KIDNEY TRANSPLANTATION

As long as the patient (recipient) is compliant to his immunosuppressive protocol and adherent to his physician, he can enjoy a semi-normal life.

RENAL TRANSPLANTATION

 

KIDNEY TRANSPLANT

 

What is the impact of a successful kidney transplant?

As long as the patient (recipient) is compliant to his immunosuppressive protocol and adherent to his physician, he can enjoy a semi-normal life. A normal kidney function may allow the patient to return to his job. Resumption of duties will make the patient to be engaged in a normal life stream, he will feel responsible, able to solve problems and he will feel valuable again and independent. The renal failure-related depression will resolve without medications. Furthermore, his sexual dysfunction will be greatly improved with increased self-well being and self-confidence. Physical performance will be also better that enable the recipient to add more for his activities. In comparison to dialysis, the story is different. General quality of life- if calculated- is definitely much better and patient survival on dialysis is much shorter. Efforts, however, should be concentrated on regulating transplant program, organ donation and continuous collaboration between international centers.

However, certain medical and non- medical have been observed among transplant patients. NOD (new onset diabetes) is one of the important side effects of immunosuppressive drugs. Dyslipidemia, hypertension and hirsutism are another problems. The latter one is of great concern, particularly in females and in teenagers that may lead to non-compliance to medication. If so, a gradual process of chronic graft rejection will ensue, up to the need of re-transplantation. The latter may not be soon available and patient may unfortunately return to dialysis. Social care and psychological support from the side of family as well as social worker is definitely warranted to cope with these post-transplant problems. Mass psychological therapy is of much concern. Role of recent media can also add more.

ALLOGRAFT

 

Is there any age limit for kidney transplant in the old age?

Actually, for long period, there was an age limit for kidney transplant in elderly, it was not allowed for people more than 75 y old to be transplanted. However, with the recent advances in the field of organ transplantation and the advent of the recent immunosuppressive protocols, this concept has been changed, there is no age limit for kidney transplantation in this cohort of people.

RENAL TRANSPLANTATION

 

What are the most common side effects for the immunosuppressive medications?

Kidney transplantation is the best ever known therapy for patients with end-stage renal failure. To keep he implanted kidney (allograft) in a healthy state and prevent its rejection by the patient immune system, he/she should be kept in a state of immunosuppression. The medical tool to achieve this state are called the “immunosuppressive drugs”. There are different regimens of the immunosuppressive medications according to the policy of each transplant center. They also differ from country zone to another, some of them are cheap an available while other groups are much costly. The latter may be utilized in research centers and in developed countries. It is noteworthy to mention that certain groups of patients may not need any kind of immunosuppression, like identical twins, but this actually very rare.

However, the benefit of immunosuppression cannot be achieved unless the patient (recipient) was very compliant to his therapeutic protocol. Hence, drug side effect will be observed by time. For example, corticosteroids may cause many drawbacks, hence they should be lowered as soon as possible, e.g., fluid retention, dyslipidemia (abnormal lipid profile, hypertension, hirsutism, hyperglycemia (increased blood sugar), weak bones density and emotional disturbance. Other agents of immunosuppressives can induce new onset diabetes (NOD), disturbed lipid profile, elevation of blood pressure (hypertension) and abnormal hair distribution (hirsutism). The latter would be problematic particularly for females and for teenagers. Non-compliance to these medications- to avoid their side effect- would be very serious to the transplant. Rather, patient should consult his/her clinician to modify or substitute his protocol, but withdrawal of the immunosuppressive agents is not an option. Here, the role of social applicators is very essential to correct the concepts of these ladies and the teenagers.

However, the immunosuppressive burden usually start with a high dose to guarantee stability of the new organ. Gradually by time, this burden will be alleviated and the doses of the immunosuppressive agents will be reduced up to complete withdrawal. The efficacy and potency of the newly admitted agents definitely have a role.

 

ALLOGRAFT

 

After kidney transplantation, what will happen to my own diseased kidney?

When your physician advice you as a kidney patient to start the preparation to renal replacement therapy (RRT) i.e. therapeutic options to replace the native kidney that include dialysis, either hemodialysis (HD) or peritoneal dialysis (PD), or kidney transplant. In most cases, when the diagnosis of end stage renal disease is considered, your kidney function is less than 15% in the USA or less than 10% in most European countries. So, the native kidneys usually left in place, while the new kidney (the graft) is usually implanted in the lower right or left abdomen. So, the native kidney still has - despite insufficient - some work to do. However, in certain clinical conditions, we obliged to remove the native kidney (the diseased one) due to one or more of the following:

1)    Infection involved the kidney tissues.

2)    Backflow of urine (called reflux) to the native kidneys.

3)    Elevation of blood pressure (Hypertension), that is out of control by antihypertensive medications.

-       Even if the new graft has been rejected, it may be left in place for immunological purposes, otherwise, it can be removed for more spacing for a new transplant.

ALLOGRAFT

 

What are the main sources of a donated kidney?

There are two main sources of a donated kidney. First, a living donor, kidney is taken from a living donor, usually a relative, and the donated kidney could be from a dead one (deceased or nonliving donor). Consent (permission) of the relatives is usually mandated in this setting.

Which is better to the patient, living or deceased kidney donor?

The advent of the new immunosuppressive protocols has a great impact on patient as well as allograft (donated kidney) outcome. However, the reported outcomes in various studies are in favor of the living donated kidney that is usually of lower chance for rejection as compared with the deceased kidney.