Kidney transplantation

Definition

Kidney transplantation is a surgical procedure to remove a healthy, functioning kidney from a living or brain-dead donor and entrench it into a patient near non-functioning kidneys.

Purpose

Kidney transplantation is performed on patients next to chronic kidney failure, or end-stage renal disease (ESRD). ESRD occur when a disease or disorder damages the kidneys so that they are no longer capable of suitably removing fluids and wastes from the body or of maintain the proper level of in no doubt kidney-regulated chemicals in the bloodstream. Without long-term dialysis or a kidney transplant, ESRD is mortal.

Precautions

Patients with a history of heart disease, lung disease, cancer, or hepatitis may not apply candidates for reception a kidney transplant.

Description

Kidney transplantation involves surgically attaching a functioning kidney, or graft, from a brain-dead organ donor (a cadaver transplant) or from a living donor, to a patient near ESRD. Living donors may be related or unrelated to the patient, but a related donor have a better chance of have a kidney that is a stronger biological "meeting" for the patient.

The surgical procedure to remove a kidney from a living donor is call a nephrectomy. The kidney donor is administered general anesthesia and an incision is made on the side or front of the belly. The blood vessels connecting the kidney to the donor are cut and clamped, and the ureter is also cut between the bladder and kidney and clamped. The kidney and an attached paragraph of ureter is removed from the donor. The vessels and ureter contained by the donor are then tied rotten and the incision is sutured together again. A similar procedure is used to harvest cadaver kidneys, although both kidneys are typically removed at once, and blood and cell sample for tissue typing are also taken.

Laparoscopic nephrectomy is a form of minimally-invasive surgery using instruments on long, narrow rods to judgment, cut, and remove the donor kidney. The surgeon views the kidney and surrounding tissue beside a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen. Once the kidney is freed, it is secured contained by a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) all-embracing, in the front of the abdominal wall below the navel. Although this surgical technique take slightly longer than a traditional nephrectomy, preliminary studies have shown that it promotes a faster taking back time, shorter hospital stays, and less post-operative headache for kidney donors.

Once removed, kidneys from live donors and cadavers are placed on rime and flushed with a cold preservative solution. The kidney can be preserved within this solution for 24-48 hours until the transplant takes place. The sooner the transplant take place after harvesting the kidney, the better the probability are for proper functioning.

During the transplant operation, the kidney recipient tolerant is typically under broad anesthesia and administered antibiotics to prevent possible infection. A catheter is placed in the bladder before surgery begin. An incision is made in the flank of the patient and the surgeon implant the kidney above the pelvic bone and below the existing, non-functioning kidney by suturing the kidney artery and vein to the forgiving's iliac artery and vein. The ureter of the strange kidney is attached directly to the bladder of the kidney recipient. Once the spanking new kidney is attached, the patient's existing, diseased kidneys may or may not be removed, depending on the circumstances surrounding the kidney ruin.

Since 1973, Medicare has picked up 80% of ESRD treatment costs, including the costs of transplantation for both the kidney donor and receiver. Medicare also covers 80% of immunosuppressive medication costs for up to three years, although federal legislation was underneath consideration in precipitate 1998 that may remove the time limit on these benefits. To qualify for Medicare ESRD benefits, a tolerant must be insured or eligible for benefits under Social Security, or be a spouse or child of an eligible American. Private insurance and state Medicaid programs normally cover the remaining 20% of treatment costs.

Preparation

Patients with chronic renal disease who call for a transplant and do not have a living donor register near United Network for Organ Sharing (UNOS) will be placed on a waiting list for a cadaver kidney transplant. UNOS is a non-profit body that is below contract with the federal management to administer the Organ Procurement and Transplant Network (OPTN) and the national Scientific Registry of Transplant Recipients (SR). Kidney availability is based on the long-suffering's health status. The most prominent factor is that the kidney be compatible to the patient's body. A human kidney have a set of six antigens, substances that stimulate the production of antibodies. (Antibodies then attach to cell they recognize as foreign and attack them.) Donors are tissue-matched for 0 to 6 of the antigens, and compatibility is determined by the number and strength of those matched pairs. Patients beside a living donor who is a close relative have the best unpredictability of a close match.

