Kidney transplantation is performed in patients who have little or no kidney activity, that is, they suffer from renal insufficiency. The advantages of kidney transplantation over dialysis (blood purification) are that a transplanted kidney allows the recipient to have a better quality of life and be more productive.
What is a kidney transplant?
A kidney transplant is performed in patients who have little or no kidney activity, that is, they suffer from renal insufficiency. The kidneys, two bean-shaped organs averaging 12 inches in length on each side of the body below the rib cage, have the important job of filtering waste from the blood, turning it into urine and excreting it. If the kidneys lose this ability, waste products can accumulate in the body and cause poisoning (uremia). If chronic kidney failure occurs, the patient is dependent on either regular dialysis or a kidney transplant. Kidney transplantation is the surgical transplantation of a healthy kidney from either a deceased brain-dead donor or a living healthy donor into the body of a kidney diseased recipient. In this procedure, the diseased kidneys are not removed, and the donor kidney is implanted in the groin region in the lower abdomen. A single kidney can take over the functions of both organs. Kidneys from deceased patients, called postmortem kidney donations, are allocated by the international intermediary Eurotransplant. A new transplant kidney functions like a healthy kidney, but often with slight functional limitations.
Function, effect, and goals
Patients with chronic renal failure requiring dialysis are eligible for kidney transplantation. Evidence suggests that transplantation prolongs the life expectancy of patients with chronic kidney disease despite the risks associated with surgery. However, transplantation implies much higher risks for patients over the age of seventy and is therefore rarely performed in the elderly. Incurable cancer as well as other serious diseases or acute inflammations also speak against kidney transplantation. Due to organ shortage, there is often a years-long waiting period for a donor kidney. Children receive a waiting time bonus, and donor kidneys can usually be found more quickly for patients with more common blood types. If a suitable donor organ is available or a suitable relative or person close to the patient is willing to be a living donor, the kidney transplant can proceed. The operation, performed under general anesthesia, takes between three and four hours. The donor kidney is implanted in the right or left lower abdomen, and its blood vessels are connected to veins and arteries of the pelvis for optimal blood flow. For urine drainage, the new kidney is connected to the urinary bladder. After the procedure, to assess whether the kidney transplant was successful, the patient’s blood is checked for a decrease in creatinine and urea. If this is the case, it means that the body is detoxified by the new kidney and urine excretion returns to normal. After a kidney transplant, a patient usually remains in the hospital for about two weeks, where immunosuppressive therapy is also started to prevent organ rejection. After discharge, follow-up examinations are initially performed several times a week, during which various laboratory values and urine quantity are checked in particular. If it is ensured that the transplant kidney takes over about half of the function of two healthy kidneys, the kidney transplantation is considered successful. However, regular follow-up examinations and strict adherence to immunosuppressive therapy are still necessary.
Risks and dangers
Although kidney transplantation is now a relatively safe operation, as with any surgical procedure, there are risks to the patient, such as the risk of bleeding or cardiac arrhythmias, and after surgery there is a risk of reduced blood flow to the leg on the graft side or adhesions in the abdomen. At any time after a kidney transplant, there is a lifelong risk of rejection of the transplant kidney. Every patient after a kidney transplant is forced to take immunosuppressive (immune weakening) medications for the rest of their life to prevent organ rejection.Despite everything, intolerance reactions to the foreign organ cannot always be avoided. Infection or chronic failure of the transplant kidney may also occur. Taking immunosuppressive drugs has serious side effects, including a general weakening of the immune system, a generally increased risk of infection, e.g. the risk of contracting pneumonia, and an increased long-term risk of developing cancer – especially certain forms of skin cancer or lymph node cancer. The functionality of the transplanted kidney declines over the years, with living donor kidneys lasting significantly longer than postmortem kidney donations.
