Kidney Transplant
Kidneys are two bean-shaped organs located just below the rib cage on either side of the spine. Each one is the size of a fist. The main function of the kidneys is to filter wastes, minerals and fluid from the blood by producing urine, and to filter out some harmful and waste materials through urine. When your kidneys lose this filtering ability, harmful fluid and waste materials build up in your body. This can lead to high blood pressure and end-stage kidney failure also known as renal disease or kidney disease. End-stage kidney failure occurs when the kidneys lose about 90 percent of their normal function. Treatment options for end-stage kidney failure include dialysis and kidney transplantation.
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Common causes of end-stage kidney failure include:
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Diabetes
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Chronic, uncontrolled high blood pressure
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Chronic glomerulonephritis – inflammation of the small filters (glomeruli) in your kidneys and eventually permanent loss of function
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Plycystic kidney disease
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Living donor kidney transplantation is an extremely comfortable method for both the recipient and the donor. However, very successful results are obtained in kidney transplantation from a person who has brain death, namely a cadaver.
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What is a kidney transplant?
Kidney transplantation is the process of replacing the failing kidney with a kidney taken from a living or cadaver, and ensuring that the kidney functions of the person continue.
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Kidneys are our vital organs. Chronic kidney failure means permanent deterioration of kidney function. Currently, the only known treatment of chronic kidney failure is kidney transplantation, which is the most common organ transplantation. Kidney transplantation can also be performed in emergencies, called acute kidney failure. Kidney transplantation allows the patient to regain his health with a surgery. Dialysis should not be considered as an alternative to kidney transplantation as it can only (partially) restore some kidney functions. Moreover, various adverse events such as strict diets, water restriction, travel barriers, isolation from social life, being left behind from work or education, and developmental delay in pediatric patients may occur for patients on dialysis. Patients on dialysis have to use drugs intensively because they are deprived of most of the functions performed by the kidneys. (blood pressure, blood-forming drugs, etc.) For these reasons, it is known that kidney transplant patients have better quality of life and duration of life than patients on dialysis. Patients can continue their lives as healthy individuals with a successful kidney transplant and postoperative follow-up.
What are the benefits of kidney transplantation?
Dialysis can only do 10% of the kidney functions of a healthy person. A successful kidney transplant (transplantation) can fulfill 100% of the kidney functions of a healthy person.
Does transplantation provide advantage over dialysis?
Dialysis can only do 10% of the kidney functions of a healthy person. A successful kidney transplant (transplantation) can fulfill 100% of the kidney functions of a healthy person.
In Which Diseases Is Kidney Transplant Applied?
Kidney transplantation is performed in the case of end-stage renal disease. Diseases such as diabetes (diabetes) , chronic, uncontrolled high blood pressure, chronic glomerulonephritis-inflammation of the small filters (glomeruli) in the kidneys and eventually permanent loss of function and polycystic kidney disease can reach the stages that require kidney transplantation by causing kidney failure in advanced stages.
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.
Who can be a kidney donor?
Anyone can be a living donor under medical and legal conditions.
Who cannot donate kidneys? Who cannot be a kidney donor?
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Persons under the age of 18
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Those with hypertension (>140/90 mmHg) or using hypertension medication
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Diabetes (Diabetes)
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People with morbid obesity
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Bilateral or recurrent nephrolithiasis (kidney stones)
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Those with a history of thrombosis or thromboembolism
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Those with chronic kidney disease (CKD)
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History of pulmonary embolism or recurrent thrombosis
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Those with psychiatric illnesses
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Those with serious medical illness (chronic lung disease, recently diagnosed cancer)
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Low GFR (< 80 ml/min)
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Proteinuria (>300 mg/24 hours)
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History of pulmonary embolism or recurrent thrombosis
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HIV infection
How is kidney transplantation 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.
What are the risks of kidney transplantation for the donor?
As with any surgery, being a kidney donor has risks. Therefore, no one can guarantee that the operation will be absolutely successful. Although there is a very low risk of death for the donor in kidney transplantation, wound and urinary tract infections may develop at very low rates.
What should be done after the transplant?
It is recommended that transplant patients do not participate in contact sports. (Boxing, wrestling, football, basketball, etc.) After the transplant, one should stay active, avoid smoking and alcohol, and follow a healthy diet program.
What are kidney transplant prices?
Kidney transplant prices are one of the most frequently asked questions in this regard. Kidney transplantation is a very important operation and should be performed by experienced surgical teams in fully equipped hospitals that are licensed for this organ transplantation (kidney transplantation).
FREQUENTLY ASKED QUESTIONS ABOUT KIDNEY TRANSPLANTATION
How Many Hours Does Kidney Transplantation Take?
Under normal conditions, kidney transplant surgery takes 3-4 hours. After approximately one hour of preoperative preparation, approximately two hours of surgery and 1-2 hours of observation, the donor and receiver are taken to the service.
What is a Living Donor Kidney Transplantation?
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 food 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.
Can Diabetics Have Kidney Transplantation?
Diabetics can also be transplanted. Because the advantages of kidney transplantation are also valid for diabetic patients. Diabetes mellitus is one of the most common causes of kidney failure today. Therefore, a large number of diabetic patients undergo kidney transplantation.
