A donor kidney transplant allows a person who has been diagnosed with progressive renal failure to restore health and return to a classic lifestyle. This is the main advantage of this method. But due to the fact that finding a donor is a big problem, scientists have been actively developing methods of maintenance therapy in recent years, allowing one to live without a transplant. When comparing these methods, doubts may arise: is it worth a kidney transplant?
Alternative therapy
A person may not live long if kidney activity stops. Very soon, fluid and harmful substances will begin to accumulate in the body, which will poison and interfere with the normal flow of chemical reactions. There are only two methods of treating pathology at the thermal stage:
- dialysis;
- transplantation.
Dialysis can be an independent method of therapy, used on an ongoing basis, or auxiliary, used temporarily until a donor is found. Hemodialysis is considered the most effective. Previously, dialysis guaranteed a short life expectancy of 5-10 years. Nowadays, the method has been improved and the average is 20-40 years. The downside is the dependence on the procedure. It can have a detrimental effect on a person’s psychological state. All your life, going to the hospital several times a week, spending several hours each time, changing plans, constantly adjusting - this requires endurance, self-discipline, and is depressing.
A kidney transplant allows you to solve the problem quickly and eliminates the need for regular visits to the clinic and hemodialysis. Taking prescribed medications in a timely manner means less stress on the psyche and self-esteem.
Lifestyle after transplant
Life returns to normal after a kidney transplant. You can go to work, play sports. A woman with a kidney transplant can become pregnant, carry to term and give birth to a child. However, you will have to undergo examinations systematically, take pills, give injections, and follow a diet.
The operation lasts on average 3-5 hours and already on the first day after the operation the patient is most often asked to begin restoring activity. After any operation, regardless of its purpose, it is necessary to monitor the patient’s condition for some time. Surgical intervention always carries a risk of developing inflammation, problematic wound healing, and more. Inpatient treatment is part of the rehabilitation period.
Nutrition after kidney transplantation is carried out for some time by introducing nutrient solutions into the blood. This eliminates unnecessary load. In the future, it is not recommended to gain excess weight, because this increases the risk of developing cardiovascular diseases. The daily diet should be perfectly balanced, containing sufficient amounts of vitamins, proteins, fats, carbohydrates, fluids, phosphates, calcium and other substances. You will have to be careful about salty and sweet foods and rationalize their consumption.
Following your doctor's recommendations will significantly improve your health. It is important to follow them, because theoretically the transplant can be carried out many times, but in practice there are restrictions. Health may deteriorate after any surgical procedure. The cost of the operation also matters. If, after a successful kidney transplant, rejection occurs for unknown reasons, the immune system reacts negatively, until factors that impede success are identified and eliminated, persistent attempts should not be made many times in a row, even if you are lucky and there is an opportunity.
Life goes on
Tested for strength
— Oleg Valentinovich, it’s been exactly 20 years since you’ve been involved in kidney transplantation...
— I started at the 4th Minsk hospital under the guidance of the legendary professor Nikolai Savchenko. Now I work at the Republican Scientific and Practical Center for Organ and Tissue Transplantation in the 9th clinic. During this time, a lot has changed.
... 1997. Colleagues did not take our kidney transplantation department seriously; the doctors did not stay long, most often going to surgery or urology. It was a kind of test of strength, dedication to a new direction in medicine. Of the doctors who performed kidney transplants in the late 1990s, the only ones left in the specialty were me and Leonid Tkachev (then he was the head of the department).
At that time, every kidney transplant operation ended with us being unable to completely stop the bleeding. A tampon made of many layers of gauze wrapped in a rubber glove was left in the wound. And the patient spent three or four days with this “wick” sticking out. The foreign body was then removed in the hope that the bleeding had stopped.
All transplantologists went through this stage: in Europe they operated this way about 30 years ago. They said: in the clinic, the operating room where kidneys were transplanted can be recognized by the blood flowing from under the door of the room.
Today we perform such operations through a small incision, using special instruments and our own practical skills. There is almost no blood loss. We complete the operation dry; often the use of a safety drain is not even required.
— Is it only in Minsk that kidney transplantation is mastered at such a high level?
— We transferred the transplantation technology to the regions. There are 6 transplant centers successfully operating in Belarus, including children’s. At the same time, our center remains a leader - about 200 transplants per year. This is a lot even for the USA, not to mention Europe. In total, approximately the same amount is done in regional centers. But just 6-7 years ago it seemed that a kidney transplant was a prohibitive technology that should be in one person’s hands. However, it is still one of the most difficult operations. Let me explain why.
Recently, the director of the National Medical Research Center for Transplantology and Artificial Organs named after Academician Shumakov (Moscow), Academician Sergei Gauthier, who has devoted more than 20 years to liver transplants for children, admitted that for him, kidney transplantation is an even more complex operation, requiring developed spatial thinking from the surgeon. When transplanting a kidney, it is impossible to correct a doctor’s mistake without damaging the organ—it will have to be removed. By the way, it is kidneys that are most often transplanted in the world.
