureter is sewn into the bladder. The operation ends with drainage.

Under favorable developments, the kidney starts to function for 5 – 7 days, until that time hemodialysis.

To prevent secondary infection prescribe antibiotics. At the same time with them the patient takes immunosuppressants.

Status track in dynamics: ongoing monitoring of indicators of blood, urine, levels of urea and creatinine, electrolytes. In doubtful cases, it is possible to perform nephrobiopsy.

Discharge from hospital occurs after 3 to 4 weeks.

In the Russian Federation of donor organs expects about 20,000 people, so the queue for transplantation can take several years. Unfortunately, some patients simply do not live up to “his” kidney. Is performed on average 1250 transplants per year, surgical intervention is possible in 22 regions of the country. If you apply to the statistics of the United States, our patients are in a worse position as the Western operations related to the transplant, is performed 10 times.

From a living person or the dead body will be received kidney transplant – to a greater extent depends on the applicable laws of the country. In the United States and Israel 30% of kidney transplantations performed from a living donor, but, for example, in Spain, the statistics are somewhat different: 97% of the transplant using cadaveric kidney. In Russia and the donor and the recipient undergoes complete clinical examination, to reduce the risk of graft rejection. Undiagnosed, for example, cancer or viral hepatitis, can lead to death, and donor and recipient.

Where do kidney transplant?

Kidney transplant in Russia

From the Federal budget allocated funding for quotas that are allocated by region. The problem is the limited number of quotas, which everyone in need is not enough.In Russia, a kidney transplant is performed only in public hospitals under the policy of compulsory health insurance, i.e., any cash that the patient is not charged. The donor may be a relative, voluntarily and freely agree to give a kidney or organ is taken from a deceased person, in the absence of lifetime ban on such actions.

If still to consider related transplantation, the best donors are twins, then brothers and sisters, parents, relatives. In any case, a kidney from a living donor better than a corpse.

Ideally, a transplant is better done before the procedure of artificial blood purification.

Not every relative can be a donor, even if there is compatibility of many of the required blood parameters. A contraindication on the part of the donor to surgery are any infectious diseases, kidney disease, alcoholism, and drug abuse, HIV infection, malignant neoplasms, viral hepatitis b and C, severe concomitant pathology, in which surgical intervention is permissible only for health reasons.

Trade bodies in Russia prohibited by applicable law.

Of all transplants, 50% have kidney transplant. In Moscow there are about a dozen clinics where the data of the operative intervention.

If you do not find a donor among relatives, the patient entered to the waiting list.

To the negative sides of organ donation in Russia can be attributed most of all the suffering, imperfection of legal documentation, so some wealthy patients go for a new kidney abroad. The cost of the operation varies considerably from country to country, the prestige of the clinic and who will be the donor.

Kidney transplant in Israel

The shortage of donor organs makes appeal for help to other countries. Kidney transplantation in Israel is an expensive operation, but the technique and expertise of the doctors returns, seemingly doomed patients to a normal life. The success of surgical intervention depends also on the immune properties of the body of the recipient. The training was aimed at suppressing the excessive activity of immune responses, which is important to prevent the rejection of donor kidneys.

Performed plasmapheresis, in which blood is cleared of circulating antibodies. Blood transfusion and the administration of specific drugs inhibits the reactions of the reflection. There is a national database of donors and recipients. The Israeli transplant has been successful transplantation of kidneys from donor to recipient even in cases when there is a mismatch of blood groups. Moreover, the simultaneous transplantation of other vital organs such as the pancreas with concomitant diabetes mellitus.

Kidney transplant in India

Kidney transplantation in India will cost much cheaper, but as the recipient is considered only living relative. This condition is stipulated by the legislation of the country. Performs well as patients with concomitant HIV or hepatitis C. In India several centers that are engaged in the solution of this problem. They are located in major cities: Delhi, Mumbai, Indore etc.

What can be complications after kidney transplantation

The most serious complication is kidney allograft rejection. After surgery it takes a while to being of the patient is normalized.

Early complications include the following:

• the failure of the anastomosis that leads to hemorrhage, hematoma;
• the accession of infection;
• the complications of the blood coagulation system (thrombosis, thrombophlebitis).

Patients with a transplanted kidney often develop disorders of erythropoiesis, and calcium metabolism.

In addition to it, there are allergic reactions, problems with the respiratory system, response of late transplant rejection.

Highly qualified staff, strict adherence to all recommendations of a quality and correctly selected drugs to minimize the risks and increase the success of the operation.

If we look at the statistics, 80% survive 5 years abroad, in patients after kidney transplantation significantly improves the quality and length of life (up to 15 – 20 years). Some women give birth to children.

How to eat after kidney transplantation

Proper nutrition can reduce the load on the transplanted kidney, which contributes to her healing. However, it is important to follow sufficient intake of potassium, magnesium and phosphorus from food. Unacceptable chronic constipation normal bowel helps the body eliminate toxins.

In the first days after surgery you can drink non-carbonated water, the patient all the necessary nutrients it receives through parenteral nutrition. Further resolved pureed vegetarian soups.

Gradually extend the diet, allowed foods list after kidney transplantation is:

• lean meats, fish and poultry;
• vegetables and fruits;
• natural dairy products with low fat, but with a maximum content of bifidobacteria and lactobacilli;
• durum pasta;
• olive oil;
• bean;
• a variety of nuts;
• dried fruits.

What not to eat after kidney transplantation

Fall under the ban of the following products:

• meats and marinades;
• sharp condiments and spices;
• fat milk, sour cream, cream;
• sharp cheese (cheese with cheese you can eat);
• sausages and offal;
• pork, bacon, kebab.

Carbonated drinks, alcohol, including beer, eat absolutely not.

Salt retains fluid in the body, which promotes swelling and increases the pressure on the urinary system, so food insufficient salting.

Flour products, sweets and pastries is not contraindicated in the case that there is no excessive kilograms and cholesterol and sugar are normal. Nutritionists is not recommended after renal transplantation consume a lot of “fast” carbohydrates and fatty foods, because treatment with immunosuppressive drugs there is a great risk of secondary diabetes mellitus, obesity, hypertension.

Preferably gentle heat treatment of products, that will allow you to keep more vitamins and minerals.

Nutritionists know plant and animal proteins are digested in different ways. Soy, beans, peas are rich in vegetable proteins, but does not have a detrimental effect on the nephrons.

Coffee, strong tea can increase blood pressure, which is a common problem after kidney transplantation. Better to drink unsweetened fruit drinks, herbal teas, rose hips, berries.

The patient with a transplanted kidney should be under constant surveillance. In addition, you need to learn to control diuresis, blood pressure.

Medicines without a large probability of rejection of the kidneys, suppress the immune system, and thus susceptibility to infections and oncologic processes increases significantly. Therefore, even in good health, it is important not to skip visits to the doctor periodically to have a full instrumental and laboratory diagnostics.