Rehabilitation after kidney transplantation

Kidney transplantation

Kidneys are a paired organ that is vital for every person. In some cases, people require a kidney transplant - a difficult, high-tech surgical procedure designed to compensate for a congenital defect or acquired pathology.

Kidney transplantation in most countries is carried out only from relatives (close and/or distant). But there are exceptions - Iran and Belarus.

Indications for transplantation

Kidney transplantation is an intervention performed when one’s own organs are no longer able, for some reason, to fully perform their functions. Usually they talk about the inability of the kidneys to perform their function in the last, fifth degree of renal failure. However, there are other indications for transplantation. Among them:

• long-term inflammatory processes in the kidneys that are chronic in nature (for example, pyelonephritis, glomerular form of nephritis);
• damage to the kidneys or their circulatory system due to diabetes;
• various congenital defects of the renal system (underdevelopment of the organ, its small size, which is why it is not able to fully perform its functions);
• a large number of cystic neoplasms on the kidney;
• some organ injuries;
• oncological pathologies.

In late-stage renal failure, the patient has only two options if he wants to survive: agree to donation, or undergo regular hemodialysis. Hemodialysis is a complex procedure for cleansing the body of accumulated urine and its breakdown products, performed in specialized centers. By agreeing to hemodialysis, the patient remains forever tied to the dialysis center, which he must visit at least once a week.

ASK ANY QUESTION ABOUT KIDNEY TRANSPLANTATION TO SPECIALISTS OF LEADING CLINICS

Procedure for transplantation

A kidney transplant is not an easy procedure, and it was not immediately successful. The intervention requires long and careful preparation if doctors and patients want to get a good result. Not only the operation itself, but also the preparatory stage plays a significant role.

Preparatory stage

The preparatory stage before kidney transplantation itself can take a considerable period of time. During this period, the patient undergoes examinations to determine whether he has chronic or acute diseases that may affect the results of the operation. If any disease is detected, the patient is recommended measures that will help achieve remission. Transplantation is performed only against the background of remission of chronic diseases.

At the preparatory stage, a number of tests are performed. Among them:

• general urine and blood tests;
• assessment of the biochemical composition of blood;
• performing a chest x-ray;
• taking an ECG;
• lung diagnostics using respiratory function;
• assessment of the condition of the esophagus, stomach and part of the intestine using gastroscopy;
• tests for infectious diseases.

If the patient is found to have any deviations from the norm, doctors will first compensate for them, and only then will they decide on a kidney transplant. At the time of transplantation, the body must be as healthy as possible for the intervention to be successful.

Progress of the operation

Kidney transplant surgery can be performed in two ways: from a living donor or from a cadaver. Today, preference is given to the first option, since it has a number of advantages, including the ability to examine the donor, a higher probability that the kidney will take root, and the ability to carefully plan the operation.

According to the legislation in force in the Russian Federation, only one of the close relatives can be a kidney donor. Moreover, his age must be at least 18 years and no more than 60. Voluntary consent is a mandatory condition.

Transplantation is performed in two ways:

• Orthotopic option

In this case, one of the patient's old kidneys is removed and a new one is placed directly in its place. The method is associated with a number of problems, and therefore is almost never used.

• Heterotopic variant

In this case, both of the patient's kidneys remain in his body, and the new organ is placed in the iliac region. Technically, this is a simpler and more effective option, and therefore preference is given to it.

Types and compatibility of transplants

Kidney transplantation occurs with an organ obtained from a corpse or from a living person (most often a relative). Kidney transplantation occurs with an organ obtained from a corpse or from a living person (usually a relative). In the second case, the survival rate is quite high with complete restoration of functions. Compatibility is determined by three main parameters:

• compatibility of alleles of the HLA genes of the donor and the patient who will undergo the transplant;
• matching the blood group of the recipient and the donor;
• matching by age, weight, gender. Preferred, but not always followed.

According to statistics, the survival rate of a recipient with an organ taken from a living person is 98%, the survival rate of the organ itself is 94% of cases. With a kidney removed from a corpse, patients survive in 94% of cases, and the transplant itself takes root in 88% of cases.

The donor must not have the following diseases:

• hepatitis B and C in acute form;
• HIV and AIDS;
• cancer;
• tuberculosis;
• venereal diseases;
• helminthic infestations.

Taking into account all these requirements, the circle of potential donors is significantly narrowed. Transplantologists propose expanding the criteria by posthumously removing kidneys and using organs from older people who died from pathologies of other organs. However, these methods are met with disapproval among people.