Buds planted
— Are our contemporaries born with bad kidneys that become unusable over time?
- Not certainly in that way. The great need for a kidney transplant is a reflection of modern realities in world medicine. Doctors successfully treat cardiovascular diseases and cancer. People live longer, and after 50, every ten years, kidney function (removing water and waste from the body) decreases by about 10%. Add to this long-term medication use, the use of contrast agents in diagnosing diseases, diabetes...
If previously our patients were mainly people aged about 40 years, now almost half of them are under 60 or more. The oldest person to whom we have transplanted a kidney is 74 years old. However, if the kidneys are not working, this does not mean that the only option is a transplant.
— What other options are there?
— Dialysis using an artificial kidney machine. In some centers, dialysis is performed in four shifts, even at night. The standard treatment duration of 12 hours per week is often enough to support patients for years.
Over the past decade, 29 dialysis units have been opened in the country. Our center and regional ones are equipped with the highest class equipment. We can say that the need for this type of treatment corresponds to the capabilities of our medicine.
Had children
— Suppose a person receives a donor kidney. How many years will she work?
“Patients often ask us this question. According to statistics, after six years, out of 100 operated on, 25 return to dialysis (kidney failure). After 10 years, almost 70% of patients have a donor organ, some for more than 30 years.
— Do they give birth with a donor kidney?
— The first child in our country that a woman gave birth to after a transplant is about 30 years old. This was an exceptional case. In 2017, the patient’s daughter, whom we prepared and cared for throughout the entire pregnancy, turned 10 years old. In 2007, with my future mother, Lyudmila Kudryashova, I visited gynecologists more than with my wife. I was unfamiliar with doctors of this profile, and besides, no one really wanted to help us: the doctors were not sure of a favorable outcome. Obstetrician-gynecologist Alexander Barsukov, later the chief obstetrician-gynecologist of the Ministry of Health, said: “A woman will give birth without problems.” He took Lyudmila under his supervision and guided her throughout the pregnancy.
We performed a caesarean section on her together at the 3rd Minsk clinic. A girl was born. Healthy! And now she's fine. Gorgeous. He studies well, studies English and dances.
Lyudmila Kudryashova opened a new page in the lives of our patients. They realized that they too could become happy mothers. There is a woman who already has two children. And in 2016, a patient with a transplanted kidney herself gave birth at the Mother and Child Republican Scientific and Practical Center; before that, all such women in labor had undergone a cesarean section.
— After transplantation, patients take drugs that suppress the immune system to prevent rejection of the donor organ. How can they have healthy, strong children?
“At first, patients are forced to take up to 40 tablets a day, but after a year or two, the number of medications is reduced to two units. We warn you in advance: you can plan a pregnancy two years after transplantation and only after consultation with a nephrologist and gynecologist.
Our patients need to take special medications for the rest of their lives. Stopping medications even five to six years after transplantation will cause an immunological reaction, which will lead to rejection of the donor organ.
Gained weight
— Do they practice transplantations in Belarus when the kidney donor is a close relative?
— In 2006, half of kidney transplants were related, now there are 6%. These were the simplest patients who were discharged on the 6-7th day after surgery, while after kidney transplantation from a deceased donor, patients stayed in the hospital for two to three weeks. Now we perform related transplants either for those who waited the longest for a donor transplant and did not receive it, or for those who need to be operated on urgently, otherwise they will die.
For children with end-stage renal disease, there is nothing better than receiving their first transplant from a living donor. Since 2009, we have performed almost 120 kidney transplants on young patients, of which about 10% were related. By the way, the average waiting period for a donor kidney from a deceased donor for children is about six months. An adult organ is transplanted into a child, and the baby must weigh at least 10 kg.
— If a newborn’s kidneys don’t work, he can’t be saved?
- Not everything is so gloomy. Modern blood purification technologies make it possible to grow such a baby to the desired weight, and then perform surgery on him.
Help "VM"
Oleg Kalachik is a laureate of the 2021 State Prize of the Republic of Belarus in the field of science and technology for the development and implementation of organ transplantation technologies in children and adults.
Author: Olga GRIGORYEVA
Source
Prognosis for kidney transplant
When the issue of quality of life is resolved, the next question arises - how long do they live after a kidney transplant? Each case is individual, of course. Only a doctor can tell his patient about risks, hopes, prospects. But general statistics are also important to know. She will help you make an informed decision. It does not usually include data on the most successful transplant cases in the history of mankind; it suggests focusing on generalized, average information, and assessing the universality of therapy.
