The only treatment option for kidney failure that can provide long-term results and improve the patient's quality of life is kidney transplantation. Thanks to the transplantation of this organ, doctors managed to help more than one patient at the terminal stage. Despite the fact that such operations have been performed for a long time, the issue of kidney transplantation in Russia does not lose its relevance due to the huge number of patients who need it. In our country, every eighth resident suffers from chronic diseases of the excretory system.
General information
This is a complex surgical process, which is the removal of organs or soft tissues from a donor and their engraftment to the recipient. About half of the surgical operations performed in the world for the purpose of organ transplantation are manipulations for kidney transplantation. About 30,000 such interventions are performed annually in the world.
Transplantology has made the whole world talk about itself, since it is this treatment technique that demonstrates a high survival rate among hopeless patients. In 80% of cases, patients overcome the five-yearthreshold after kidney transplant.
Compared to dialysis, which was not so long ago the only way to support the life of seriously ill patients, kidney transplantation significantly improves the patient's quality of life, as it eliminates the need for a permanent stay in a medical facility. However, the waiting time for surgery may be too long due to the shortage of donor organs. Then dialysis becomes, in fact, the only way to maintain the functionality of the patient's body. In addition, in order to keep the implanted kidney in a satisfactory condition for as long as possible, the recipient will have to take medicines until the last days, be periodically examined by specialists and be responsible to himself for his lifestyle, diet, work activity, etc.
Methods of obtaining a transplant
If a person needs a kidney transplant, the first step is to find a donor for him. A person who wants to donate his organ to a needy person can be a living person (in Russia it can only be a relative) or a deceased person, if before death he or his relatives entered into an agreement on the removal of a kidney. The first option is more preferable, as it increases the chances for the recipient to survive the organ. In the second case, a donor organ is taken from a person with documented brain death, which is documented.
According to statistics, a kidney transplant from a living donor is more successful. It is connected withthe doctor's ability to plan the operation in advance and get more time to undergo an examination, prepare the recipient, while the implantation of the organ of a deceased person is carried out as soon as possible due to the inability of doctors to delay the inevitable processes of tissue decomposition.
To whom surgery is recommended
The main indication for transplantation is serious disorders in the functioning of the kidneys. If a patient is diagnosed with chronic renal failure, this means that his body loses its ability to perform the functions of purifying the blood. Partially compensate for this violation can be due to dialysis. Terminal renal failure is the last phase of chronic kidney pathologies, complications of congenital anomalies or damage. In this case, a kidney transplant operation or continuous use of renal replacement therapy is required, which is aimed at artificially removing toxic metabolic products from the body. Otherwise, general intoxication of the body may occur and, as a result, the death of the patient.
Diseases that lead to chronic renal failure include:
- interstitial nephritis (inflammatory process in the interstitial renal tissue);
- pyelonephritis (infection of an organ);
- glomerulonephritis (disorders in the functioning of the glomerular apparatus);
- polycystic kidney disease (multiple benign tumors);
- nephropathy (damage to the glomerulus and parenchyma of the kidneys on the background of diabetes mellitus);
- kidney inflammation howcomplication of systemic lupus erythematosus;
- nephrosclerosis (replacement of he althy parenchyma cells with fibrous tissue).
Are there any contraindications
In modern transplantology, there is no consensus on the cases in which an operation to engraft a donor organ is not recommended. In different medical centers, the list of contraindications for kidney transplantation may vary slightly. Most often, a transplant is denied to patients in the case of:
- Incompatibility of the recipient's immunological reaction to the donor's lymphocytes. None of the qualified specialists will undertake such an operation, since in this case the risk of hyperacute rejection of a foreign organ will be extremely high.
- Oncological pathologies. Transplantation is contraindicated even some time after tumor treatment. In the predominant number of cases, patients are allowed to transplant after at least two years from the moment of radical cancer treatment. At the same time, in some medical centers specializing in transplantation, they do not wait for any deadlines if they have successfully removed cancer of the kidney, bladder, cervix, and skin basalioma at an early stage. After treatment for cervical cancer, breast cancer, melanoma, the observation period is increased to 5 years.
- Infections. Absolute contraindications to donor kidney transplantation are HIV infection, active hepatitis B, C, tuberculosis. After curing of tuberculosis, the patient is followed up for at least a year.
- Chronic diseases that can worsen the patient's conditionin the postoperative period. These include peptic ulcer of the gastrointestinal tract, heart failure.
Not so long ago, nephropathy, which occurs as a complication of diabetes mellitus, was considered a contraindication to kidney transplantation. Such patients do have a worse survival prognosis after transplantation, however, with correct and timely treatment, the patient's chances of recovery increase several times.