Can Those With Hepatitis Have Kidney Transplantation?
Patients with hepatitis should be evaluated in detail for liver cirrhosis or chronic hepatitis. In the absence of these conditions, transplantation can be performed.
What is the Expected Life expectancy in Kidney Transplantation?
Half of the patients with a living kidney transplant enter 25 years healthy, while half of the cadaveric kidney transplant patients enter 10 years away from dialysis and in good health. 80% of transplant patients continue their old jobs.
Blood Type Test For Kidney Transplantation
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:
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If the recipient's blood type is A, the donor should be either A or O.
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If the recipient's blood type is B, the donor should be blood group B or O.
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If the recipient's blood type is O, the donor blood type should be O.
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If the recipient's blood type is AB, the donor blood group can be A, B, AB or O.
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AB blood group is the easiest to match. Because a person with AB blood type accepts all other blood types.
Tissue typing
The second test, which is a blood test for the determination of human leukocyte antigens (HLA), is called tissue typing. Antigens are markers found on many cells of the body that uniquely distinguish each individual. These tokens are inherited from parents. 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.
Cross match
Throughout life, the body produces substances called antibodies that help destroy foreign substances. When a donor kidney is available, a test called crossmatch is done to make sure the recipient does not have preformed antibodies against the donor.
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Cross-matching is done by mixing the recipient's blood with cells from the donor. If the crossmatch is positive, it means there are antibodies against the donor. The recipient should not receive this kidney unless specific treatment is given prior to transplant to lower antibody levels. If the crossmatch is negative, it means that the recipient has no antibodies against the donor and is eligible to receive this kidney. Several cross-matches are performed in preparation for a living donor transplant, and a final cross-match is performed 48 hours before such transplant.
Serological tests
Testing is also done for viruses such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus) to select appropriate preventive drugs after transplantation.
Can Elderly People Be Donors?
If kidney failure patients do not have a very important health problem, they should be transplanted. Although the chance of transplantation seems to be low in elderly patients, since the negative effects of dialysis cause their bodies to wear out in a much shorter time, these patients should be evaluated within the scope of transplantation, considering that the patient group that benefits most from transplantation is the elderly. In the program of the European Transplant Center, which is specific to this group, kidneys taken from the elderly are transplanted to the elderly. If a patient aged 80 or more does not have a problem in kidney functions, it gives very successful results when transplanted to an elderly patient. Even a person with advanced heart disease has no drawbacks in having a kidney transplant after the necessary examinations and treatments are performed. The important thing is to ensure that the person has a healthy heart by applying the necessary treatment or operation after the heart examination of the patient. Then kidney transplantation can be done in a very healthy way. For example; There is no harm in transplanting a bypassed person. Transplantation can be done months after heart surgery.
When Should Kidney Transplantation Be Done?
​When kidney function falls below 20% in patients with chronic renal failure, kidney transplantation treatment is needed.
Who Needs Kidney Transplantation?
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.
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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 improve 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.
What is kidney transplant recipient 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.
What is kidney transplant recipient 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.
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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.
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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.
What is a robotic kidney transplant?
Today, at the most advanced point of kidney transplantation, the kidney is attached to the recipient with da Vinci Robotic Surgery. Robotic kidney transplant surgery has significant advantages, especially in overweight patients. You can click on the link to get information about robotic kidney transplantation.
How does the kidney transplant evaluation process work?
The kidney transplant evaluation process begins with the determination of donor and donor blood groups and tissue types.
What are the possible risks and side effects of kidney transplant surgery?
Possible risks after kidney transplant surgery include:
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Temporary kidney function deficiency: Your new kidney may not start working right away. You may need dialysis until kidney function returns.
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Organ rejection: Your body may reject the donor organ and you may need certain medications to help your body accept the new kidney.
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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.
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Vulnerability to cancer: The immunosuppressant drugs used after the transplant can make you more vulnerable to cancer.
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Diabetes: Drugs taken after kidney transplant can cause diabetes.
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Narrowing of the artery that carries blood to the kidney
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Coagulation in veins
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Infection
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Bleeding
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Gaining weight
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Hypertension
What is the recovery time after kidney transplant?
Two weeks after the kidney transplant, you start to feel much better; however, you must use anti-rejection medication regularly after the transplant.
What are the risks from immunosuppressive drugs?
Preventive drugs weaken the immune system and increase the risk of infections with ordinary and different organisms. Infections can be serious, damage the transplanted kidney, or be life-threatening. Cancers are more difficult to treat in patients using anti-rejection drugs. The risk of diabetes also increases. As a result, it may be necessary to be treated with insulin injections or pills.
What are the advantages of living donor kidney transplantation?
There are many advantages of live donation. The kidney works immediately. The kidney is less likely to be rejected. Grafts are longer lasting. A living donor's kidney is completely healthy. They are known to work better and longer than cadaver kidneys. In addition, there are thousands of patients on the waiting list who are diagnosed with kidney failure and are waiting for a kidney transplant. There are not enough dead (cadaveric) donors. Organ distress and mortality rates can be reduced with living donor kidney transplantation.
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