ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Kidney Transplant

Kidney failure is a disease that occurs as a result of the accumulation of water, urea, creatinine, uric acid and other toxic substances in the body due to the kidneys' deterioration and inability to perform their functions due to various reasons. Patients may seek treatments such as dialysis and kidney transplantation with complaints such as high blood pressure and shortness of breath as a result of water accumulation in their bodies, or with complaints such as nausea, vomiting, abdominal pain, weakness, weakness, anorexia caused by urea and other toxic substances, or with the risk of cardiac arrest as a result of high potassium. needs.

People with end-stage renal disease cannot survive if they are not treated. There are two treatment alternatives for these patients: dialysis and kidney transplant. The choice of these treatment alternatives should be decided by the physician, patient and family in consultation. Dialysis is a treatment method that keeps the patient alive. However, no machine can perform all the functions of a natural organ. For this reason, kidney transplantation has great advantages in terms of both the patient's life expectancy and the quality of life. Patients get rid of the restrictions that limit their lives, especially food and drink, and lead their lives as healthy people who eat freely. Work and social life returns to normal. They now have the opportunity to dedicate the long time they spend in treatment centers for dialysis to themselves. They live longer. It should be emphasized that kidney transplant expenses are much less than dialysis. If possible, it is best to complete the preparations and perform the surgery in a very short time before opening the fistula and starting dialysis.
Kidney transplantation is the implantation of a healthy organ that can perform these functions in the body of patients with end-stage renal failure. The healthy organ required for kidney transplantation is obtained from cadavers or living donors. In our country, transplantations are carried out mostly with kidneys obtained from living donors. The results of transplants with kidneys obtained from living donors are better than those with kidneys from cadavers. However, in order for organ transplantation to cure a large number of patients, the number of organ donations from cadavers should increase.

When Should Kidney Transplantation Be Performed?

Dialysis or kidney transplant treatment is needed when kidney function falls below 15% in patients with chronic renal failure. In all patients who do not have any problems, kidney transplantation should be considered first and its possibilities should be investigated. Dialysis saves the life of the patients and keeps them alive, but there are various complications, especially the damage of the vessels over time. For this reason, transplantation without dialysis has advantages in terms of kidney and patient health.

What are the Benefits of Kidney Transplantation?

Dialysis can only do 10% of the kidney functions of a healthy person. A successful kidney transplant can restore 70-80% of the kidney functions of a healthy person.

Does Kidney Transplant Provide Advantage over Dialysis?

It has great advantages. 1-2 weeks after surgery, the vast majority of patients regain a completely normal life. Apart from the drugs they take in the morning and evening, their working and social lives are within normal limits. As in dialysis, they do not have to live on a machine for 3-4 hours 3 days a week.

What is Living Donor Kidney Transplantation?

Most kidney transplants in our country are performed with kidneys from living donors. Since enough organs cannot be taken from cadavers, the waiting times are very long. Therefore, patients have to undergo dialysis for a long time.

When a person has end-stage chronic renal failure, it is imperative to start treatment. The patient should either be started on dialysis or have a kidney transplant. Considering the life expectancy, the quality of life and the costs of the treatments, kidney transplantation is by far the leading method. For this reason, it is the most ethical and correct decision for the physician who guides the patient to recommend kidney transplantation in the first place. A living donor is needed for the patient to be transplanted soon. The best solution for patients who have a donor that meets the legal and medical conditions mentioned above is to be transplanted as soon as possible. If there are living donors for the patients who continue dialysis, it is the best option for them to be transplanted as soon as possible.

Who Cannot Have Kidney Transplantation?

Very few patients cannot be transplanted. Those with active infections cannot be transplanted. After the treatment of these patients, transplantation can be performed. In patients with tumors, after the tumor is treated, a certain period of time should pass depending on the type of tumor, and transplantation can be performed after it is determined that there is no recurrence. Transplantation is not possible in cases where the tumor has spread to other organs. Due to the high risk of losing the transplanted kidney in blood type incompatible patients, it is not generally recommended at the moment. If the test (cross-match test) performed by mixing the blood of the recipient and the donor is positive, the transplant is not performed. Advanced age is a relative obstacle for kidney transplantation. The biological age of the patient should be evaluated together with the general condition and the condition of other organs. Age alone should not be considered as a barrier for transplantation.