Cadaveric kidneys are removed immediately after the biological death of the donor. Such a transplant, according to one of the methods, is cleared of blood and connected to a special apparatus for artificial pumping of fluids, then continuously washed with a preservative solution (Viaspan, EuroCollins, UW, Custodiol). Another, less expensive method uses a triple bag system for storage no higher than 5-6°C. For this:

1. The organ, cleared of blood, is placed in a sterile bag with a preservative solution;
2. This package is placed in the second, with a layer of sterile snow;
3. The outer third bag is filled with ice-cold saline.

The best graft survival rates are observed when transplanted in the first 24 hours after removal, but the organ can remain in these conditions for up to 72 hours. As a rule, surgery is performed as soon as a suitable organ becomes available. The recipient can remain at home or in the hospital all this time, waiting for his turn.

Today in the Russian Federation, kidney transplantation is permitted only from a capable close relative who has given his voluntary consent to the removal and transplantation of an organ who is between the ages of 18 and 65 years.

Prices and features of kidney transplantation in different countries

Kidney transplantation is a high-tech operation that requires the presence in the hospital of not only special equipment, but also a number of special medications. Performing the intervention costs differently in different countries, but in any case the price will be considerable.

Kidney transplantation in most countries is carried out only from relatives (close and/or distant). This is directly stated in the legislation of a particular country. But in some countries, kidney transplants are performed from unrelated donors. For example, such a transplant can be performed in Iran, the only condition is that the donor and recipient must have the same common citizenship. In the Republic of Belarus, a transplant from a third-party donor can be performed without taking into account citizenship.

How much does a kidney transplant cost in Russia?

Until recently, a person with kidney failure simply slowly faded away. Now an organ transplant gives the patient years of a full life. Kidney transplantation in Russia and its cost are important issues that concern the patient. This is a complex operation that must be performed by experienced specialists, but often for Russian citizens the problem is not in finding transplant specialists, but in the difficulty of finding a donor kidney.

Kidney transplant is the most common operation in transplantology. Such procedures account for 50% of all organ transplants. Every year, 30 thousand such operations are performed worldwide, and five-year patient survival is achieved in 4/5 cases. But the number of patients who need a kidney transplant is significantly greater than the number of transplantations performed. This is mainly due to the shortage of donor organs.

According to Russian law, donation is free of charge, and the sale of organs is illegal. A kidney for transplantation is selected subject to several conditions:

• it must be compatible with the patient’s body;
• the donor is related to the recipient by family relationship;
• there is a person’s consent to the use of his organs after death.

Any citizen of Russia can count on free provision of a donor organ and payment of all medical expenses. There is no queue for organs in the Russian Federation, but there is a waiting list. After adding a patient to this list, he must be ready to rush to the hospital at any time.

In fact, most patients die without waiting for surgery, so wealthier patients prefer to go to private medical centers.

In private medical centers, the cost of transplantation may fluctuate. This will depend on the following factors:

• type of medical facility;
• who is the donor;
• urgency of the operation and the patient's condition.

How much a transplant costs also depends on the experience of the specialist performing the operation. When we are talking about a transplantologist with many years of experience, the cost of the operation increases by 30%, or even by half. Therefore, there is no clear answer to the question of how much a kidney transplant costs in Russia.

It has already been mentioned that the trade in organs is officially prohibited in the Russian Federation. But if the sale of a kidney were allowed (as in Iran), then one could get from 10 to 200 thousand dollars for it, that is, from 600 thousand to 15 million rubles. In fact, organs are sold on the black market, where the cost of such a “good” is much lower. The following factors influence pricing:

• state of the organ;
• blood type (its rarity);
• lifestyle and bad habits of the donor;
• predisposition to allergies and intolerance to certain drugs.

And although there is no official data on how much this organ costs in the Russian Federation, according to some sources, it will cost the buyer 10-100 thousand dollars, but the donor himself often receives 2-20 thousand dollars. The price is significantly influenced by the specific location. So, in the provinces you can buy a kidney for just 30-40 thousand rubles.

As a rule, a transplant is necessary at the end stage of renal failure, when both organs (or a single kidney) can no longer cleanse the blood. Nitrogenous waste accumulates in the body, poisoning the body. Without urgent correction, this phenomenon leads to death. But no drugs can slow down the development of kidney failure.

