VERIFIED CONTENTAuthor: Krzysztof Bialazite

Kidney transplantation is the most effective treatment for end-stage renal disease. In 2022, a total of 749 kidney transplant procedures were performed in Poland. Despite the high effectiveness of this method of treatment, unfortunately not all patients can receive a kidney transplant. Find out about kidney transplantation, when it is impossible to do, and what treatments can be an alternative to kidney transplantation.

Kidney transplantis the best method of treating end-stage renal disease. The kidneys are one of the most commonly transplanted organs. Thanks to kidney transplantation, it is possible to completely replace the function of a failing organ.

What are recommended kidney transplants?

The primary function of the kidneys in our body is blood filtration. The kidneys are a kind of "sieve" that separates the necessary blood components from toxins and waste products. Thanks to the work of the kidneys, unnecessary or harmful substances can be excreted from the body with urine.

Kidney failure is damage to this organ, resulting in impairment of its filtration function. The more severe the kidney failure is, the less effective it is in cleansing our body of toxins.

The most advanced stage of this disease is called end-stage renal disease. If left untreated, the condition is potentially life-threatening. Toxic metabolic products accumulate in the body, which can damage other organs.

End-stage renal disease may develop as a result of various diseases of this organ. The most common cause of advanced renal failure in adults is diabetes.

Other diseases that can lead to this condition are:

  • hypertension,
  • glomerulonephritis
  • and kidney cystic disease.

Advanced kidney failure in children is most often the result of birth defects of the urinary system.

End-stage renal disease is an indication for the implementation of renal replacement therapy, which enables the replacement of the failing organ.

There are two basic forms of treatmentrenal replacement. The first is dialysis, i.e. regular cleansing of toxins from the blood using special devices. The second, which guarantees greater efficiency and comfort of the patient's life, is a kidney transplant. To perform a successful kidney transplant, the patient must be properly qualified and a suitable donor must be found.

Kidney transplantation is most often performed in patients who have previously received dialysis. In some cases, when the donor can be found quickly enough, the so-called pre-emptive transplant. The transplant is then performed before the complete loss of kidney function, before the patient begins dialysis.

The observations so far indicate that pre-transplantation is associated with a better rate of transplant acceptance and an improved prognosis for the patient.

How does a kidney transplant work?

Kidney transplantation is a long procedure consisting of several steps. At the beginning, the patient is qualified for transplant and a series of tests are performed to exclude any contraindications.

The next step is the search for an organ donor. When it is found, a kidney transplant operation is performed. After the procedure, regular medical check-ups and lifelong medication are necessary.

A patient prepared for a kidney transplant requires a thorough he alth analysis. The moment when the patient is referred for transplant depends on many factors - the state of kidney function, the course of the disease to date, and general he alth and prognosis. Qualification for transplant requires performing tests that allow to predict the risks associated with surgery and further treatment.

Necessary are, among others virological, hormonal and immunological tests. Often, already at the preparation stage, it turns out that the patient cannot be qualified for a kidney transplant due to contraindications to surgery or severe comorbidities.

If successful, the patient is placed on the organ waiting list. In Poland, the vast majority of organs are obtained from deceased donors. Waiting for a kidney that meets the selection criteria (blood group compatibility, appropriate similarity of tissue antigens) may take up to several years.

If a compatible donor is found in the patient's family, the transplant is performed immediately. In 2022, 717 kidney transplants from deceased donors and only 31 from living donors were performed in Poland.

A kidney transplant operation involves placing an organ in the abdominal cavity onhip bone height. The new kidney is properly connected to the blood vessels so that it can start filtering the blood. The ureter is then sutured to the bladder to allow urine to drain freely.

After surgery, the kidney should be operational within a few days. The patient requires high doses of immunosuppressive drugs to prevent transplant rejection. Over time, the doses of drugs are gradually reduced, but a certain amount of them must be taken by the patient for the rest of his life.

Immunosuppressive treatment after kidney transplantation is one of the basic conditions for transplant success. Immunosuppressants suppress the immune system response that could otherwise be directed against the new kidney. Thanks to them, the risk of transplant rejection is significantly reduced. However, it is worth knowing that immunosuppressive treatment can cause side effects.

These include, among others we reduce protection against infections and increase the risk of certain cancers. For this reason, a patient qualified for kidney transplantation cannot have contraindications to taking immunosuppressive drugs (including active infections and neoplastic diseases).

