Kidney transplant is a long-term solution for kidney failure patients. Those with kidney failure need dialysis to continue their lives. Because the blood needs to be filtered to get rid of foreign substances. This is possible mechanically only with dialysis. Depending on their condition, patients should undergo dialysis once or more than once a week. It is a tiring and time-consuming treatment for these patients. In addition, the condition of patients may worsen as they undergo dialysis. Therefore, if appropriate, kidney transplantation is very effective.
WHAT IS KIDNEY TRANSPLANT?
Currently, the most successful treatment method for kidney failure is kidney transplantation. Kidney transplantation is done from live or cadaver donors (donors). In successful kidney transplantations from both living donors and cadavers, some but not all kidney functions are fulfilled, as in dialysis treatments, and the quality of life of the patients increases.
The important thing in kidney transplantation is not the placement of a kidney, but the operation of the transplanted kidney for many years. It is possible to make the kidney work much longer after a living kidney transplant than in a cadaver transplant. The most important reason for this is that, in contrast to transplantation from a cadaver, a kidney is transplanted from a living donor whose health has been examined in detail beforehand. It also contributes to the success of the recipient and the donor being thoroughly examined and operated in the best health condition in a controlled manner.
When it comes to the first year after living donor kidney transplantation, 95% of the patients lead a healthy and dialysis-free life. After cadaver kidney transplantation, these rates are around 80-85%. Half of the patients with a living kidney transplant enter 25 years healthy, while half of the patients with a cadaveric kidney transplant are healthy and away from dialysis for 10 years.
80% of transplant patients continue their old jobs. Especially young patients who have a transplant can work, get married and have children (both male and female patients). The patient's life expectancy is extended by an average of three times.
IN WHICH DISEASES IS KIDNEY TRANSPLANT PERFORMED?
Kidney transplantation is performed in the case of end-stage renal disease. Kidney failure, which is one of the most insidious diseases of our age and can occur without any symptoms, is spreading rapidly day by day. The most important causes of chronic kidney failure are; diabetes, high blood pressure and kidney inflammation (nephritis). The disease, which progresses without any symptoms, begins to show symptoms when the filtering function of the kidneys, which should be at 85-100, falls below 30. When you wake up in the morning, swelling under the eyelids, mild edema in the hands and feet, weakness and excessive foaming during urination are the most important symptoms. The presence of a significant amount of protein in a person's urine causes foamy urine. Normally, less than 150 mg of protein per day can be found in the urine. Excess protein in the urine is abnormal and is known as proteinuria or microalbuminuria. Foaming in the urine indicates the onset of kidney disease or even progression of the disease.
Since the necessary precautions are not taken, the rapidly progressing disease may impair the function of the kidney, which can function properly for 10-20 years, within 2-3 years. A decrease in the filtering function rate below 15 makes it difficult for patients with chronic renal failure to survive without a supportive treatment. Kidney transplantation is generally recommended for patients who have no other treatment option than dialysis or transplantation, in order to increase their quality of life and provide permanent recovery in a short time. Acute renal failure is the loss of function of the kidneys that occurs in a very short time and is sometimes reversible. However, in irreversible loss of function, transplantation planning should be done without losing time.
HOW IS KIDNEY TRANSPLANT PERFORMED?
Despite all the efforts made all over the world, cadaveric transplants from people with brain death have not reached a sufficient level and these numbers have been increasing very slowly over the years. As a solution to organ failure, kidney transplants from living donors have come to the fore.
Considering the health and postoperative comfort of living kidney donors, removal of the kidney with the closed method (laparoscopic method) is quite common. With the closed method, the surgery is performed through small holes in the patient's abdomen instead of making a large surgical incision in the patient's body. Kidney surgery with the closed method is performed through 3 holes of 0.5-1 cm in the abdomen of the patient, and at the end of the operation, the kidney is removed through a 5-6 cm incision made in the inguinal region of the patient. Compared to open surgery, patients experience much less pain after the operation, stay in the hospital for a shorter time, and return to their normal lives and work faster. In the open method used in the past, undesirable side effects such as hernia, numbness, wound infection, which are seen after the surgery in patients, are almost never seen in this technique. This operation, which is performed only through 3 holes opened to the body and a small incision to remove the kidney, provides successful results in cosmetic terms compared to open surgery. Donors who start walking, drinking water and eating on the evening of the operation can be discharged 2 days after the operation. The sutures are hidden and aesthetic sutures and these sutures do not need to be removed after the surgery.
