The process of kidney graft rejection is a serious one, it means failure of the whole transplant surgery.
What are the criteria of a rejected kidney graft?
The process of
kidney graft rejection is a serious one, it means failure of the whole
transplant surgery. Patient (recipient) may express fever, painful/tender
graft, rigors, decreased urine output and elevation of blood pressure. Kidney
function tests will be declined also, and by time patient unfortunately will
return to dialysis again. However, the full-blown picture with its dramatic
manifestation is rare now owing to the great advancement in genetic studies and
tissue typing. Moreover, the advent of the newly introduced anti-rejection
medications led to a great decline in the graft rejection rates. Another
important factor that allow the patient’s immune system to attack the foreign
graft, it the patient’s compliance and how much he/she is adherent to the
treating team.
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ALLOGRAFT |
What are the common causes of kidney graft rejection?
Sure, the poor
preparation, bad choosing of donors (donor selection) and non-adherence to the
treating physician are all augmenting factors that can induce and progress the
process of allograft rejection. Difference in blood groping is a major factor
for rejection, however, recent advances in the process of removing or
modulating hypersensitivity (desensitization) protocols, particularly in Japan,
have led to bypass this obstacle. Another vital factor of rejection is that
seen in teenagers, who are usually non-compliant and less adherent to their
physicians. Compliance to the immunosuppressive protocols is also pivotal in
keeping the kidney graft in a stable condition. Some of these medications needs
to be adjusted according to their blood levels, over dosage will lead to drug
toxicity, whilst under dosing will result in rejection, the latter can go
unnoticed in a prolonged rejection process called chronic rejection that may be
manifest after years. The risk of rejection has been recognized by
nephrologists as a high risk and a low risk patient, according to the nature of
the current risk factors. However, two important factors have been considered
on the long run to increase the kidney graft longevity
- Adjustment of blood pressure (the lower the better
- Optimization of the lipid profile to keep kidney vessels in a healthy states
Can my original disease recur in my new kidney?
The answer is
yes, but not all original kidney diseases can recur to your kidney. For example,
diabetes mellitus, IgA disease and membranous nephropathy can recur but their
recurrence may be modified by the current immunosuppressive medications.
Actually glomerular (active portion of the kidney tissue) diseases can occur de
novo (newly occurring) or may be recurrent diseases. To differentiate both
entities, patient should have clear details as regard his original disease,
unfortunately, this may not be available for all patients. Many patients
commenced on dialysis and proceed to a kidney transplant with no clear cause of
kidney failure. A kidney biopsy should be available, an intervention that may
be refused by many patients. However, a full detailed history and serial
serology and other laboratory investigations may help determine the current
situation
https://www.researchgate.net/publication/328430921_Complement-mediated_renal_diseases_after_ kidney_transplantation_-_current_diagnostic_and_therapeutic_options_in_de_novo_and_recurrent_
diseases
If rejection occur, can we implant another one?
Recent series
have should that kidney transplantation can be performed for the second, third
even the fourth time. Of course, precaution and preparation, particularly
surgical issues will be different every time in regard to location of the graft
and operative inlets.
Is kidney transplantation available at any time?
Kidney
transplantation is the best therapeutic option for a patient with a kidney
failure. A perfect preparation to the recipient and good selection of the
donated kidney will allow better longevity to the implanted graft.
Unfortunately, the donated kidney is not available all the time or for every
subject. Some patients may be offered a kidney from partner, a friend, and
“transplant tourism” or may be urged to an illegal maneuver and buy a kidney.
The latter maneuver is very serious, as there are usually no specific safe
protocols to proceed in transplantation.
However, in
view of the shortage of the offered kidneys and the prolonged waiting lists,
nephrologists admitted a new strategy to expand the pool of kidney donation
that is called “Extended donor criteria” or “EDC”. This protocol made the
criteria of kidney donation less restricted as regard the age, basal renal
function and other associated condition. However, this expansion will be on the
expense of graft survival and outcome. On the other hand, some centers may
proceed in kidney transplant by implantation of two kidneys that is called “Dual
kidney transplant”. All these trials to compensate with the shortage of the
offered kidneys, either living or cadaveric (deceased or dead donor). However, some governments manage the all
steps of kidney transplantation to be on health authority’s supervision. In
this situation both donor and recipient did not know each other and the
authority manage all the necessary steps without any interference. Another maneuver
have been admitted in the transplant field that is concerned with cooperation
between transplant centers using a large scale of data base, so that an offered
organs can be exchanged between centers according to the current criteria of
genetic data.
Is there any new hope to cope with this shortage?