A transplant candidate faces a more pessimistic prognosis than a systematic dialysis candidate, although the patient's age should be taken into account. From the point of view of life expectancy, in one case dialysis is preferable, in another - transplantation. For example, transplant patients aged 40-59 years live on average 10 years longer than patients of the same age undergoing hemodialysis. At the age of 20-39 years, the prognosis is even more optimistic for people with a kidney transplant. Their life expectancy is reported to be 17 years longer than that of patients aged 20-39 years who undergo regular hemodialysis.
Transplantation in childhood
In childhood, transplantation gives good results. The procedure is associated with great risks, alas, because an adult’s kidney is transplanted into the child’s body - only a person who has reached the age of majority can be a donor. The organs of a deceased donor take less well, and before risking the patient’s health by using the internal organs of a deceased child as donor material, you should think twice.
A kidney from a fully formed organism is a worthy option that inspires reasonable trust. The main obstacle is that it is larger in size, for its functioning it requires a strictly defined volume of blood, it is designed to synthesize urine in an amount normal for an adult. The average life expectancy of a transplanted adult kidney into a child’s body is 20-25 years. In the case of a kidney transplant into an adult's body, the numbers do not change.
Regulation
The model is organized through voluntary worker organizations. Recipients and the government pay for donors. Charitable organizations help those who cannot pay on their own.[9]
The Charitable Association for the Support of Kidney Patients (CASKP) and the Charitable Foundation for Special Diseases (CFSD), under the supervision of the Ministry of Health, regulate the trade in organs with government support. Organizations match donors with recipients by running tests to ensure compatibility. To prevent corruption or inequality, “neither the transplant center nor the transplant physicians are involved in identifying potential suppliers.”[6] The amounts paid to the donor vary in Iran; however, averages range from $2,000 to $4,000 per kidney donation.[2] On the contrary, compatible buds sold worldwide. the black market can fetch more than $160,000 in some cases.[10]
Forecast for adults
According to statistics, in the first year after surgery, if the kidney was received from a living donor, rejection will occur in 2% of cases. If the donor is deceased, the probability of rejection in the first year increases, amounting to 6%. And in subsequent years, the new element is threatened with death. This is primarily facilitated by the immune system. The kidney will never be perceived as something native, natural; it will forever remain a foreign object. That is why you will have to take additional medications. Any cold is a threat. After a kidney transplant, you need to pay a lot of attention to your health.
Every year of functioning, according to statistics, the kidney dies by 3-5% if the donor is a living person. It dies at 5-8%, if the donor was a deceased person. This reaction is not entirely clear. Scientists don't know why it dies. This is not rejection as such, but a gradual decline in performance. Rejection is a sudden process that develops rapidly and is a threat to life.
The problem of gradual loss of function, as well as rejection, is solved quite simply: sooner or later a new operation may be needed or you will have to agree to regular dialysis. However, by this time a revolution may occur in science and a revolutionary method of therapy will be invented, which has no equal.
Background
The first kidney transplant in the Middle East region was performed in 1967 in Iran. These surgeries only became commonplace in the mid-1980s. Iran allows kidney donation from both cadavers and paid donors. Before Parliament passed legislation in April 2000 justifying the procurement of organs from those considered clinically dead, donor-compensated transplants accounted for more than 99 percent of cases. It is now estimated that 13 percent of donations come from corpses.[5] Market advocates such as the Cato Institute argue that after financial incentives were introduced into the kidney market, Iran eliminated the transplant waiting list by 1999.[6] However, closer examination reveals that many Iranians suffering from end-stage renal disease are not diagnosed or referred for dialysis and will never be eligible for transplantation.[7] Ahad Ghods of Hashemi Nejad Kidney Hospital in Iran admitted that "this is the main reason why the kidney transplant waiting list was quickly and successfully eliminated in Iran." [8]
Search for new treatments
Research into the problem of renal failure, the reaction of the body and the implanted organ, and the development of complications continues. I. I. Mechnikov, in his studies of phagocytes, once discovered that in many internal organs, during the aging process, cells are replaced by connective tissue. Nephrons in renal failure are also replaced by it. It is synthesized from phagocytes. Phagocytes capture and absorb, absorb solid particles and harmful microorganisms, and remove them from the body. They are part of the immune system, a source of disease at the same time. They create connective tissue using collagens. A high content of this protein in the urine is one of the signs of kidney failure.
The membranes of the internal organs, the so-called storm, are made of connective tissue, ensuring their shape and integrity. Connective tissue is needed for the formation and restoration of ligaments, tendons, cartilage, bones, and blood vessels. Scars are made of it. Collagenesis is a whole complex of diseases of different etiologies associated with connective tissue pathology. These are congenital and acquired health problems. Renal failure is not classified as collagenosis, but is associated with a number of pathologies, as is the phenomenon of premature aging of organs, the body, the outer skin, and the appearance of wrinkles. It is obvious that the replacement of nephrons with connective tissue is a process similar to aging.