Kidney transplantation is a surgery performed by reaching the inguinal veins from outside the peritoneum. In kidney transplant surgery, the kidney is placed in the right or left inguinal region, not in its original place. The vessels of the donor kidney are joined with the inguinal veins of the recipient, and the urinary tract of the donor kidney with the recipient's bladder with the help of sutures. The patient's non-functioning kidneys are usually not removed, except in rare cases.
Recovery process after kidney transplant is very fast. Since there is no contact with the intestines during the operation, the patient begins to eat very quickly after the operation. In the first 4 days, the urine output of the patients who are followed up with a urinary catheter, are removed on the 4th postoperative day.
If a kidney transplant was performed from a living donor, the patient is usually discharged on the 5th day, as kidney function begins immediately. However, if a cadaveric kidney transplant was performed, a longer hospital stay may be required, as the kidney will begin to do its job in a few days or weeks.
BENEFITS OF A RENAL TRANSPLANT
Undoubtedly, kidney transplantation is the best treatment for end-stage renal disease patients. Dialysis methods (hemodialysis or peritoneal dialysis) can do 5% of the work done by two kidneys of a healthy person under the best conditions. A successfully transplanted kidney provides 10 times this amount (50% of the work done by both kidneys of a healthy person).
Most transplant patients feel much more energetic and better than they would on dialysis. While many of them are able to do the job that they could not do before, their chances of finding a job are higher than those of dialysis patients. Most of them have a significant improvement in their sexual life compared to the dialysis period, female patients can become pregnant more easily and give birth to healthy children.
WHAT ARE THE RISKS OF KIDNEY TRANSPLANT FOR THE DONOR?
Since kidney transplantation is an important operation, there are some risks for both the recipient and the donor. A person who voluntarily becomes a kidney donor is very valuable both by the patient and by the doctors. Because, thanks to the person who volunteers, a patient regains his health. Many medical tests are performed for the donor and all data are analyzed in detail. It is then approved by a council of physicians. In other words, it is not possible for a physician to make the decision of an individual to be a donor alone. As with any surgery, it is not possible to guarantee 100% health for both the donor and the recipient after a kidney transplant. Because researches have proven that the risk of death in kidney transplant operations is 1 in 3000. Along with the risk of urinary tract infection, the risk of wound infection is also possible. However, these risks are at the same rate as any other surgery. For a few days following the surgery, the donor's body will be sore. Depending on the donor's condition, the donor is discharged from the hospital within 5 days. In a small percentage of patients, pain may occur at the surgery site 1 year later. After 2 months after the surgery, the individual returns to all normal activities. He can lift heavy or do sports. The donor can lead a healthy life by having regular check-ups after the transplant surgery.
FREQUENTLY ASKED QUESTIONS
Does Kidney Transplantation Provide Advantage over Dialysis?
It has great advantages. After 1-2 weeks after the surgery, the vast majority of patients regain a completely normal life. Apart from the drugs they take in the morning and evening, their working and social lives are within normal limits. As in dialysis, they do not have to live on a machine for 3-4 hours, 3 days a week.
Who Cannot Have Kidney Transplantation?
There are very few patients who cannot be transplanted. Those with active infections cannot be transplanted. Transplantation can be performed after the treatment of these patients. In patients with tumors, after the tumor is treated, a certain period of time is waited according to the type of tumor, and transplantation can be performed after it is determined that there is no recurrence. Transplantation is not possible in cases where the tumor has spread to other organs. Due to the high risk of losing the transplanted kidney in blood group incompatible patients, it is not generally recommended at the moment. If the test (cross-match test) performed by mixing the blood of the recipient and the donor is positive, the transplant is not performed. Advanced age is a relative obstacle for kidney transplantation. The biological age of the patient should be evaluated together with the general condition and the condition of other organs. Age alone should not be considered as a barrier for transplantation.
What Should Be Done After the Transplant?
After the transplant, the patient stays in the hospital for about 1 week. The purpose of this is to intervene immediately in the complications that may occur, thus protecting the health of both the patient and the kidney. Usually, urination starts immediately after the transplant, but it may take a short time for the kidney to filter the blood. For this reason, it may be possible for the patient to undergo dialysis several times after transplantation. After the 8th week following the transplant, the patient is expected to return to his normal life. After the transplant, the patient should have regular check-ups. Thus, it is evaluated whether the kidney and the patient's health are in place. After the operation, analyzes and tests are quite frequent. For this reason, it may be necessary to reside in a place close to the operation center for a while. After a kidney transplant, some medications are prescribed to prevent the body from rejecting the kidney. These drugs must be used for life. Otherwise, the body may suddenly reject the kidney and the patient's condition may worsen. These drugs also reduce the risk of infection after the operation.
