Kidney Transplant: A Long-Term Treatment Option

 

 

 

     In a normal person's body, there are kidneys, which look like red-brown beans, located under the ribcage on both sides of the waist. Their important function is to expel water and various waste products from the body through urine. If the kidney fails or malfunction, waste will accumulate in the body, adversely affecting various internal organs and resulting in the patient's death.

     In addition, the kidneys also perform other functions, including regulating the amount of water, mineral salts, acidity, and alkalinity in the body, regulating blood pressure, producing the Erythropoietin hormone to stimulate the creation of red blood cells, and controlling the production of vitamin D, calcium, and phosphorus.

 

Symptoms of Kidney Failure In Patients

     Kidney failure or kidney malfunction will result in the accumulation of waste in the body, causing nausea, vomiting, loss of appetite, fatigue, anemia, itching, high blood pressure, heart failure, irregular heartbeat, difficulty breathing, lung flooding, and fragile bones that break easily. Seizures may occur, and the brain may stop functioning if there is a lot of waste accumulated in the brain. If children experience kidney failure, it can impair their normal growth.

 

Causes of Kidney Failure

     Causes of kidney failure include diabetes, high blood pressure, kidney stones, inflammation of the kidney tissue, autoimmune disease, Polycystic kidney disease, and hereditary kidney disease.

 

 

---

Some causes can be prevented, such as diabetes and high blood pressure. If patients receive good care and control, it can prevent the occurrence of chronic kidney disease.

 

The Treatment

     When the patient has chronic kidney failure and has entered the final stage, it is necessary to receive treatment so that their body can excrete waste products and continue living. There are three ways to treat kidney failure patients and make them live a long life with a good quality of life, as follows.

 

1. Hemodialysis

     This method involves taking the patient's blood with a large amount of waste and passing it into the blood dialysis machine, which filters waste products from the blood and returns the purified blood to the patient's body. Hemodialysis with a hemodialysis machine can be performed 2 - 3 times a week, for about 4 hours each time. After hemodialysis, the patient's body will be stronger and able to live a normal life. However, patients must come for dialysis at the hemodialysis center regularly.

 

2. Peritoneal dialysis (CAPD)

     In this method, the patients need to infuse 2 liters of dialysis solution into their abdomen about 4 times a day. While the solution is in the abdominal cavity, various wastes in the body will spread from the bloodstream into the solution in the abdominal cavity, reducing waste in the blood. This method makes patients return to a healthy physical condition, but patients must undergo peritoneal dialysis daily.

 

3. Kidney transplantation

     Kidney replacement is the best method of chronic kidney disease treatment since it has the best quality of life and survival rate compared to other treatment methods. Kidney transplants can be divided into 2 types:

 

3.1. Kidney transplant from a living donor

     This is a method of kidney transplantation using a donated kidney from relatives, including parents, siblings, children, grandchildren, uncles, aunts, or even from a legal husband or wife. The donor will donate 1 kidney, from which normal people have 2 kidneys, and can donate 1 kidney while leaving the other kidney intact. The donor must be in perfect health and donate voluntarily.

 

3.2.  Kidney transplant from a brain-dead patient

     This is a method of kidney transplantation using a donated kidney from a deceased person. A kidney transplant donation from a brain-dead patient after deceased. In Thailand, the Thai Red Cross Society will be the recipient of donations and allocate kidneys to kidney failure patients.

 

 

 

 

 

---

Kidney transplant recipients can expect a successful procedure, leading to a long life with good quality and the ability to return to normal activities, including work and even pregnancy.

 

 

Qualifications of Kidney Transplant Recipients

• Must be a patient with end-stage renal disease, with kidney function is less than 15%. In the case of waiting to receive a kidney from a brain-dead patient from the Thai Red Cross Organ Donation Center, must receive treatment for kidney failure with a hemodialysis machine or peritoneal dialysis with fluid to have the right to receive a kidney.
• No infection.
• Not a person infected with HIV.
• If one does not have cirrhosis of the liver, one cannot have a kidney transplant.
• Not currently having cancer or had cancer that has been cured for at least 2-5 years, depending on the type of cancer.
• Do not have a high-risk condition for surgery, such as ischemic heart disease, heart failure, etc.
• No abnormal blood clotting.
• Not in an abnormal mental state.
• Not a drug addict.
• Other cases are at the discretion of the doctors.

 

Risks and Complications in Kidney Transplant Surgery

1.  Kidney rejection

    The body begins to resist the new kidney; this is the reason why it is necessary to take immunosuppressing drugs every day. Kidney rejection can occur slowly or suddenly. A common response of the immune system is to fight off cancer infections and foreign organisms. The treating doctor and the kidney transplant team need to maintain a balance of resistance to rejection of the kidney by giving immunosuppressive medicine and providing knowledge about the side effects of the medicine.

 

     Normally, you would certainly not refuse to receive a new kidney, but the body's immune system cannot do this; it still always performs its function, which is to resist foreign substances, such as cancer, including the new kidney that was transplanted.