It is not recommended to resort to a donor kidney transplant if the patient refuses to comply with medical prescriptions. The indiscipline of recipients in 5-10% of cases leads to rejection of the implanted organ. Failure to comply with prescriptions prescribed by specialists regarding immunosuppressive therapy, diet and lifestyle is fraught with serious complications. Another contraindication associated with the inability of the patient to follow the rules after a kidney transplant is mental disorders, changes in behavior on the background of drug addiction and alcoholism.
Of course, transplantation is not carried out if the donor and recipient have incompatible blood types. In addition to absolute contraindications, there are also relative ones. A kidney is transplanted to children and the elderly only in isolated cases, since the performance of such operations is associated with increased complexity and a low probability of survival of the organ. If a potential donor does not meet the stated requirements, has serious pathologies, his participation in transplantation is called into question, to dispel whichadvisory opinions of highly specialized specialists will help.
Transplant techniques
Operations to engraft an organ to a recipient are classified as follows:
- Isogenic transplantation. Here, a blood relative acts as a donor - a person whose biological material has a genetic and immunological similarity. This is the most common type of kidney transplant manipulation.
- Allogeneic transplantation. A stranger becomes a donor if there is compatibility with the patient's body. In our country, organs are transplanted only from a deceased donor.
- Replantation means the return of an organ to a person. The need for such an operation arises due to a serious injury, separation or cutting off of an organ.
In addition, transplant operations are distinguished based on the location of the implanted organ. So, for example, the most difficult is heterotopic transplantation, when a “foreign” organ engrafts itself in an anatomically intended place, while the non-functioning kidney of the recipient is removed. In orthotopic transplantation, the engrafted organ is placed elsewhere, most often in the iliac zone, and the diseased kidney remains, it is not removed.
How to prepare for a transplant
To understand whether to do a kidney transplant, whether this treatment option is appropriate, the patient must undergo a comprehensive clinical examination. Comprehensive diagnostics will identify or exclude possible contraindications. Beforethe patient will be on the waiting list for a kidney transplant, he must:
- Provide laboratory tests of blood, urine and sputum.
- Pass x-ray, ultrasound and other types of instrumental studies (gastroscopy, electrocardiography, MRI, CT).
- Get advice from highly specialized specialists (psychologist, narcologist, otolaryngologist, dentist, cardiologist, gastroenterologist, hematologist). For female recipients, a recommendation from a gynecologist is also mandatory.
Before the actual operation, the patient will have to undergo a second examination, as it can take from several weeks to several months to wait for a suitable donor organ.
If there are no contraindications, the compatibility of the donor and the recipient is determined, the patient is placed in an inpatient department. In some cases, kidney transplantation is preceded by dialysis - an artificial blood purification procedure is resorted to a couple of days before transplantation. The patient is prescribed sedatives if his psychological condition requires it.
The last food and liquid intake before surgery occurs 8-10 hours before the operation. In addition, the recipient must sign the relevant papers in order to formalize their consent to this type of intervention. The package of documents also includes confirmation of informing about possible risks, threats to he alth and life.
How is the operation going
A kidney transplant from a living donor takes place in several stages. As a rule, the nephrectomy procedure in the recipient proceeds almost simultaneously withsurgical removal of a donor organ; therefore, such transplantation requires the participation of several teams of specialists. Compared to an operation to engraft an organ from a deceased donor to a patient (here the kidney is prepared in advance), this surgical intervention can take much longer.
Transplantation is performed under general anesthesia. While one team of specialists performs a nephrectomy on the donor, the second team prepares the place for the transplant in the recipient. After that, the organ is fixed and connected to the artery, vein and ureter of the patient. The next mandatory step is bladder catheterization.
The main indicator of a successful operation is the urine output of the transplanted kidney after a few days. In the normal state of the organ, it reaches its full functionality within a week, therefore, according to reviews, a kidney transplant does not require a long stay in the hospital. If there are no complications, the patient is discharged after a couple of weeks.
The quality of life after a kidney transplant from a donor also does not suffer. The one remaining organ grows over time and fully performs the necessary functions.
Do children get kidney transplants
In adulthood, dialysis is much easier to tolerate than in early life. Such treatment can bring difficulties not only physically, but also mentally. Long stay on dialysis interferes with the normal development and growth of the child. If the baby has an indication for transplantation, the operation must be performed insoon. At the same time, in childhood, a kidney transplant, according to reviews, has a better chance of a successful outcome. The organ takes root quickly, the patient's condition quickly stabilizes.
Often, difficulties arise at the stage of finding a suitable donor. If an urgent kidney transplant is needed, an organ from an adult is transplanted to a child. However, this option is possible only if there is enough space in the retroperitoneal space of a small recipient for organ implantation. In addition, the risk of insufficient blood supply to the "new" kidney due to the small diameter of the vessels cannot be ruled out. Children with diseases of the heart or cardiovascular system, pathologies of a mental nature, the operation is contraindicated.
Life after surgery
To the question about a kidney transplant: "How long do they usually live with an implanted organ?" no one can give a definitive answer. The success of engraftment of an organ largely depends not only on the characteristics of the human body, but also on strict adherence to the recommendations of the attending physician.
