All patients with end stage renal disease must be taken into consideration for transplantation, except for those at risk for another condition which endangers life. Kidney transplantation is now a common procedure: for all children older than 6 months with renal failure, kidney transplantation is the treatment of choice. A successful transplant not only frees the patient from a long dialysis, but also provides other metabolic functions of the kidney.

kidney transplant

kidney transplant

The survival of patients one year after transplantation from living relative donor is> 95%, with approximately 90% of allografts functioning. Subsequently, there has been an annual loss of transplants varies from 3 to 5%, including those due to death of the patient. The one-year survival rate of patients undergoing cadaveric transplantation is approximately 90% and graft survival varies between 70 and 90%, depending on the centers. In subsequent years, you lose a 5-8% of transplants each year. At present, many renal transplant recipients are carrying bodies are working more than 30 years. Although it was previously believed that patients over 55 years, the transplant would entail an unacceptable risk, the more sophisticated use of immunosuppressive drugs and the close immunological control allow you to allografts in selected patients during the 7th decade of life and beyond.

Donor selection and preservation of the kidney: the kidneys for transplant are obtained from living relatives or cadavers, excluding donors with a history of hypertension, diabetes or malignant diseases (except perhaps those with tumors that originated in the CNS). In potential living donors are also assessed emotional stability, normal bilateral renal function, absence of other systemic diseases and histocompatibility. A living donor gives up her renal reserve capacity, may have a psychological conflicts and complex faces some morbidity from nephrectomy, despite this, the significant improvement in long-term prognosis for the recipient of an allograft with good pairing usually justifies the consideration of a relative as a donor.

Over 2 / 3 of transplanted kidneys come from cadavers of previously healthy subjects who went to meet brain death but maintained a stable renal and cardiovascular function. After brain death, kidneys are taken as soon as possible and cooled by perfusion. For a simple hypothermic storage, it irrigates the kidney with special cooling solutions containing relatively high concentrations of low permeant substances (eg. Mannitol, or hydroxyethyl starch) and intracellular electrolyte concentrations close to those, the organ is then stored in a Frozen solution. Kidneys preserved in this way usually maintain a good feature if they are transplanted within 48 h. Using more complex techniques of hypothermic pulsatile perfusion continued with a perfusion fluid oxygen based plasma, the kidneys were successfully transplanted after ex vivo perfusion also of 72 h.

Preparing pre-transplant and the transplant procedure: preparation includes pre-transplant hemodialysis, to ensure a relatively normal metabolic state and the guarantee of having lower urinary tract functionally sound and free from infection. Drainage may be required bladder reconstruction, nephrectomy of kidneys infected or construction of a loop ileostomy. The transplanted kidney is usually placed in the iliac fossa retroperitoneal position. The vascular anastomoses are performed on the iliac vessels and ureteral continuity is reestablished.

Treatment of rejection: Despite prophylaxis with immunosuppressive agents is begun just before or at the same time of transplantation, most recipients must meet one or more episodes of acute rejection in the first period after surgery. The presence of rejection is suggested by the deterioration of renal function, hypertension, from the increase of weight, pain and swelling of the transplant, fever and the appearance of proteins, cells and renal tubular cells in urinary sediment. In recipients treated with cyclosporine is sometimes difficult to distinguish from drug-induced nephrotoxicity framework of rejection, with biopsy. Intensification of immunosuppressive therapy usually reverses the rejection. If the rejection is not resolved, the immunosuppressive therapy is discontinued and the patient returns to dialysis waiting to undergo a transplant later. If the reaction of rejection and withdrawal of immunosuppressive agents followed by the appearance of hematuria, fever or body softening, it becomes necessary to nephrectomy of the transplanted kidney.

Most episodes of rejection and other complications occurs within 3-4 months after transplantation, the majority of patients return to a state of health and daily activity as normal. However, unless there will be no serious infections or toxicity, immunosuppressive therapy should be continued, because even a brief suspension may precipitate rejection.

Complications: Some patients undergo irreversible chronic rejection in transplantation. Other late complications include drug toxicity, resumption of basic renal disease, adverse effects of prednisone and infections. Moreover, in recipients of kidney transplants has increased the incidence of malignant tumors. The risk of epithelial cancer is 10 to 15 times higher than normal, while that of lymphoma, approximately 30 times. The treatment of these tumors is similar to that of tumors in immunosuppressed patients. The reduction or discontinuation of immunosuppression is generally not necessary for the treatment of squamous cell epithelioma, but is recommended in case of more aggressive tumors and lymphomas. In recent years, in transplant recipients have become more frequent B-cell lymphomas associated with EBV. Although individual associations were assumed with the use of cyclosporine and treatment protocols using OKT3 or ALG, the correlation is more likely that the overall degree of immunosuppression achieved with more powerful immunosuppressive agents.

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