The only treatment option for kidney failure, which can give a long-term result and improve the patient's quality of life, is considered a kidney transplant. Thanks to 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, one in eight residents 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 the engraftment of their recipient. About half of the surgeries carried out in the world for organ transplantation are kidney transplant manipulations. About 30 thousand such interventions are carried out annually in the world.
Transplantology made the whole world talk about itself, since it is this therapeutic technique that demonstrates high survival among hopeless patients. In 80% of cases, patients overcome the five-year threshold after a kidney transplant.
Compared to dialysis, which not so long ago was the only way to support vital activity of severe patients, renal transplantation significantly improves the patient's quality of life, as it eliminates the need for a permanent stay in a medical facility. However, the expectation of surgery may be too long due to a 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 medications until the last days, periodically be examined by specialists and be responsible to himself for his lifestyle, diet, work, etc.
Transplant Methods
If a person needs a kidney transplant, first of all it is necessary to find a donor for him. A living person (in Russia he can only be a relative) or deceased, if he or his relatives concluded an agreement on the removal of a kidney, can act as a person who wants to give his organ to the needy. 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 a fixed brain death, which is documented.
According to statistics, a kidney transplant from a living donor is more successful. This is due to the doctor’s ability to plan the operation in advance and get more time to undergo 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 tissue decomposition processes.
Who is recommended for surgery
The main indication for transplantation is serious impairment of kidney function. If a patient is diagnosed with chronic renal failure, this means that his body loses its ability to perform blood purification functions. Partially to compensate for this violation can be due to dialysis. Terminal renal failure is the last phase of chronic kidney disease, complications of congenital malformations or damage. In this case, a kidney transplant operation or continuous use of renal replacement therapy, which is aimed at artificially removing toxic metabolic products from the body, is required. Otherwise, general intoxication of the body and, as a consequence, the death of the patient may occur.
The diseases that lead to chronic renal failure include:
- interstitial nephritis (inflammatory process in interstitial renal tissue);
- pyelonephritis (infectious organ damage);
- glomerulonephritis (disorders in the glomerular apparatus);
- renal polycystic (multiple benign tumors);
- nephropathy (damage to glomeruli and renal parenchyma against diabetes mellitus);
- inflammation of the kidneys as a complication of systemic lupus erythematosus;
- nephrosclerosis (replacement of healthy parenchyma cells with fibrous tissue).
Are there any contraindications
In modern transplantology, there is no consensus on the cases in which the operation of engraftment of a donor organ is not recommended. In different medical centers, the list of contraindications for kidney transplantation may vary slightly. Most often, patients are refused a transplant if:
- Incompatibilities of the immunological reaction of the recipient to donor lymphocytes. None of the qualified specialists will undertake such an operation, since in this case the risk of over-acute rejection of a foreign organ will be extremely high.
- Oncological pathologies. Transplantation is contraindicated even some time after tumor treatment. In a 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, some medical centers specializing in transplantation do not wait any time if successful removal of cancer of the kidney, bladder, cervix, skin basal cell carcinoma was carried out at an early stage. After treatment for cancer of the cervix, breast, melanoma, the observation period is increased to 5 years.
- Infections An absolute contraindication to donor kidney transplantation is HIV infection, active hepatitis B, C, and tuberculosis. After treatment for tuberculosis, the patient is observed for at least a year.
- Chronic diseases that can worsen the condition of the patient in 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 a kidney transplant. Such patients really have a worse prognosis of survival 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. Indiscipline of recipients in 5-10% of cases leads to rejection of the implanted organ. Failure to comply with the appointments prescribed by specialists regarding immunosuppressive therapy, diet and lifestyle is fraught with serious complications. Another contraindication associated with the patient's inability to follow the rules after a kidney transplant is mental disorders, changes in behavior against the background of drug addiction and alcoholism.
Of course, transplantation is not carried out if the donor and recipient have incompatible blood groups. In addition to absolute contraindications, there are relative ones. For children, elderly people, a kidney is transplanted only in isolated cases, since the performance of such operations is associated with increased complexity and a low probability of organ survival. If the potential donor does not meet the stated requirements, has serious pathologies, his participation in the transplantation is called into question, which can be dispelled by the recommendations of narrow-profile specialists.
Transplantation techniques
Organ engraftment operations to the recipient are classified as follows:
- Isogenic transplantation. Here, a blood relative, a person whose biological material has genetic and immunological similarities, acts as a donor. 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 implies the return to a person of his own organ. The need for such an operation arises due to serious injury, separation or clipping of the organ.
In addition, transplant operations are distinguished based on the location of the implanted organ. So, for example, heterotopic transplantation is the most difficult, when a “foreign” organ takes root in the anatomically designated place, while the non-functioning kidney of the recipient is removed. During orthotopic transplantation, the organ to be implanted is placed in another place, 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 have a kidney transplant, whether this treatment option is appropriate, the patient must undergo a comprehensive clinical examination. Comprehensive diagnostics will identify or rule out possible contraindications. Before the patient enters the line for a kidney transplant, he must:
- Take laboratory tests of blood, urine and sputum.
- To undergo X-ray, ultrasound and other types of instrumental studies (gastroscopy, electrocardiography, MRI, CT).
- Get advice from specialized specialists (psychologist, narcologist, otolaryngologist, dentist, cardiologist, gastroenterologist, hematologist). For female recipients, a recommendation from a gynecologist is also mandatory.
Before the immediate operation, the patient will have to undergo a re-examination, as it may 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 a hospital unit. In some cases, a kidney transplant is preceded by dialysis - they resort to the procedure of artificial blood purification a couple of days before transplantation. The patient is prescribed sedatives if his psychological condition requires it.