Potential kidney donors experience a complete medical history and physical examination to evaluate their suitability for donation. Extensive blood test are performed on both donor and receiver. The blood samples are used to tissue type for antigen match, and confirm that blood types are compatible. A panel of reactive antibody (PRA) is performed by mixing white blood cell from the donor and serum from the recipient to ensure that the receiver antibodies will not have a distrustful reaction to the donor antigens. A urine question paper is performed on the donor to evaluate his kidney function. In some cases, a special dye that shows up on x rays is injected into an artery, and x rays are taken to show the blood supply of the donor kidney (a procedure call an arteriogram).

Once compatibility is confirmed and the physical preparations for kidney transplantation are complete, both donor and recipient may bear a psychological or psychiatric evaluation to ensure that they are emotionally prepared for the transplant procedure and aftercare regimen.

Aftercare

Kidney donors and recipients will experience some discomfort within the area of the incision. Pain relievers are administered following the transplant operation. Patients may also experience numbness, cause by severed nerves, near or on the incision.

A regimen of immunosuppressive, or anti-rejection, medication is prescribed to prevent the body's immune system from rejecting the current kidney. Common immunosuppressants include cyclosporine, prednisone, and azathioprine. The kidney recipient will be required to steal immunosuppressants for the life span of the contemporary kidney. Intravenous antibodies may also be administered after transplant surgery. Daclizumab, a monoclonal antibody, is a promising new psychiatric help that can be used in conjunction next to standard immunosuppressive medications to eat up the incidence of organ rejection.

Transplant recipients may obligation to adjust their dietary habits. Certain immunosuppressive medication cause increased appetite or sodium and protein retention, and the lenient may have to adjust his or her intake of calories, brackish, and protein to compensate.

Risks

As with any surgical procedure, the kidney transplantation procedure carry some risk for both a living donor and a graft recipient. Possible complications include infection and bleeding (hemorrhage). The most adjectives complication for kidney recipients is a urine seep. In approximately 5% of kidney transplants, the ureter suffers some damage, which results surrounded by the leak. This problem is usually correctable near follow-up surgery.

The biggest risk to the recovering transplant recipient is not from the operation or the kidney itself, but from the immunosuppressive medication he or she must help yourself to. Because these drugs suppress the immune system, the patient is susceptible to infections such as cytomegalovirus (CMV) and varicella (chickenpox). The immunosuppressants can also grounds a host of possible side effects, from high blood pressure to osteoporosis. Prescription and dosage adjustment can lessen side effects for some patients.

Normal results

The new kidney may start functioning without beating about the bush, or may take several weeks to fire up producing urine. Living donor kidneys are more likely to fire up functioning earlier than cadaver kidneys, which frequently suffer some reversible weaken during the kidney transplant and storage procedure. Patients may have to experience dialysis for several weeks while their new kidney establishes an agreeable level of functioning.

The nouns of a kidney transplant graft depends on the strength of the match between donor and receiver and the source of the kidney. Cadaver kidneys have a four-year survival rate of 66%, compared to an 80.9% survival rate for living donor kidneys. However, nearby have be cases of cadaver and living, related donor kidneys functioning well for over 25 years.

Studies own shown that after they recover from surgery, kidney donors typically enjoy no long-term complications from the loss of one kidney, and their remaining kidney will increase its functioning to compensate for the loss of the other.

Abnormal results

A transplanted kidney may be rejected by the patient. Rejection occur when the patient's immune system recognize the new kidney as a foreign body and attacks the kidney. It may materialize soon after transplantation, or several months or years after the procedure has taken place. Rejection episodes are not exceptional in the first weeks after transplantation surgery, and are treated next to high-dose injections of immunosuppressant drugs. If a rejection episode cannot be reversed and kidney failure continues, the forgiving will typically go support on dialysis. Another transplant procedure can be attempted at a later date if another kidney become available.

Key Terms

Arteriogram

A diagnostic test that involves viewing the arteries and/or attached organs by injecting a contrast environment, or dye, into the artery and taking an x ray.

Dialysis

A blood filtration psychiatric help that replaces the function of the kidneys, filtering fluids and spend products out of the bloodstream. There are two types of dialysis treatment--hemodialysis, which uses an artificial kidney, or dialyzer, as a blood filter; and peritoneal dialysis, which uses the patient's abdominal cavity (peritoneum) as a blood filter.

Iliac artery

Large blood vessel in the pelvis that lead into the leg.

Immunosuppressive medication

Drugs given to a transplant recipient to prevent his or her immune system from attacking the transplanted organ.

Rejection

The process where the immune system attacks tissue it sees as foreign to the body.

Videoscope

A surgical camera.