Kidney transplantation

A kidney transplant is a surgical procedure to remove the diseased kidney and replace it with a new, healthy organ.

The kidneys are responsible for numerous bodily functions, for example:

  • Regulating electrolyte balance and maintaining acid-base balance in the body.
  • Regulation of blood pressure.
  • Excretion of toxic substances such as ammonium and urea.
  • Reabsorption of amino acids and glucose and production of hormones.
  • Production of the required amount of erythropoietin and vitamin D.

This pair of organs is located behind the abdominal cavity.


Classification of kidney transplantation

Kidney transplants can be mainly classified into 2 types:

  1. If the kidney comes from a deceased person, it is called post-mortem donation.
  2. If the kidney comes from a living person, it is called living donation.

Deceased donors can be divided into two groups: donors after brain death (irreversible loss of brain functions) and donors after cardiac death.
Living donor transplantation can be divided into two types: genetically related transplantation (if the donor is a family member) and unrelated transplantation (if the donor is not biologically related to the recipient).

Nowadays, research on artificial kidneys is very advanced, which is obtained as follows:

  1. The kidney is removed from the donor and the cells are removed from it. In this way, only the structure remains, which consists mainly of collagen fibers.
  2. Cells from the patient are implanted into this structure.
  3. Then the transplant is performed, which does not cause a rejection reaction, since it does not contain foreign cells.

Reasons and indications for kidney transplantation

Kidney transplantation may be recommended for people with end-stage kidney disease, i.e. if there is chronic kidney failure (CNV), which usually requires dialysis (a procedure for filtering waste and other substances from the blood).

Kidney diseases that can cause CNV include:

  • renal insufficiency due to diabetes or arterial hypertension; People suffering from diabetes may need a kidney and pancreas transplant;
  • polycystic kidney or other hereditary diseases;
  • glomerulonephritis, an inflammation of the filtering units of the kidney;
  • hemolytic uremic syndrome, a rare condition that causes renal insufficiency;
  • lupus and other diseases of the immune system;
  • other diseases, such as congenital kidney defects, may require a kidney transplant.

Requirements for the donor

The kidney donor must necessarily be a healthy person whose heart and lung function is largely normal. There must be no type of liver disease.
Anyone suffering from HIV, cardiovascular disease, infectious diseases or terminal cancer is not allowed to donate a kidney.

The donor is subjected to a monitoring process that concerns the correspondence between the type of tissue and the blood of the donor and recipient.
An important prerequisite for the success of a kidney transplant is the compatibility of blood groups between donor and recipient.
The compatibility of HLA (human leukocyte antigens) and less crucial antigens is also desirable.

Urine and blood tests are also carried out to determine creatinine and electrolyte levels.
The donor must be of legal age and must not be subject to drug and alcohol abuse.
The donor’s urinary tract, blood vessels, and the kidney itself must be healthy for a transplant.
The potential kidney donor must be willing to donate the kidney and must not be coerced into doing so or suffer from a disease that could make a transplant procedure dangerous.

Risks of kidney transplantation

After transplantation, complications may occur, such as:

  • bleeding (hemorrhage);
  • Infections;
  • occlusion of the blood vessels of the new kidney;
  • leakage or blockage of urine in the ureter;
  • weak functioning of the new kidney.

Even if the new kidney is necessary for the organism, it can be rejected. Rejection is a normal reaction of the body to a foreign object or tissue.
When a kidney is transplanted into the recipient’s body, the immune system reacts to it as if it were a threat and attacks the new organ. To ensure the survival of the transplanted organ, it is necessary to take medication to outwit the immune system.

Medications used to prevent or treat rejection have specific side effects that depend on the particular medicine.

Zu den Kontraindikationen für eine Nierentransplantation gehören:

  • bestehende oder rezidivierende Infektion, die nicht effektiv behandelt werden kann;
  • Tumor-Metastasen, also die Verbreitung einer primären Krebserkrankung in eine oder mehrere Körperbereiche;
  • schwere Herzerkrankungen oder andere Krankheiten, die die Fähigkeit einschränken, einen chirurgischen Eingriff zu tolerieren;
  • gravierender Gesundheitszustand, der nicht mit der Niere zusammenhängt und sich nach der Transplantation nicht bessern würde;
  • Non-observance of therapy.

Depending on the specific disease, there may be further risks.
One should talk to one’s doctor about any concerns before the procedure.

In children undergoing a kidney transplant, growth may be halted or slowed down.

