Kidney transplantation

Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal failure. The main types are deceased and living donor transplant. In the former, the kidney originates from a deceased person. In the latter, the kidney is being donated by a living organ donor.

History

The first successful kidney transplantations were done in 1952 in Boston and Paris. The transplantation was done between identical twins, to eliminate any problems of an immune reaction. It was actually the first successful human organ transplant in history. Kidney transplants were slow to catch on, for example the first kidney transplant in the United Kingdom did not occur until 1960 when Michael Woodruff performed one between identical twins in Edinburgh. Until the routine use of medications to prevent and treat acute rejection, introduced in 1964, deceased donor transplantation was not performed. The kidney was the easiest organ to transplant, tissue-typing was simple, the organ was relatively easy to remove and implant, live donors could be used without difficulty, and in the event of failure, kidney dialysis was available from the 1940s. Tissue-typing was essential to the success, early attempts in the 1950s on sufferers from Bright's disease had been very unsuccessful. The transplantation was done by Dr. Joseph E. Murray, who received the Nobel Prize for Medicine in 1990. The donor is still alive as of 2005, the recipient died eight years after the transplantation.

Kidney-pancreas transplant

Occasionally, the kidney is transplanted together with the pancreas. This is done in patients with diabetes mellitus type I, in whom the diabetes is due to destruction of the beta cells of the pancreas and in whom the diabetes has caused renal failure (diabetic nephropathy). This is almost always a deceased donor transplant. Only a few living donor (partial) pancreas transplants have been done. For individuals with diabetes and renal failure, the advantages of earlier transplant from a living donor are approximately equal to the risks of continued dialysis until a combined kidney and pancreas are available from a deceased donor.

These procedures are commonly abbreviated as follows::

"SKP transplant", for "simultaneous kidney-pancreas transplant"
"PAK transplant", for "pancreas after kidney transplant"

(By contrast, "PTA" refers to "Pancreas transplant alone".)

Compatibility

The donor and recipient have to be ABO blood group compatible, and should ideally share as many HLA and "minor antigens" as possible. This decreases the risk of transplant rejection and need for dialysis and a further transplant. The risk of rejection after transplant may be reduced if the donor and recipient share as many HLA antigens as possible, if the recipient is not already sensitized to potential donor HLA antigens, and if immunosuppressant levels are kept in an appropriate range. In the United States, up to 17% of all deceased donor kidney transplants have no HLA mismatch.

Procedure

The kidney is usually placed in a location different from the original kidney (often in the iliac fossa), and as a result it is often necessary to use a different blood supply:

The renal artery of the kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac artery in the recipient.
The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.

Post Operation

The transplant surgery lasts about 3 hours. The donor kidney will be placed in the lower abdomen. The blood vessels from the donor kidney will be connected to arteries and veins in the reciepients body. The final step is connecting the ureter from the donor kidney to the bladder. Blood is then able to flow through the new kidney, and the kidney will begin to filter and remove wastes and to produce urine.

The new kidney should begin functioning immediately after surgery. Hospital stay is typically for 7 to 10 days. If complications arise, additional medicines may be administered to help the kidney produce urine. Additional medicines are such as prednisone, azathioprine, and cyclosporine, are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the patients life.

Acute rejection and occurs in 25% to 55% of people after transplant during the first 60 days. ^*

Complications

Problems after a transplant may include:

Transplant rejection (hyperacute, acute or chronic)
Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection
Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants)
Imbalances in electrolytes including Calcium and Phosphate which can lead to bone problems amongst other things
Other side effects of medications including gastrointestinal inflammation and ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a male-pattern distribution), hair loss, obesity, acne, diabetes mellitus (type 2), hypercholesterolemia and others.

Kidney transplant statistics

Country	Cadaveric transplants	Living donor transplants	Total transplants
Canada	724	388	1,112 (in 2000)	^*
France	1,991	136	2,127 (in 2003)	^*
Italy	1,489	135	1,624 (in 2003)
Spain	1,991	60	2,051 (in 2003)
United Kingdom	1,297	439	1,736 (in 2003)	^*
United States	8,670	6,468	15,138 (in 2003)	^*

References

External links

Nephrology | Surgery | Transplantation medicine | Surgical procedures

Niertransplantatie | Munuaisensiirto

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