Can Diabetics Have Kidney Transplantation?

Diabetics can also be transplanted. Because the advantages of kidney transplantation are also valid for diabetics. Diabetes mellitus is one of the most common causes of kidney failure today. Therefore, a large number of diabetic patients undergo kidney transplantation. Careful attention should be paid to the treatment and follow-up of diabetes after transplantation.

Can those with hepatitis have a kidney transplant?

Patients with hepatitis should be evaluated in detail for liver cirrhosis or chronic hepatitis. In the absence of these conditions, transplantation can be performed. There is no harm in using drugs in the treatment of hepatitis B after transplantation. Thus, the treatment of hepatitis B can be continued successfully after kidney transplantation. It is not possible to use drugs used in the treatment of patients with hepatitis C after kidney transplantation. It can cause kidney loss. For this reason, if treatment is required in patients with hepatitis C, it is appropriate to do this before transplantation. Whether patients with hepatitis are suitable for transplantation or not should be decided in consultation with hepatology.

How is Kidney Transplantation Performed?

Kidney transplantation is done with healthy kidneys from cadavers or living donors. In our country, transplantation is carried out mostly with kidneys taken from living relatives. In our hospital, we perform the surgery of live donors with the closed (laparoscopic) method. Since the surgical wound is very small in transplantations performed with this method, the patient has very few complaints of pain and similar postoperative issues. Postoperative wound-related problems are rare. For this reason, the postoperative period of the patients is comfortable.

The surgery of the recipient is performed through an incision made in the groin area. The arteries and veins in this region are prepared. The veins of the kidney are stitched to these veins to provide blood supply to the organ. The procedure ends by connecting the urinary tract to the bladder with the appropriate surgical technique.

What is the life expectancy in Kidney Transplantation?

Life expectancy in organ transplants performed today is much better than the alternative dialysis treatment. In our Kidney Transplant Center, we perform kidney transplants with a success rate of 99%.

The quality of life of kidney transplant patients is like a normal healthy person. Since the machine to which the patient is on dialysis cannot fulfill all the functions of the living kidney tissue, patients on dialysis live with many restrictions, especially not being able to drink water freely and eat everything. Over time, they encounter additional problems such as anemia, cardiovascular diseases, and various infections. For these reasons and because they spend a significant part of their time in dialysis centers, they do not have a chance to live like a healthy person.

In short, kidney transplant recipients can take part in working life and social life because they gain back both their mental and physical health and the time they spend on dialysis.

Kidney Transplant Blood Type Matching

There should be a A-B-O blood type compatibility. Rh compatibility is not required. Recipient and donor pairings are made according to the table below.

ReceiverDonor

OO

AO and A

BO and B

ABO, A, B and AB

Who Can Give a Kidney for Transplantation?

Today, the distribution of kidneys taken from a cadaver is carried out within the rules of the coordination system established by our Ministry of Health. The lists of patients registered in organ transplant centers are also recorded in the coordination computer. The list of patients who can be implanted is sent to the center by the Ministry. The organ is transplanted to the appropriate patient in the order in this list.

Transplantation of patients with living donors can be done faster and earlier. According to the laws in our country, the patient can receive organs from their first four degree relatives. It is also possible to receive organs from relatives or non-relatives. However, an ethics committee decision is needed for transplantation from such donors. A person must be at least 18 years old to be a donor. There is no strict limit for the upper age. It is decided whether the organ of the donor candidate can be taken or not, according to the results of the examination and medical examinations.

Who Cannot Give Kidneys?

Cancer patients, those with active infectious diseases, diabetics, kidney patients, pregnant women, those with other organ failure cannot be a kidney donor. In those with high blood pressure, a decision should be made after detailed examination.

Can Transplant from Elderly Donors Be Performed?

The age factor is important of course, but each case should be evaluated separately. Not the age on the identity card of the patient, but the biological age is very important, The donor should be evaluated for the heart, kidney, lung, and other systems. In this way, kidney transplantation can be performed successfully from healthy, advanced-aged donors by careful evaluation.

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