Can Diabetics Have Kidney Transplantation?
Diabetics can also be transplanted. Because the advantages of kidney transplantation are also valid for diabetics. Diabetes mellitus is one of the most common causes of kidney failure today. Therefore, kidney transplantation is performed for many diabetic patients. Careful attention should be paid to the treatment and follow-up of diabetes after transplantation.
Can those with hepatitis have a kidney transplant?
Patients with hepatitis should be evaluated in detail for liver cirrhosis or chronic hepatitis. In the absence of these conditions, transplantation can be performed. There is no harm in using drugs in the treatment of hepatitis B after transplantation. Thus, the treatment of hepatitis B can be continued successfully after kidney transplantation (transplantation). It is not possible to use drugs used in the treatment of patients with hepatitis C after kidney transplantation. It can cause kidney loss. For this reason, if treatment is required in patients with hepatitis C, it is appropriate to do this before transplantation. Whether patients with hepatitis are suitable for transplantation should be decided in consultation with hepatology.
Who cannot be a living donor for a kidney transplant?
Persons under the age of 18
Those with hypertension (>140/90 mmHg) or using hypertension medication
People with morbid obesity
Bilateral or recurrent nephrolithiasis (kidney stones)
Those with a history of thrombosis or thromboembolism
Those with chronic kidney disease (CKD)
History of pulmonary embolism or recurrent thrombosis
Those with psychiatric illnesses
Those with serious medical illness (chronic lung disease, recently diagnosed cancer)
Low GFR (< 80 ml/min)
Proteinuria (>300 mg/24 hours)
History of pulmonary embolism or recurrent thrombosis
What are the possible risks and side effects of kidney transplant surgery?
Possible risks after kidney transplant surgery include:
Temporary kidney function deficiency: Your new kidney may not start working right away. You may need dialysis until kidney function returns.
Organ rejection: Your body may reject the donor organ and you may need certain medications to help your body accept the new kidney.
Kidney failure: Chronic rejection may begin years later. The kidney may lose its functions after a while, similar to the first kidney disease. As a result of this situation, you may need to have a second transplant or go on dialysis again.
Vulnerability to cancer: The immunosuppressant drugs used after the transplant can make you more vulnerable to cancer.
Diabetes: Drugs taken after kidney transplant can cause diabetes.
narrowing of the artery that carries blood to the kidney
coagulation in veins
Blood Type Matching
There are four blood types: A, B, AB, and O. Everyone fits into one of these hereditary groups. There must be blood group compatibility between the recipient and the donor. The following list shows the compatible blood groups:
If the recipient's blood type is A, the donor should be either A or O.
If the recipient's blood type is B, the donor should be blood group B or O.
If the recipient's blood type is O, the donor blood type should be O.
If the recipient's blood type is AB, the donor blood group can be A, B, AB or O.
AB blood group is the easiest to match. Because a person with AB blood type accepts all other blood types.
Tissue typing test is a blood test that shows a person's genetic makeup (genetic fingerprint). As with blood group compatibility, it is investigated whether the tissue types of the donor and recipient match.
While the success of transplants made from cadavers is largely dependent on tissue compatibility, it has been understood that transplants made from living donors are not as important as previously thought.
When transplants from twin siblings (all tissues are the same) and transplants performed with only blood group compatibility without any tissue compatibility, it is seen that the rate of survival of the transplanted kidney in the 5th year is negligibly less than 7% in tissue mismatched twins. When transplants with no tissue compatibility are compared with transplants from those with 5 out of 6 tissue compatibility, it is seen that the survival rate of the transplanted kidney at 5 years is similar (80%).
Tissue types are characteristic sets of antigens that are passed on to humans from their parents and are found on the surface of nearly all cells. Just like the blood group, it does not change for life and is our password as an individual. Everyone has a tissue type and 6 different antigens that make up that tissue type.
There are three basic tissue type characteristics (antigens): A, B and DR. Each individual shows 6 characteristics in total, 2A, 2B and 2DR, one from the mother and one from the father.
Especially in transplants made from cadavers, the greater the compatibility between these six antigens of the donor and recipient, the higher the chance of the kidney to work. Among these antigens, DR match is more important than A or B match.