Technique of kidney transplantation

Usually, transplantation involves the removal and replacement of a single kidney. Sometimes the diseased kidney remains in the body, and the transplanted kidney is placed in the lower abdomen. In this case, the artery of the transplanted kidney is connected to the external iliac artery, and the vein of the new kidney is connected to the external iliac vein of the recipient.

The main complication of this procedure is rejection, especially if the transplanted kidney comes from a person who does not genetically match.
The immune system recognizes the transplanted kidney as a foreign body and rejects it. This necessitates the suppression of the immune system with appropriate immunosuppressants.
However, a suppressed immune system can make the recipient susceptible to infections.

Therefore, it is important to find the right balance to prevent rejection of the transplanted kidney and at the same time ensure the protection of the patient from dangerous infectious diseases.

Heart disease, cancer, and infections can exacerbate the complications associated with a transplant.

New surgical technique
Previously, the removal of the kidney from the body of living donors was only possible in open surgery.
Today, both removal from the donor and transplantation into the recipient can be performed laparoscopically.
To do this, a 5 cm incision above the pubic bone and 3 small incisions in the abdomen are sufficient to implant the kidney.
In the past, the incision was very long and extended from the abdomen to the back.
In this way, the recovery time is shortened and bleeding, possible complications and postoperative pain are less.
In some other countries, transplants can be performed using the Da Vinci robot, which allows the doctor to work more precisely.

How long does the procedure take?
A kidney transplant takes between 3 and 4 hours.

Postoperative course after kidney transplantation

In the hospital
After the operation, the patient is taken to the recovery room for observation. If blood pressure, pulse and breathing are stable, the patient can be transferred to the hospital’s intensive care unit (ICU).
In most cases, a kidney transplant requires a hospital stay of 2 to 3 weeks.
A living donor’s kidney can start producing urine immediately, while that of a deceased donor sometimes takes more time.
As long as the amount of urine excreted is insufficient, dialysis may be necessary.
The bladder is supplied with a catheter to drain urine. The amount of urine is carefully measured to check the operability of the new kidney.

Blood samples are taken regularly to monitor the condition of the new kidney and other functions of organs such as the liver, lungs, and bloodstream.
The diet begins in liquid form and is slowly replaced by solid foods as soon as they are tolerated.
Hydration may be limited as long as the new kidney is not yet fully functioning.
The day after the operation, you can already start physical activities again.
One should get up from bed and move several times a day.
For any pain, you can take painkillers, as prescribed by the doctor.
Aspirin or other pain medications may increase the likelihood of bleeding.
Therefore, it is allowed to take only those drugs that have been prescribed by the doctor.
A doctor, nutritionist and physiotherapist will show what measures are needed after discharge from the hospital.
Recovery takes about 2 to 3 months before you can return to your normal lifestyle before surgery.

Postoperative course at home
Once you return home, the surgical area must be kept clean and dry.
The doctor will give special instructions for cleaning.
Sutures or surgical staples are removed during an outpatient check-up.

In the period specified by the doctor, one should not drive a car.
One should avoid any activity or position that puts pressure on the new kidney.

Graft rejection

The doctor should be notified in the following cases:

  • fever, which may be a sign of rejection or infection of the urinary tract;
  • redness, swelling, bleeding or other discharge in the area of the surgical wound;
  • increased pain around the surgical wound, which may be a sign of rejection or infection.

Fever and kidney pain are among the most common symptoms of rejection.

The increase in creatinine levels in the blood (blood test to measure kidney function) and/or blood pressure (monitored by the doctor) may also indicate a rejection reaction.
Rejection symptoms may be similar to symptoms of other diseases or problems. If in doubt, you should always consult the doctor: frequent visits to the doctor and contacts with the doctor are important.

A kidney transplant carries risks that must be encountered during the operation and risks or side effects due to the medication against a possible rejection reaction.
The recipient’s body can completely reject the transplanted organ before any postoperative medication can even be administered.

Medications that need to be taken after the transplant can bring some side effects, such as acne, diabetes, high blood pressure, high cholesterol, swelling, and weight gain.

How long does a transplanted kidney last?

Some people live with the same transplanted kidney for the rest of their lives, but the average shelf life can be seen in the following table:

DurationPercentage of patients
1 year95 %
5 years85-90 %
10 years75 %

What is the life expectancy? Prognosis for patients with kidney transplantation

The life expectancy of a patient with a transplanted kidney has improved greatly in recent years, as there are anti-rejection drugs that have reduced the problem of rejection.
Today, the life expectancy of a patient with a single kidney is just as high as that of people with two kidneys.

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