Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). This procedure can be classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient’s surgeon, and Hartwell Harrison, surgeon for the donor.
Preparation and Evaluation
Before receiving a kidney transplant, a person with ESRD must undergo a thorough medical evaluation to ensure they are healthy enough to undergo transplant surgery. If deemed a good candidate, they can be placed on a waiting list to receive a kidney from a deceased donor.
Benefits and Risks
People with ESRD who receive a kidney transplant generally live longer than those on dialysis and may have a better quality of life. However, recipients must remain on immunosuppressants for as long as the new kidney is working to prevent rejection.
Historical Context
The first human kidney transplant was attempted in 1933 by Yuriy Vorony but failed due to graft rejection. A successful transplant was performed in 1950 on Ruth Tucker, and subsequent transplants were carried out between living patients. The first truly successful transplant occurred in 1954 by a team led by Joseph Murray.
Global Statistics
In 2018, an estimated 95,479 kidney transplants were performed worldwide, with 36% coming from living donors. For this and later work, Murray received the Nobel Prize for Medicine in 1990.
Donor and Recipient Screening
The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. Common diseases leading to ESRD include renovascular disease, infection, diabetes mellitus, and autoimmune conditions. Diabetes is the most common known cause, accounting for approximately 25% of those in the United States.
Donor Requirements
Kidney transplant requirements vary by program, with limits on age, health, and certain medical conditions. Candidates are screened to ensure compliance with medications and may be excluded if they have mental illness or significant substance abuse issues, HIV (though research suggests it may not be a complete contraindication), significant cardiovascular disease, or incurable terminal infectious diseases.
Living Kidney Donor Evaluation
Living kidney donor evaluation includes medical and psychosocial components. Screening for psychosocial problems that might complicate donation is essential, as well as assessing the general health and surgical risk of the donor. Exclusion criteria include diabetes, uncontrolled hypertension, morbid obesity, heart or lung disease, history of cancer, family history of kidney disease, and impaired kidney performance or proteinuria.
Organ Trade and Market
The relationship between a donor and recipient has evolved from identical twins to acquaintances and strangers (‘altruistic donors’). Exchanges and chains of living donor transplants have expanded the donor pool. The acceptance of altruistic donors enabled these chains, which are triggered when an incompatible donor donates a kidney to a patient who had another willing but incompatible donor.
Legal and Ethical Considerations
The FDA approved Cedars-Sinai High Dose IVIG therapy in 2004, reducing the need for blood type matching and compatibility. However, some studies suggest that lifelong risk of chronic kidney disease is higher in kidney donors than in the general population.
Deceased Donor Transplants
Deceased donors can be divided into two groups: brain-dead (BD) donors and donation after cardiac death (DCD) donors. Brain-dead donors are considered medically and legally dead but still have a functioning heart, allowing for surgical procedures to start while organs are perfused. DCD donors undergo treatment withdrawal, and the patient is then rushed to the operating room where organs are recovered.
Organ Donation Systems
Many governments have implemented opt-in systems to increase organ donations. The Welsh Government passed Human Transplantation (Wales) Act 2013 in December 2015, enabling an opt-out organ donation register in Wales, the first country in the UK to do so.
Transplant Procedures and Outcomes
Kidney transplantation is generally considered safe and effective but carries risks such as rejection, infection, side effects of medications, surgical complications, recurrence of original kidney disease, post-surgery complications, and cardiovascular disease. Compatibility between the donor and recipient is crucial, with ABO blood group and crossmatch (human leukocyte antigen – HLA) compatibility being required.
Transplant Surgery
Kidney transplant surgery takes about three hours and involves connecting blood vessels to the recipient’s body. The new kidney usually starts functioning immediately but may require 3-5 days for living donor kidneys or 7-15 days for cadaveric donations.
Post-Transplant Care
Immunosuppressant drugs are used to prevent rejection, with common medications including tacrolimus, mycophenolate, and prednisolone. Periodic ultrasound assessments are used to monitor for transplant rejection, with imaging also evaluating supportive structures such as blood vessels and ureters.
Risks Post-Transplant
Problems after a transplant may include post-operative complications, transplant rejection, infections, lymphoproliferative disorder, skin tumours, electrolyte imbalances, proteinuria, hypertension, recurrence of the original cause of kidney failure, and side effects from medications such as gastrointestinal inflammation, hirsutism, hair loss, obesity, acne, diabetes mellitus type 2, hypercholesterolemia, osteoporosis, alloimmune injury, recurrent glomerulonephritis, and infections due to immunosuppressant drugs.
Conclusion
Kidney transplantation is a life-saving procedure that can significantly improve the quality of life for patients with end-stage renal disease. While it comes with its own set of challenges, advancements in medical technology and donor screening have made this procedure more accessible and effective than ever before.
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This page is based on the article Kidney transplantation published in Wikipedia (retrieved on December 17, 2024) and was automatically summarized using artificial intelligence.
