Diagnosis
To confirm the diagnosis of renal hypofunction or renal failure, among other things, the filtration rate of the kidney is determined, ultrasound and imaging procedures such as CT and MRI are used, and various laboratory parameters (creatinine, cystaine C, 24-hour urine collection) are determined. In individual cases, a piece of tissue is surgically removed from the kidney and examined in the laboratory (biopsy). An important prerequisite for a kidney transplant is that the donor’s and recipient’s blood groups match.
Contraindications are patients with severe tumor diseases with a poor chance of recovery, acute infections and severe heart disease. A kidney is transplanted in patients suffering from terminal renal failure (irreversible kidney dysfunction). This can also be caused by the fact that more than one third of the patient’s own kidney tissue (on both sides) is already dysfunctional and the patient will therefore be on dialysis for the rest of his life.
The body is no longer able to perform the vital detoxification function, which leads to multiple organ failure and thus to death after a short time. Kidney failure can be triggered, for example, by the regular intake of pain medication over a long period of time, diseases of the renal corpuscles due to a delayed cold, cysts in the kidney tissue that impair kidney function, inflammation of the renal pelvis, which occurs frequently in patients and cannot heal properly, the kidney of the water sack in cases of urinary retention, as well as diabetes and high blood pressure.Because the kidney no longer functions properly, it can no longer concentrate the urine sufficiently to remove the harmful substances from the body. The guidelines for such an organ transfer within the framework of a kidney transplant are laid down in the Transplantation Act.
A prerequisite for receiving a donor kidney is blood group compatibility of the ABO system. This means that the blood groups of donor and recipient must match so that the recipient does not produce antibodies against the donor’s blood group. If antibodies are formed, the recipient’s kidneys would be rejected and the organ transplant would fail.
A kidney transplant cannot be performed in patients who suffer from a malignant tumor that has already spread (metastatic malignoma). Transplantation is also not possible in the presence of an active systemic infection or in HIV (AIDS). If the life expectancy of the patient is less than two years, a kidney transplantation is also ruled out.
Particular consideration must be given to organ transplantation in cases of advanced arteriosclerosis (hardening of the arteries) or if the patient does not cooperate (compliance). If the kidney transplantation goes well, the kidney immediately excretes urine. If this is not the case, there is probably slight damage to the kidney tissue.
This damage can be caused by transport (transport from the donor to the recipient) or often also by donations from deceased persons, since the kidneys are very sensitive outside of an organism. After the operation, the body must be given a blood-thinning agent (usually heparin), otherwise there is a risk of a blood clot forming at the surgical suture. A blood clot is a clot of coagulated blood that can come loose and clog a renal vessel, for example.
This has life-threatening consequences. Despite blood thinning, there is a residual risk that such a clot can form. In rare cases, the ureter (connection between the kidneys and the urethra) at the execution at the kidneys, may leak, which can only be corrected surgically.
If the operation goes according to plan, the kidney can already form and drain urine during the operation. If this is not the case even after a delay, it must be expected that the kidney is in a damaged condition. This can happen, for example, during transport from the donor body to the recipient body, as the kidney is not supplied with oxygen during this time.
Complications most frequently occurring after kidney transplantation can be divided into four groups: 1. postoperative complications include bleeding, blood clots in the renal vessels (thrombosis), acute renal failure of the transplanted organ (acute loss of function) or leakage of the ureter (ureter leakage). 2 Acute rejection after a kidney transplant means that the recipient organism recognizes the donated organ as foreign to the body and rejects it as a defense mechanism. Consequently, the new kidney cannot perform its function.
In order to avert the acute rejection reactions, a so-called corticoid pulse therapy (high-dose administration of cortisone in a short time without subsequent slow dose reduction) is initiated or the immunosuppressive treatment is intensified. If there is no response to steroids (steroid resistance), other drugs are administered (ATG, OTK3).
- Postoperative complications
- Rejection reaction
- Consequences of immunosuppressive therapy
- Recurrence of the underlying disease (recurrence)
3) Among the complications that can occur after kidney transplantation are also the effects of immunosuppressive therapy, as mentioned above.
These include an increased susceptibility to infections on the one hand, and an increased development rate of malignant tumors (malignancies) on the other. The transplanted patient is frequently infected with Pneumocystis jiroveci (pneumonia), viruses of the herpes group (CMV = cytomegalovirus, HSV = herpes simplex virus, EBV = Epstein-Barr virus, VZV = varicella zoster virus; various clinical pictures) or polyoma BK virus (nephropathy). The most common malignancies in kidney transplant patients are skin tumors or B-cell lymphomas caused by EBV, and lymph node tumors caused by Epstein-Barr virus. 4. another complication that can occur after a kidney transplant is the recurrence of the underlying disease. This is the recurrence of the disease that originally affected the patient’s own kidneys in the new transplanted organ.Finally, patients with kidney transplantation often have a high blood pressure, which requires lifelong treatment.
