Kidney Transplant Clinic
Nephrology physicians make maximum effort to stop the kidney damage and, if possible, correct it in people who develop impaired kidney functions due to different diseases, The aim is to keep one’s own kidneys working for the longest time. Despite all the interventions, when the kidney failure reaches the final stage, a treatment is needed for the patient to survive. Currently, kidney transplantation is the ideal treatment for all possible patients.
In case of encountering the disease, the first reaction that emerges in every person is the desire to have an analysis again, often with the thought that there are errors in the tests. When the results point to the same situation, first anger and then despair emerge. In this difficult process, it is extremely important for healthcare professionals to make sure that kidney damage is irreversible. At this point, the results of the examination, examination, radiological examination and the patient’s history reveal the course of the disease clearly.
Evaluations for kidney transplantation in patients with end-stage renal failure who have irreversible loss of kidney function are two-stage. First of all, it is investigated whether there is any obstacle for the patient to be transplanted. Systematically, all organ systems are evaluated. Cardiovascular system health is an important evaluation area at this stage. All co-morbidities, blood tests, radiological examinations of the patient are evaluated in relation to having a kidney transplant. A plan is executed where all additional problems detected can be treated. As a result, there are two alternatives for patients who are able to undergo kidney transplant, such as transplantation of the kidney to be obtained from the organ donation from the deceased and the transplantation of the kidney to be obtained from a living donor.
Blood Type and Tissue Compatibility
The primary importance in the evaluation between kidney recipient and kidney donor is blood group compatibility. If you can donate blood to a person, you can donate kidney too. Rh group has no significance in kidney transplantation. That is, an Rh negative person can donate a kidney to an Rh positive person or vice versa. If there is no blood type match, cross transplantation comes into question. This transplant is based on kidney replacement of at least two couples.
The basis of blood group compatibility is given in the table below.
A. A or AB
B B or AB
0 A, B, AB or 0
- Kidney transplantation can be performed from all blood groups of AB blood group.
- Group 0 (zero) can donate kidney to all blood groups.
In Case of Tissue Incompatibility
Whether there is a tissue incompatibility is more important than tissue compatibility. The tissue groups of the donor kidney differ from the recipient except that the donor and recipient are identical twins. If kidneys taken from parents are transplanted to their children, tissue resemblance is often half and half. In kidney transplants between unrelated husband and wife, there is often no tissue similarity. However, kidney transplantation can be successfully performed. The main determinant is whether the patient has a pre-developed defense against the tissues of the kidney to be transplanted to the patient. The tests carried out investigate whether there is a discrepancy in this sense. Evaluation of the results of these tests as “suitable for kidney transplantation”; It means that after the kidney taken from the donor is transplanted to the recipient in surgery, when the vessels are opened, there will be no obstacle for the kidney to work in terms of the immune system.
In the period after the surgery is performed, drug treatment is applied so that the patient’s body does not understand that the transplanted kidney belongs to a different person and does not reject the organ. This treatment, which is called immunosuppressive therapy, is a little more intense in the early period after surgery, and after the first 3 months, the doses and numbers are reduced. However, it is a lifelong treatment. Whether the recipient or donor has viral hepatitis is not an absolute barrier to transplant. Transplantation can be performed by performing the necessary controls, tests and organizing preventive treatments.
What is the Lifespan of a Transplanted Kidney?
In the literature, there are patients who have had a transplant kidney that has stayed functional for more than 30 years, and who lost their kidneys in the first year after the transplant. Reported success rates after a living donor kidney transplant are in the range of 93-98 percent. ‘Kidney transplant’ has become the gold standard treatment due to its high success rates. However, it should not be forgotten that kidney transplantation is also a treatment method. Therefore, it is not a treatment that promises 100 percent success. There are many factors that determine success. Many factors such as the patient’s general health status, social habits (smoking, alcohol), the experience of the team that will perform the treatment, the patient’s taking the post-treatment medications on the watch in line with the recommendations of his doctors, and compliance with the polyclinic visits affect the result.
Kidney rejection can occur when a patient who has had a long period after kidney transplantation without any problems discontinues their medication without consulting their doctors. For this reason, a person who is a candidate for kidney transplantation is explained in detail that he will use drugs after the transplant and come to regular polyclinic visits.
What Happens In Case of Organ Rejection?
Even in cases where patients and physicians apply everything properly, it is possible for the body to try to reject the organ. Outpatient clinic controls are extremely important in terms of early detection of this situation.
In patient education, situations and complaints that may occur other than polyclinic visits are explained and it is ensured that they apply to their doctors in possible situations. In these cases, the patient is hospitalized and treated for organ rejection. Most of the patients with organ rejection respond to treatment. In the meantime, a biopsy may be required for the transplanted kidney. The treatment to be given is determined according to the result of the biopsy, which is the method that most clearly describes organ rejection. In some patients, biopsy is performed for post-treatment re-evaluation purposes, thus evaluating the effectiveness of the treatment applied.
The experience gained to date shows that in eligible patients, kidney transplantation gives patients both freedom and a high quality of life compared to hemodialysis or peritoneal dialysis. In order to evaluate the risk correctly, it is necessary to evaluate the risks of dialysis methods, which are alternative to kidney transplantation. While the only alternative is dialysis treatments for patients who are not able to have a kidney transplant, kidney transplantation is the gold standard treatment for all other patients.