Pathology is provoked by the following diseases:

• chronic pyelonephritis or glomerulonephritis;
• congenital kidney pathologies;
• tumor formations;
• urolithiasis disease;
• nephropathy in diabetes;
• injuries.

For these indications, kidney transplantation is performed first on children, since hemodialysis is very difficult for them.

When a depressing diagnosis is announced and a kidney transplant is planned, the patient is given a list of examinations to be added to the waiting list. During diagnosis, contraindications for organ transplantation are excluded:

• AIDS;
• drug addiction;
• active hepatitis;
• psychical deviations;
• active form of tuberculosis;
• malignant formations;
• diseases with a lifespan of up to 2 years;
• severe pathologies of the cardiovascular system;
• respiratory failure due to chronic lung diseases.

In order to identify contraindications in a timely manner, a set of examinations is carried out:

• fibrogastroscopy;
• coronary angiography;
• Ultrasound of the abdominal organs;
• laboratory tests of urine and blood;
• HLA histocompatibility typing;
• X-ray of the lungs and study of their functionality.

While waiting for a transplant, the person undergoes hemodialysis regularly. He has to do tests for hidden infections, as well as vaccinations. Since an invitation to surgery can arrive at any time, you should always be prepared for it. After the notification, you need to refrain from eating and quickly get to the medical center.

Waiting for a donor organ is a long process. Often, kidneys come from people who have been declared brain dead, mostly those who died in car accidents. But the practice of organ transplantation from a living donor is becoming more widespread. This is explained by the following factors:

• planned intervention;
• fewer complications;
• greater likelihood of survival;
• thorough examination of the donor;
• decreasing the duration of cold ischemia;
• no long wait;
• the likelihood of transplantation before the start of hemodialysis;
• increased life expectancy after surgery.

A donor can be any person aged 18-65 years who has given consent to remove a kidney. He should not have somatic or mental pathologies and arterial hypertension. The doctor must ensure normal kidney function, since the donor will have to live with one organ in the future.

Types of transplantation

Kidney transplantation in Russia and abroad uses 2 main methods:

• orthotopic;
• heterotopic.

During an orthotopic transplant, a kidney is implanted in its typical location, replacing a non-functional one. During the operation, the renal arteries and veins are sutured to the patient’s vessels. But such interventions are rarely performed due to many side effects.

In a situation with heterotopic surgery, the kidney is sutured in an uncharacteristic place (iliac zone). During such an operation, the vessels of the organ are connected to the iliac vessels, and only after the blood supply to the kidney is restored, the ureter is sutured into the urinary reservoir.

The latter option is much easier, because the iliac vessels are larger than the renal vessels and access to them is not difficult. The transplant lasts 3-4 hours. Time is of the essence when performing a cadaveric organ transplant. If an organ is being transplanted from a living donor, two teams of transplant surgeons work simultaneously in the operating room.

Why choose Belarus for a kidney transplant

Today, Belarus is one of the best options if a kidney transplant is needed. There are several reasons for this. Among them:

• the ability to remotely submit documents confirming the need for transplantation to the clinic where the transplantation procedure will take place;
• short terms of the preliminary stage and diagnostics (on average 5-7 days);
• high professionalism of doctors performing surgical interventions;
• extensive experience in performing kidney transplantation operations;
• inclusion in the cost not only of the operation itself, but also of the hospital stay after it.

However, the most important feature of Belarus is that a kidney transplant can be done not from a relative, but a donor can be found in the country itself.

The clinic undertakes the search for the person from whom the kidney will be transplanted. Therefore, if a person does not have a natural donor, contacting one of the Belarusian clinics involved in organ transplantation is the best option.

Contraindications for kidney transplant

Kidney transplantation is prohibited if at least one of the following factors is present:

• lack of compatibility with the donor organ (determined by doctors based on the reaction of the patient’s immune system);
• infectious diseases or malignant tumors that are active or cured no more than 2 years ago (the transplanted organ may also be affected by these pathologies);
• acute diseases of other organs and systems: stomach ulcers, pathologies of the cardiovascular system, hypertension;
• recent myocardial infarction;
• diabetes, which can cause kidney failure (type I diabetics are allowed to undergo a kidney transplant, but it must be accompanied by a simultaneous pancreas transplant);
• negative mental processes caused by alcoholism, drug use, schizophrenia and epilepsy.

Too young or old age can also cause failure, as it interferes with the normal survival of the graft.