kidney transplant
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What is a kidney transplant?
A kidney transplant replaces a diseased or damaged kidney with a healthy one from a living relative or a deceased person. It is a treatment option for people with chronic renal failure needing dialysis. The surgery for a kidney transplant is usually straightforward. The patient can be supported with dialysis before and after the operation.
After the transplant, the patient receives medication to suppress the immune system and prevent rejection of the new kidney. If there are no complications, the patient can usually return to a normal life within two months.
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Why do some people need kidney transplants?
People may need a kidney transplant when their kidneys are damaged or diseased and no longer function properly, a condition known as chronic renal failure. This failure can result from various conditions, including diabetic nephropathy, vascular disease, or other disorders.
When kidney function deteriorates, waste products and excess fluid accumulate in the body, leading to a range of symptoms such as weakness, swelling, high blood pressure, and nerve damage. A kidney transplant becomes necessary when the residual kidney function is inadequate to sustain life. The transplant replaces the diseased kidney with a healthy one from a donor, offering a chance to return to a normal life.
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How is a kidney transplant surgery performed?
During a kidney transplant, the new kidney is placed in the iliac fossa, in the groin area. The renal artery and vein are connected to the iliac artery and vein, and the ureter from the new kidney is connected to the existing ureter or directly to the bladder. Unless the original kidneys are infected or too large, they are typically left in place.
To prevent rejection, the recipient undergoes testing to match them with a donor kidney. The traits used in determining a successful match include blood groups and tissue markers. Following the transplant, the patient receives medication to suppress the immune system and prevent rejection of the new kidney.
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Where do donated kidneys come from?
Donated kidneys come from either living donors or deceased donors. Living donors can donate a kidney, and deceased donors are classified as donation after brain death or donation after cardiac death.
Living donors are frequently relatives of the recipient because their kidneys are less likely to be rejected. However, kidneys from recently deceased persons are more common due to greater availability and to obviate risk to the living.
The demand for organs is higher than the supply, which is an ethical concern. Illegal organ trade and trafficking can result in the exploitation of living donors.
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What challenges can happen after a kidney transplant?
After a kidney transplant, some degree of rejection is fairly common, especially with kidneys from deceased donors. Rejection may be acute, happening within months, or chronic, occurring gradually.
To prevent rejection, immunosuppressant drugs are essential but lower resistance to infection, which can cause systemic complications. These drugs can cause side effects and require careful dosage adjustments. There is also an increased risk of developing malignant growths, particularly lymphomas.
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How do new kidneys help improve a person's life?
A new kidney transplant can significantly improve a person's life by eliminating the symptoms of kidney failure, such as extreme weakness, anemia, and edema (swelling from fluid collection). The transplant restores the kidney's ability to remove waste and excess water, which alleviates strain on the heart and prevents inflammation and nerve damage.
With a functioning kidney graft, individuals can often return to a normal existence, resuming work and other activities, with women being able to bear children and men able to become fathers. Though recipients must continue taking immunosuppressive drugs to prevent rejection of the new organ, successful kidney transplants offer a good chance for complete rehabilitation and a return to a normal life.
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kidney transplant, replacement of a diseased or damaged kidney with a healthy one obtained either from a living relative or a recently deceased person. Kidney transplant is a treatment for persons who have chronic renal failure requiring dialysis. Although kidney transplants were carried out in the late 1950s, clinically significant transplantation did not begin until about 1962–63, when the immunosuppressive drug azathioprine was developed to help counteract the rejection of the new organ by the body’s immune system. Because a kidney from a related donor is less likely to be rejected by the body, transplants from living relatives are more successful than those from cadavers. Nevertheless, cadavers are common sources for transplants because of their greater availability and because they obviate the risk to living donors. The development of more-effective immunosuppressive drugs such as cyclosporine has increased the success rates of both related donor and cadaver kidney transplants. Today, more than four-fifths of patients with transplanted kidneys will survive for more than five years.
Before transplantation, the immunologic characteristics of the recipient are carefully analyzed, and a donor is selected whose immunologic profile is matched as closely to the recipient’s as possible. Traits used in determining a successful match include blood groups and tissue markers that enable the immune system to distinguish between the body’s own tissues and foreign tissue. Alternatively, novel techniques have been developed to enable patients’ immune systems to accept kidneys from incompatible donors. In desensitization therapy, for example, antibodies that normally would attack the nonmatched organ are filtered out from the patient’s blood.
A transplant operation will be cancelled if the recipient has any infection, because of the risk that infection could damage the donor organ or further impair the health of the patient. Persons with chronic renal failure who also have active cancer are not considered candidates for kidney transplant, particularly because immunosuppressive drugs may suppress the body’s ability to contain the cancer.
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The new kidney is implanted in the iliac fossa, a space in the groin area just below and to the side of the umbilicus; usually a right kidney is placed in the left fossa and vice versa to aid in making new attachments between blood vessels. The renal artery and vein are connected to the iliac artery and vein, and the ureter from the new kidney is either connected to the existing ureter or attached directly to the bladder. Formerly both of the recipient’s kidneys were removed; they are now left in place unless they are infected or are too large to permit the new organ to be implanted.
Some degree of rejection, although treatable with medications, is fairly common, especially for cadaver kidneys. Some patients receive two or three kidneys before the body accepts one. Rejection may begin within minutes after the new organ is attached. Acute rejection, in which the tissues of the new kidney are injured by the immune system and the organ suddenly fails to function, can occur up to several years after operation but is most common in the first three months. Chronic rejection, in which deterioration of kidney function is more gradual, also may occur. Large doses of immunosuppressive drugs, along with drugs that retard the formation of blood clots, can halt acute rejection and save the transplant; if the medication does not help, the kidney is usually removed before infection or other complications set in.
Kidneys taken from living donors often begin to function immediately, while those from cadavers may take up to two weeks for tissues to adjust and become functional. If there are no complications from the transplant and no signs of rejection, recipients can resume virtually normal lives within two months, although they must usually continue taking immunosuppressive drugs for several years. Because the drugs lower resistance to infection, however, other systemic complications may arise with time.