Familiarity with kidney transplantation

Kidney transplantation is one of the most common transplants performed in the world and in Iran. The first successful transplant in the world was a kidney transplant, which was performed in 1954 at Harvard University in Boston, USA. In this surgery, the brother donated his kidney to his twin brother. Dr. Joe Murray, who performed the surgery, received the 1990 Nobel Prize in Medicine. In our dear country, about 2,500 kidney transplants are performed annually, more than half of which are performed from brain donors and the rest from living donors.
The most common causes of chronic kidney failure in our country, like other countries in the world, are diabetes, high blood pressure and chronic kidney infections. Some inherited diseases also lead to chronic kidney failure. In children, inherited diseases and urinary disorders can lead to chronic kidney failure.
Chronic kidney failure will eventually lead to dependence on dialysis. It should be noted that the best treatment for chronic kidney failure is transplantation. Transplanted patients will have a longer life expectancy and a better quality of life than dialysis patients. Patients with chronic renal failure need to be referred to a transplant center by their doctor. At these centers, the patient is evaluated by the transplant team, consisting of a transplant surgeon, a kidney specialist, and other physicians, to determine if the patient will benefit from the transplant and tolerate the transplant surgery.
The kidney needed for the transplant can be from a living person (family or stranger) or a brain dead donor. Unfortunately, in our country, matching tests are not performed yet. These tests are very helpful in pairing the donor and receiver in the best possible way.
The donor and recipient must at least be blood type-matched. After the kidney is properly prepared, the person undergoes kidney transplant surgery. It should be noted that in this operation, the patient’s own kidneys will remain in place, but the new kidney in the patient’s pelvis will be connected to the vessels of the lower extremities and bladder. Sometimes the new kidney does not start working right away. During this time, the patient may need dialysis, perhaps temporarily, for the new kidney to function. This is more common in kidneys used as brain dead donors. This is because these kidneys are sometimes out of the human body for hours and there is no blood flow in them until the transplant is done.
After surgery, the transplant team carefully evaluates kidney function, especially for transplant rejection. Immediately after the transplant, it is necessary to start taking anti-transplant drugs, which the patient should take for the rest of his life. These drugs reduce the risk of transplant rejection by weakening the patient’s immune system. But it should be noted that this is not safe and will predispose the person to infection. Therefore, the transplant team should carefully examine the patient for infections, the patient should be aware of this and in case of symptoms such as fever, cough, heartburn, diarrhea or any unusual symptoms, immediately inform the transplant team. The patient needs to be in regular contact with the transplant team so that kidney function can be carefully evaluated.
Early complications of kidney transplantation are relatively rare, but can include clotting of transplanted kidney arteries, leakage of urine, or infection. New transplant rejection drugs increase the rate of this complication in the past
It was 80 percent, reduced to less than 10 percent. It should be noted that the rejection of acute transplantation today rarely causes organ failure and in many cases can be treated. Unfortunately, these drugs still do not have much effect on the chronic rejection of transplantation, which occurs in the years after transplantation. Chronic rejection of the present transplant, except for renal transplantation,
There is no solution. Long-term rejection drugs are associated with side effects that the transplant team must diagnose and treat in a timely manner. Some of these side effects include infections (especially viral and fungal infections), risk of high blood pressure, diabetes or cancer. Consumption of these drugs also has a high cost that should be considered for adequate insurance coverage in our country. It should be noted that despite the high cost of transplantation, this work is less expensive than dialysis and, in addition to improving the patient’s quality of life, also increases the life expectancy of the patient compared to dialysis. Therefore, bonding is in the interest of society in many ways.

Dr. Reza Saidi Firoozabadi – Transplant surgeon