 

2.  Several types of kidney rejection

• Hyperacute Rejection is the sudden and serious rejection of a kidney; most often, the kidney will die immediately and occurs in the first hours after a kidney transplant. The kidney must be removed immediately.
• Acute Humoral Rejection and Acute Cellular Rejection are acute kidney rejections after kidney transplantation. It can occur in the first 1-2 weeks, is more common in the first 1-6 months, and may occur at any time throughout the life of the transplanted kidney. Some cases occur 5 - 10 years after a kidney transplant.
• Chronic Allograft Nephropathy is a slow, gradual rejection of the kidneys. After a kidney transplant, the kidneys will slowly deteriorate. Patients with rejection must receive timely treatment. The doctor will have to do a kidney biopsy to take kidney tissue to check what type of rejection it is and how severe it is, so that medicine can treat the kidney rejection quickly.
• Risk of various infections such as infections in the bloodstream, lungs, urinary tract, surgical wounds, in the abdomen, in the liver, in the intestines, brain, etc.
• Postoperative complications include blood flow from the wound, abdominal cavity, wound infection, narrowed blood vessels, congested blood vessels, narrowed, leakage ureter, etc.
• Complications of anesthesia, lung collapse, pneumonia, and respiratory failure.
• Heart complications coronary artery disease, heart failure, irregular heartbeat.
• Gastrointestinal complications include stomach ulcers and gastrointestinal bleeding in the stomach.
• Stroke or rupture of a blood vessel in the brain.
• Serious complications in No. 2-7 are mostly treatable but sometimes result in loss of life.
• Exacerbation of past kidney disease such as IgA, FSGN, etc.
• Patients may be affected due to infection or other hidden diseases that cannot be detected by current medical technology, but the disease can occur later in the future.

 

 

 

---

Immediate treatment for kidney transplant rejection can help the new kidney recover. However, prolonged, untreated rejection may lead to irreversible damage.

 

 

Kidney transplant surgery from a living donor

     For kidney donation, the donor's remaining kidney compensates, and blood type compatibility is essential. HLA typing and DNA testing are also crucial for assessing genetic compatibility, directly benefiting the recipient's long-term health.

 

     The lymphocyte crossmatch is a crucial blood test in kidney transplantation, determining if a recipient's blood reacts to donor cells. A negative result, indicating no reaction, predicts high success rates for the kidney transplant.

 

Qualifications of a living kidney donor

• Age equal to or older than 18 years old to 60 years old. If older than 60 years, must be in good physical condition at the discretion of the doctor.
• No high blood pressure (systolic blood pressure value no more than 140 mm. Hg and diastolic blood pressure values no more than 90 mm. Hg).
• No diabetes.
• No history of chronic kidney disease.
• Have protein in the urine no more than 300 milligrams per 24 hours or albumin in the urine no more than 100 milligrams per 24 hours.
• Have a glomerular filtration rate of more than 90 ml/minute/1.73 square meters. If the filtration rate is less than 90 but more than 70 ml/minute/1.73 square meters, it can be donated, but other risks should be considered as well.
• No obesity.
• Not suffering from serious medical illnesses such as chronic pulmonary embolism, ischemic heart disease, cancer, hepatitis, or serious liver disease. There is no infection in the body, drug addiction, psychosis, or any type of neurosis etc.
• No HIV infection
• Must be a relative by blood (genetically related) or a spouse according to the Medical Council regulations.
• It must not be a kidney trade.
• Kidney donors and donor recipients can cancel their donation at any time.

 

Advantages of receiving a kidney from a living donor

• Living kidney recipients will have a longer kidney lifespan.
• Surgery can be scheduled; this gives time to prepare physically and mentally.
• Immunosuppressants and other medications may be used less frequently. This makes it possible to avoid more risks from complications.

 

Complications after kidney transplant surgery

1.  Kidney Rejection

     This symptom can occur when the body begins to resist new kidneys. This is why it is necessary to take immunosuppressive drugs every day. Kidney rejection can occur slowly or suddenly. A common response is that the immune system's function is to fight infection, cancer, and foreign organisms. The treating doctor and kidney transplant team need to maintain a balance of resistance to kidney rejection by giving immune-suppressing drugs and providing knowledge about the side effects of the drugs.

 

---

Normally, patients would not refuse to receive a new kidney, but their body's immune system is still doing its job resisting foreign substances such as germs, and cancer, including the new kidney that has been transplanted.

 

2.  If you have any of these symptoms

     It may indicate that the new kidney has started to be rejected, and you should contact your doctor. Immediate kidney diseases include fever or cold-like symptoms, tiredness, more fatigue than usual, swelling of the body such as in the eyelids, hands, or feet, abdominal pain, especially in the kidney that was implanted, cloudy urine, burning, and pain when urinating, urinating volume less than 1 liter per day while drinking a normal amount of fluids, urine is dark yellow to orange or has blood in it. 

     In case of rejection of the new kidney, if treatment is given immediately, there may be a chance that the new kidney will recover its functionality. If left untreated for an extended period, it may become irreparable.

 

 

Seeing your doctor regularly after a kidney transplant is important

• Check the soundness of the body and mind.
• Check the function of the new kidney, if an abnormality occurs from resistance or relapses of the old disease. However, sometimes there are no symptoms, but they are only found through blood and urine tests.
• Check for various complications, important complications have the potential to be fatal, including infections, heart disease, liver disease, cancer, diabetes, and lipid disease.

 

For inquiries and registration as a kidney transplant recipient, contact 064-5646059.