The last intake of food and fluid before surgery occurs in 8-10 hours. In addition, the recipient must sign the relevant papers in order to obtain his consent to this kind of intervention. The package of documents also includes confirmation of information about probable risks, threats to health and life.
How is the operation
A kidney transplant takes place in several stages from a living donor. As a rule, the recipient's nephrectomy procedure proceeds almost simultaneously with the surgical removal of the donor organ; therefore, such a transplantation requires the participation of several teams of specialists. Compared with the operation of engrafting an organ from a deceased donor (here the kidney is prepared in advance), this surgical intervention can last much longer.
Transplantation is performed under general anesthesia. While one team of specialists carries out a nephrectomy for the donor, the second prepares the transplant site for the recipient. After that, the organ is fixed and connected to the artery, vein and ureter of the patient. The next mandatory step is catheterization of the bladder.
The main indicator of a successful operation is the performance of urine by a 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, after a couple of weeks the patient is discharged.
The quality of life after a kidney transplant is also not affected by the donor. One remaining organ increases over time and fully fulfills the necessary functions.
Is the kidney transplanted to children?
In adulthood, dialysis is much easier to tolerate than in early life. Such treatment can bring difficulties not only physically, but also psychically. Long-term dialysis interferes with the normal development and growth of the child. If the baby has an indication for transplantation, the operation must be carried out in the near future. 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 necessary, the organ is transplanted from an adult. However, this option is possible only if there is enough space in the retroperitoneal space of the small recipient for organ implantation. In addition, the risk of insufficient blood supply to the “new” kidney cannot be ruled out due to the small diameter of the vessels. For children with diseases of the heart or cardiovascular system, pathologies of a mental nature, surgery is contraindicated.
Life after surgery
When asked about a kidney transplant: "How long do they usually live with an implanted organ?" unequivocally no one will answer. The success of organ engraftment largely depends not only on the characteristics of the human body, but also on strict compliance with the recommendations of the attending physician.
After transplantation, a long rehabilitation is required, which includes bed rest, taking anti-inflammatory and immunosuppressive drugs, a radical review of the daily menu and constant medical supervision. In general, the prognosis can be considered favorable, with a well-conducted intervention and a satisfactory course of the rehabilitation period, a person will certainly return to normal life. In some cases, after 15-20 years, a second transplant is required.
How to eat properly with a transplanted kidney
Diet minimizes the risk of complications. Initially, after surgery, the patient can receive nutrients only through the 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 that you adhere to the basic principles of nutrition after kidney transplantation not only to the recipient, but also to the donor:
- Limit salt intake, and it is advisable to refuse spices and spices altogether, since these substances contribute to the retention of fluid in the body and cause thirst.
- Do not include canned foods on the menu.
- Exclude fatty meats, fish, sausages, fast food from the diet.
- Vegetable food should prevail in the diet, and you should be careful with animal proteins.
- Under the strictest ban, any alcoholic beverages, 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, preventing 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 in the hospital under round-the-clock supervision of doctors. To assess the functioning of the transplant, blood and urine tests are regularly performed for electrolytes, urea, creatinine, ultrasound and other instrumental diagnostics are performed to assess the quality of blood flow in the transplanted kidney.
There are several possible complications after a kidney transplant. The patient’s life may be in real danger, therefore it is important to recognize negative changes in the body as early as possible. Their cause may be:
- Poor connection of blood vessels, which can provoke bleeding. As a result, the patient has hematomas in the retroperitoneal space.
- Inflammation and suppuration of the suture on the body after surgery. Therapy, which is carried out in order to minimize the risk of rejection, weakens the immune system, which can lead to infection of the wound.
- Thrombosis in the iliac arteries or deep veins of the legs.
- Rejection. May occur suddenly (oversensitive) or during the first months after surgery. Sometimes rejection becomes chronic. In this case, it is a sluggish and subtle reaction. Its occurrence is fraught with serious consequences. If immunosuppressants cannot correct the situation, the donor kidney will die.
Rejection of a new organ can be suspected by a number of signs. Patients usually complain of pain, swelling, fever, and blood pressure, decreased urination, shortness of breath, and general malaise. . .
Transplant operations are a type of high-tech medical care. In Russia, a kidney transplant is done by more than 40 medical organizations that have the appropriate license. It is worth noting that for each region quotas are allocated from the federal budget for operations for free to needy patients, but, unfortunately, there are not enough public funds. On average, the cost of a kidney transplant is about 1 million rubles. At the same time, this is not about the price of the 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 there are clinics specializing in transplantation of other organs. The leading institutions in Moscow are:
- Federal Center for Transplantology and Artificial Organs.
- Russian Surgery Center named after academician B.V. Petrovsky RAMS.
- Cancer Research Center RAMS.
- SC of cardiovascular surgery named after A.N. Bakulev RAMS.
- Medical and Surgical Center named after N.I. Pirogov.
- Russian Children's Clinical Hospital of Roszdrav.
- Military Medical Academy named after S. M. Kirov.
There are also transplantology departments in 23 regions and cities, including St. Petersburg, Novosibirsk, Voronezh, Nizhny Novgorod, Krasnoyarsk, Khabarovsk, Yekaterinburg. Information about the nearest kidney transplant medical center can be obtained from the territorial departments of the Ministry of Health. There, patients leave applications for quotas.
Throughout life after transplantation, the patient should constantly monitor his health, take medications to suppress the immune response - they will help prevent rejection. In addition, the patient should periodically undergo diagnostic procedures and lead a healthy lifestyle.
For the health of a person who participated in the transplantation as a donor, the risks are less serious, nevertheless, in the future life with one kidney, there is still a share of the probability of negative consequences.