Kidney transplant treatment sheet

A kidney transplant is the best treatment for chronic kidney failure and significantly improves the quality of life for patients with a lack of kidney function and who need haemodialysis or peritoneal dialysis. Nowadays this is a routine procedure, which is not risk-free but which does allow patients subsequently to lead a normal, or close to normal, life. The transplant process consists of surgery to connect the renal artery and vein and also the ureter of the transplanted kidney to the recipient's bladder.Following a few hours in the Intensive Care Department for monitoring, the patient will be transferred to the nephrology ward and will remain there for a few days before progressively resuming their normal life.

El trasplantament renal és el millor tractament de la insuficiència renal crònica i millora substancialment la qualitat de vida dels pacients amb fallida de la funció renal i que haurien de rebre hemodiàlisi o diàlisi peritoneal. Actualment és un procediment rutinari, no exempt de riscos però que permet assolir una vida normal o pràcticament normal. El procés d'implantació consisteix en una cirurgia de connexió de l'arteria i la vena renal i també de l'urèter del ronyó trasplantat a la bufeta del receptor. Després d'unes hores al Servei de Cures intensives per al seu millor control, el pacient passa a la sala de Nefrologia, on estarà ingressat uns dies abans de restablir progressivament a la seva vida normal.

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It is very important to consider that people who receive a kidney transplant will have to take medication for the rest of their lives to ensure the body does not reject the transplanted organ. Regular appointments to monitor the functioning of the transplanted kidney and the levels in the blood of medication used to control rejection are also necessary. The medication used partly reduces the body’s defences and can allow opportunistic infections and neoplastic diseases to occur. Strict monitoring of immunosuppression levels must therefore be carried out at all times. A kidney biopsy may be necessary at different stages of the kidney transplant’s evolution in order to determine the condition of the organ, as blood tests only give an indirect indication. The life expectancy of patients who have had a kidney transplant may be similar to that of the general population, but other factors mentioned must be taken into account in addition to cardiovascular health such as weight, blood sugar levels and lipids in the blood in addition to arterial pressure.

Performing a kidney transplant requires careful preparation once the patient is experiencing kidney failure. A kidney donor must be found. This may be a living donor or a kidney from a deceased person. Outcomes are very good in both instances, and the choice of which to use depends on the personal situation of each patient. For example, a kidney from a living donor would be chosen if someone volunteers to donate and if compatibility tests carried out before the transplant are positive. If there is no donor, a kidney from a deceased donor will be considered, providing the compatibility tests are positive.

Diagnostic tests related to kidney transplant include the assessment performed before it is carried out. These are general assessments of the recipient's health to ensure they will be able to recovery from the surgery without any issues and also immunology tests to minimise the risk of organ rejection.

Tests to prepare for the transplant include imaging tests (ultrasound and CT scan) to determine the implantation area, compatibility tests, and subsequent follow-up tests for monitoring (ultrasounds and blood tests).

To ensure the success of a transplant, in other words, good initial function that lasts over time:

The recipient’s suitability to receive the kidney is assessed: assuming they have no other active illnesses, such as an infection or neoplasia.
Immunological activity is also measured in the recipient to determine how likely they are to reject the organ. Whether they are sensitised; if they have a very active immune system due to having received a kidney that is no longer working, there are different treatments to reduce the degree of sensitisation.
The level of compatibility between the donor and recipient to ensure the patient will tolerate the transplanted kidney.

Over 500 transplants are carried out in Catalonia every year, with very good transplanted kidney survival rates. However, this is variable and cannot be predicted in each case. As advances in knowledge and technology are made, we are increasingly able to accurately monitor and control transplanted kidneys to lengthen their lifespan.
Biotechnology and translational research (which creates a network of different biomedical specialisations) will be able to make important advances over the coming years. The success of kidney transplants nowadays is largely down to the precise nature of the medication used to prevent rejection.