Dr. Tuncay Dağel

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Kidney Health and Diseases

What is Kidney Transplantation?

What is Kidney Transplantation? When is it done?

In patients with chronic renal failure, it is recommended to discuss the treatment options with the patient, physician and family and decide on the treatment method to be applied when the filtration function of the kidney is below 30 ml/minute for the creatinine clearance rate. Treatment methods are divided into 3 as hemodialysis, peritoneal dialysis and kidney transplantation.

These treatments are usually started when the filtration rate of the kidney falls below 15 ml/minute. However, the timing of initiation of treatment may vary according to the patient’s condition and underlying disease.

Why is Kidney Transplantation Performed?

With the developments in dialysis technology, dialysis has started to be done better and dialysis has started to be applied to an increasing number of patients all over the world. Changes in dialysis technology, as well as developments in the follow-up and treatment of anemia (erythroprotein), and other problems have both improved the quality of life and caused a significant decrease in the number of blood transfusions. Again, systems developed to reduce infection in peritoneal dialysis patients have been quite successful. Although all these technological developments lead to an increase in the quality and duration of life of the patients, the problems caused by the ongoing uremic environment (heart, lung, gastrointestinal systems, psychological and sexual problems), the time spent for dialysis treatment, and the decreased economic power due to the disease. still limits the ideal treatment method for this disease to be dialysis. After organ transplantation, the decrease in dependency and the disappearance of the uremic environment lead to the improvement of both the health status of the patient, his social and economic status, and an increase in the quality of life. For these reasons, the aim is to provide organ transplantation to more patients all over the world. However, patients who cannot have an organ transplant can continue their lives for many years with increasing quality with technological developments.

From Whom Can Kidney Be Taken?

Two sources for kidney transplantation today; brain-dead persons (cadavers) and living donors. In our country, numerical superiority is in transplants from living donors. However, the aim is to increase the number of cadaveric transplants in our country.

In our country, organ transplantation is allowed up to the fourth degree relatives. In our country, restrictions have been imposed on organ transplants from unrelated people to prevent organ trade. Organ transplantation from unrelated living donors is possible only after obtaining the permission of the regional established ethical committees.

Who Cannot Have Kidney Transplantation?

Although there are some general principles in this regard, practices vary according to the center.

reversible kidney disease

Uncontrolled, ongoing infection

Current or recent cancer disease (depends on cancer type; 2-5 years disease-free period)

Uncontrolled chronic infection (tuberculosis, osteoarthritis, etc.)

Uncontrolled glomerulonephritis

Patients with advanced coronary artery disease that cannot be treated with balloon or bypass

Patients with severely impaired pumping function of the heart

ongoing drug or drug addiction

Patients who could not comply with the treatment, disrupting the regular check-ups

Uncontrolled psychiatric illnesses

What is the Importance of Blood Group in Kidney Transplantation?

In kidney transplantation, blood group compatibility is sought first. Blood group compatibility is just like in blood transfusion, that is, those with O blood group are the general donor, and those with AB blood group are the general recipient. Rh compatibility does not matter.

What are the Other Important Factors in Organ Transplantation?

Another important antigenic construct in organ rejection or acceptance is tissue compatibility antigens. In this antigenic structure, which is called human leukocyte antigens (HLA), half from the mother and half from the father, Class I antigens are named A, B, C and class II antigens DR, DP, DQ. The important ones in organ transplantation are DR, B, and A antigens in order of importance. If these antigenic structures, two of each, for a total of six, are exactly the same in the recipient and donor, complete compatibility is mentioned. In fully compatible organ transplants, the period of stay of the organ without any problem is prolonged.

A crossmatch test is performed to determine whether the organ will be accepted in the recipient. With this test, it is understood whether the person who will receive the organ has previously encountered the antigens (that is, the structures that initiate rejection events) in the donor. A positive test indicates that donor antigens have been encountered before. In case of T lymphocyte crossmatch positivity, since the risk of rapid rejection of the organ is high, organ transplantation is not performed in this case. Transplantation is only done when the crossmatch test is negative.

Kidney Transplantation for Diabetes Patients?

Kidney transplantation is also performed successfully in diabetic patients, and there is an increase in the quality of life after transplantation in these patients. Pancreas transplants performed in patients with type 1 insulin-dependent diabetes also provide blood sugar control. When the risk of cardiovascular disease is high in those who have had diabetes for many years, they should be examined in more detail, especially in this respect.

Close monitoring and strict control of blood sugar is important in those who have diabetes before and those who develop diabetes after organ transplantation.

How is it decided which patient will be implanted with the organs taken from the cadaver?

In our country, the list of kidney recipient candidates according to tissue groups and brain deaths have been reported to the Ministry of Health in recent years as a legal obligation. In this way, organs are sent from the cadaver whose tissue group is determined (by evaluating the dialysis times and some medical conditions) to the people with the most compatibility among the tissue groups.

However, the preoperative cross match test should be negative in cadaveric transplants.

What Is Done To Prevent Rejection After Kidney Transplantation?

After organ transplantation, the patient must take certain medications on a daily basis to prevent rejection of the organ. In addition, various drugs can be used to prevent the development of infection in the first six months after surgery.

In the first days after organ transplantation, more and high doses of drugs are given to prevent rejection of the organ. In the follow-up, the doses of drugs are administered at lower doses by monitoring the status of kidney tests and drug levels. There are also various drugs used to prevent organ rejection after organ transplantation and to treat it if it is rejected.