How Long Does It Take to Prepare for a Kidney Transplant?
Transplantation period may vary depending on the examination and examination results of kidney recipient and donor candidates. Preparations can be completed in 3-4 business days, unless there are concomitant diseases or findings that require further examination. Kidney transplant is not a treatment completed with surgery. It starts with surgery and continues for life. For this reason, the process until the preparations are completed may differ from person to person. Because the goal is to achieve the highest success rate, especially in living donor kidney transplantation.
Who Can Become a Kidney Donor?
Anyone who is over the age of 18 and who is mentally healthy who can make a decision about their own body can become an organ donor. While evaluating a kidney donor in our center, we prefer to start the examination process with those who volunteer in the family as much as possible with older ones. We evaluate the cases where the volunteer kidney donor is single in line with the patient’s condition. There may be serious differences between bone age and biological age in the assessment of kidney donor age. Sometimes a 70-year-old person who takes good care of himself and avoids harmful social habits may be a more ideal donor candidate than a much younger person. Therefore, the decisive factor is the general health status. Kidney donors can donate kidneys as it has been demonstrated that they can live a healthy life with a single kidney in line with the evaluations made.
When The Hospitalization Takes Place Kidney Transplant Surgery?
Except for special cases, hospitalization is made one day before the operation. Oral feeding is discontinued after midnight. Immunosuppressive therapy is started the night before the operation. The relatives of the inpatient, including kidney transplantation, should know that this process will go with immunosuppressive treatments, so there is no standard patient visit process. It is clear that visitors from outside increase the risk of infection. For this reason, it is important that patients’ relatives are informed about this before hospitalization. Even if they come to the hospital, they are not allowed to enter the patient’s room. On the morning of the surgery, first a kidney donor and then a kidney transmitter are operated. After patients leave the room, they are transferred to the operating room. All files are reviewed and checked by our anesthesia team and patients are put to sleep following the necessary preparations. Kidney transplant patient stays in intensive care overnight. S/he is awake and kept in intensive care for close follow-up purposes only. The next morning, after all results and examination, he is taken to the service.
The kidney donor is operated with a closed method. Patient is directed to the service as soon as possible by the anesthesia team after the operation. the patient mobilizes on the evening of the operation, and breathing exercise is started. While kidney donors are discharged after hospitalization for 2-3 days, kidney donors are hospitalized for 7 days on average. One week after the kidney donor is discharged, s/he is called for re-assessment. The reassessment schedule to be applied for later is planned. Kidney donors do not need regular medication use after their surgery. They go back to their jobs. There are no prohibitions in nutrition provided that it is within the limits of healthy nutrition.
Drug training is started for kidney recipients on the 2nd day. The training given during hospitalization before discharge is completed by the organ transplant coordinator, after being thoroughly reviewed in detail.
What Kind of Treatment Is 'Cross-Match Transplant' in Kidney Transplant?
When kidney transplantation cannot be performed due to reasons such as blood group or tissue incompatibility between the recipient and the donor, it is to perform a kidney replacement with a couple with similar problems.
Donor and recipient surgeries and treatment are the same. The only change is in donor. Therefore, the ages of kidney donors should be close to each other in cross transplant.
Cross transplants can be performed as double-triple cross.
Who is in the Organ Transplant Team?
Organ transplantation can be performed in full-fledged hospitals built for this purpose. At the center of the team are organ transplant surgeons, nephrology, immunology, anesthesiology, radiology specialists, patient preparation unit and coordination.
In addition, the treatment process is completed with the contributions of cardiology, infectious diseases, chest diseases, hematology departments, intensive care unit and all units of the hospital.
What should the discharged patients pay attention to at their homes?
Kidney transplant patients often show extreme sensitivity to cleaning the house for fear of infection. The source of infection is often our hands. It is both impossible and unnecessary to sterilize the home. Avoiding close contact with someone with a viral disease that is easy to infect such as flu, flu, good ventilation of the house, proper hand cleaning after using the toilet, separating their towels and using liquid soap are sufficient. The use of masks is only useful in crowded environments that are not well ventilated. There is no need to use a mask in the open air. It is OK for the patient to eat with his family and watch television after discharge.
Low tempo walks are recommended as far as weather conditions permit. Driving alone is not recommended for the first month after discharge. Daily life activities are planned within the knowledge of the doctor at the polyclinic controls. A sick report is issued for 3 months after discharge for kidney recipient patients. At the end of 3 months, they are allowed to start work depending on the patient’s condition.
With kidney transplantation, our aim is to help our patients achieve their jobs and productivity.
What Should Be Considered About Nutrition?
Some foods that affect the drugs in the diet after kidney transplantation, “grapefruit in particular” are strictly prohibited. Because, an immunosuppressive drug used can cause a significant increase in blood level.
Since herbal tea mixtures can contain many different herbs, they are not recommended in terms of their unknown effects. Mediterranean cuisine with mainly olive oil is recommended within the limits of healthy eating.
There may be a significant increase in appetite due to the normalization of creatinine values and the cortisol drug used. For this reason, it is necessary to pay attention to nutrition without being fooled by appetite. It should be kept in mind that gaining weight can invite additional health problems. Sugary foods, pastries and salt should be avoided. Salad consumption is the most beneficial eating habit. However, it is extremely important to wash the salad ingredients well and to use them after soaking in vinegar-added water. Food sold out the open should not be consumed.
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