Contraindications to kidney transplant

Contraindications to kidney transplantation may appear at any stage of the procedure. Patient disqualification may result from both the inability to perform surgery and contraindications to further stages of treatment. An obvious obstacle in transplantation is also the lack of a suitable donor.

For kidney transplantation to be possible, there must be sufficient compatibility of the antigens of the donor and recipient tissues, as well as full compatibility of blood groups in the AB0 system. A contraindication to kidney transplantation is also the advanced age of the recipient and short life expectancy (less than 2 years).

A patient who requires a kidney transplant may not be admitted to this method of treatment at an early stage of qualification. This situation is most often the result of serious comorbidities that make surgery impossible.

A kidney transplant operation is a surgical procedure performed under general anesthesia. There are many somatic diseases that prevent anesthesia or significantly increase the risk of perioperative complications.

The most common examples of such diseases are:

  • cardiovascular diseases (heart failure, serious arrhythmias, ischemic heart disease),
  • lung diseases (decompensated asthma, chronic obstructive pulmonary disease),
  • failureliver
  • or severe blood coagulation disorders.

A factor that makes the procedure much more difficult and sometimes impossible to carry out the procedure may be significant obesity (BMI over 30).

Most of the diseases listed above are chronic. In some cases, they may constitute a temporary contraindication. For example, severe and uncontrolled asthma causing daily shortness of breath makes surgery impossible. In many cases, optimal treatment allows for disease control, so that the patient can be admitted to the procedure.

Another group of contraindications to kidney transplantation are conditions that prevent taking immunosuppressive drugs. Immunosuppressants prevent transplant rejection, but at the same time weaken the body's immunity. For this reason, they can increase the risk of infections and cancer.

Active bacterial and viral infections, as well as cancer, are contraindications for kidney transplantation. However, it is worth knowing that in many cases this is a temporary contraindication.

Adequate treatment of the infection usually achieves a medical condition in which kidney transplantation is possible. This also applies to chronic viral infections such as HIV, HBV, and HCV.

Proper therapy allows you to control the activity of these infections. The exceptions are the states of exacerbation of infections (acute hepatitis B and C), as well as their severe complications (including full-blown AIDS syndrome, cirrhosis of the liver).

All neoplastic diseases are a contraindication to kidney transplantation, both during their duration and up to 2 years after recovery. For some cancers, it may be necessary to wait up to 5 years after stopping treatment.

The procedure of kidney transplantation requires long-term and regular cooperation between the patient and the medical team. A contraindication to this form of treatment may be mental states that make it impossible to establish an appropriate therapeutic relationship.

A patient who does not comply with medical recommendations or does not cooperate with the treatment is at a high risk of transplant rejection.

Patients with mental disorders, as well as those addicted to alcohol or psychoactive substances, require a mental balance or effective addiction therapy before kidney transplantation.

Kidney Transplant - Alternative Treatment Methods

Kidney transplantation is the best form of treatment for end stage renal disease. Unfortunately, due to the insufficient number of organ donors and the existence of contraindications for transplantation, not everyonethe patient may receive a new kidney.

What treatments are used in patients who have been disqualified from kidney transplantation or have to wait for a suitable donor?

The basic form of renal replacement therapy is dialysis, i.e. the mechanical cleansing of toxins from the blood. The two most commonly used forms of dialysis in Poland are hemodialysis (blood filtration using a special device - dialyzer) and peritoneal dialysis (in this case, the patient's peritoneum is the filter).

Hemodialysis patients must report to the dialysis center regularly (usually 3 times a week) and spend several hours there. In the case of peritoneal dialysis, the patient performs the procedure at home on his own, which allows you to stay active (work, study). However, this form of dialysis requires in-depth patient education and cooperation.

Currently, there are many clinical trials conducted around the world on new methods of treating end-stage renal failure. One of the directions of research are the so-called portable artificial kidney (WAK - Wearable Artificial Kidney).

These are special dialysis machines, but portable and much smaller than standard dialyzers. Research aims to minimize device dimensions and evaluate their long-term impact on treatment outcomes.

Another promising direction of research are experiments with the use of stem cells. Their goal is to regenerate failing kidneys and restore their functions using stem cells derived from amniotic fluid.

The results of research conducted in laboratory conditions so far are promising. The next phases of clinical trials will be aimed at assessing the safety and effectiveness of this method of treatment in the living human body.

Category:

Urology and Nephrology