After transplantation, long-term rehabilitation is required, which includes bed rest, taking anti-inflammatory and immunosuppressive drugs, a radical revision of the daily menu and constant medical supervision. In general, the prognosis can be considered favorable, with a high-quality intervention and a satisfactory course of the rehabilitation period, a person will certainly return to normal life. In some cases, after 15-20 years, it is requiredretransplant.
How to eat right with a kidney transplant
Diet minimizes the risk of complications. Initially, after the operation, the patient can receive nutrients only through infusion infusion of medicinal solutions. A patient can be prescribed a diet after a kidney transplant after 5-7 days.
The body of a person who has undergone such a serious surgical intervention especially needs a balanced supply of vitamins, calcium, phosphates, and nutrients. Weight gain is unacceptable, as extra pounds can lead to a number of negative consequences.
Doctors recommend following the basic principles of nutrition after kidney transplantation not only for the recipient, but also for the donor:
- Limit s alt intake, and it is advisable to refuse spices altogether, since these substances contribute to fluid retention in the body and cause thirst.
- Do not include canned foods on the menu.
- Exclude fatty meats, fish, sausages, fast food from the diet.
- Plant food should prevail in the diet, and animal proteins should be more careful.
- Under the strictest ban any alcoholic drinks, coffee and strong tea.
- Instead of whole milk, it is advisable to drink low-fat kefir or yogurt without additives.
- Limit daily fluid intake to 1.5-2 liters to prevent increased stress on the kidneys.
Why the organ does not take root, signs of rejection
At the stage of the postoperative period, the patient is inhospital under round-the-clock medical supervision. To assess the functioning of the transplant, blood and urine tests for electrolytes, urea, creatinine are regularly performed, ultrasound and other instrumental diagnostics are performed to assess the quality of blood flow in the transplanted kidney.
There are several options for complications after a kidney transplant. The patient's life may be in real danger, so it is important to recognize negative changes in the body as early as possible. Their cause may be:
- Unsatisfactory connection of vessels, which can provoke bleeding. As a result, the patient develops hematomas in the retroperitoneal space.
- Inflammation and suppuration of the seam on the body after surgery. Therapy, which is given to minimize the risk of rejection, weakens the immune system, which can lead to infection of the wound.
- Thromboids in the iliac arteries or deep veins of the legs.
- Rejection. It may appear suddenly (hyperacute) or during the first months after surgery. Sometimes rejection becomes chronic. In this case, it is a sluggish and inconspicuous reaction. Its occurrence is fraught with serious consequences. If immunosuppressive drugs fail to correct the situation, the donor kidney will die.
Rejection of a new organ can be suspected for a number of reasons. Typically, patients complain of pain, swelling, elevated body temperature and blood pressure, decreased frequencyurination, shortness of breath and general malaise. When such signs appear, the patient needs immediate medical attention. In the event of acute rejection, the doctor will decide whether to increase the dose of the immunosuppressive drug or replace it with a stronger one.
Where kidney transplant is done
Transplant operations are a type of high-tech medical care. In Russia, kidney transplantation is performed by more than 40 medical organizations that have the appropriate license. It is worth noting that quotas are allocated from the federal budget for each region to perform operations free of charge for needy patients, but, unfortunately, there are not enough public funds for all. The average cost of a kidney transplant is about 1 million rubles. At the same time, we are not talking about the price of a donor organ, since such trade is prohibited in Russia, but about the cost of surgical intervention, regardless of which organ will be transplanted - from a relative or from a deceased donor.
There are more medical centers that deal with kidney transplantation in our country than clinics that specialize in transplanting other organs. Leading institutions in Moscow are:
- FNC of Transplantology and Artificial Organs.
- RNC of Surgery named after academician B. V. Petrovsky RAMS.
- Oncological Research Center of the Russian Academy of Medical Sciences.
- SC Cardiovascular Surgery named after A. N. Bakulev RAMS.
- Medical and Surgical Center named after N. I. Pirogov.
- Russian Children's Clinical HospitalRoszdrav.
- Military Medical Academy named after S. M. Kirov.
There are also transplantation departments in 23 regions and cities, including St. Petersburg, Novosibirsk, Voronezh, Nizhny Novgorod, Krasnoyarsk, Khabarovsk, Yekaterinburg. Information about the nearest medical center for kidney transplantation can be obtained from the territorial structures of the Ministry of He alth. In the same place, patients leave applications for a quota.
Throughout his life after transplantation, the patient must constantly monitor his he alth, take drugs to suppress the immune response - they will help prevent rejection. In addition, the patient should undergo periodic diagnostic procedures and lead a he althy lifestyle.
For the he alth of a person who participated in transplantation as a donor, the risks are less serious, however, in later life with one kidney, there is still a share of the likelihood of negative consequences.
