Some things to know about kidney transplant

The article was written by Professor, Dr. Do Tat Cuong - Advisor of Internal Medicine - Department of General Internal Medicine - Vinmec Times City International Hospital

The kidneys perform many important functions such as: excreting toxic substances after the body has metabolized them through urine excretion, regulating blood pressure, regulating acid-base balance, water-electrolyte balance. , participate in red blood cell differentiation, regulate calcium - phosphorus metabolism... When a patient suffers from various kidney-urinary diseases, if both kidneys are no longer able to do that and cannot recover, This is called end-stage renal failure. The patient then only survives on one of three kidney replacement therapies: artificial kidney, peritoneal dialysis or kidney transplant, in which kidney transplantation is the most ideal treatment because a transplanted kidney can ensure fully equivalent function of the two kidneys have been damaged. While the other two methods can only partially replace kidney function, which is to remove toxins and correct homeostasis, the other functions do not. In addition, kidney transplant patients no longer have to go to the hospital every day or every other day for dialysis.

What is a kidney transplant? A kidney transplant is not the removal of a diseased kidney and the transplant of a new kidney in the same place. In essence, a kidney transplant is the removal of a kidney from a healthy person or a good kidney from a brain-dead person to be transplanted into the abdomen (in fact, outside the abdomen because the transplanted kidney is outside the peritoneum).
The most favorable place to place a new kidney is usually the right (or left) pelvic fossa. The grafted renal artery and vein will be connected to the ipsilateral iliac artery and vein, and the grafted renal ureter will be sutured to the bladder. People only remove 1 or 2 pathological kidneys in some special cases (polycystic kidney too large, kidney disease with severe chronic inflammation, severe renal artery stenosis). A person can receive multiple kidney transplants, if the transplanted kidney fails.

Where does the source of the kidney for transplant come from? The source of the kidney for transplantation can be from a living donor or from a person who has been brain dead. Whether a brain dead person can get a kidney for a transplant is decided by the hospital's expert committees. Since 2007 in our country, there has been a law for kidney transplant to take organs from brain dead people to transplant to patients. The source of a kidney transplant from a healthy kidney donor can be related by blood (parents, biological fathers, siblings, more distant blood relations: inner brothers) or unrelated (completely unrelated). . Currently, in our country, most patients receive kidney transplants from blood donors. In fact, those who are not related by blood must demonstrate a "voluntary kidney donation for humanitarian purposes" for medical treatment, not for sale (the law prohibits the sale of organs). Therefore, this source of transplanted kidney is now very rare. For kidney donors, if they are carefully consulted, examined and carried out complete and accurate tests, a kidney transplant to transplant to another person is safe and does not affect the quality of life and age. life expectancy of the donor (including partial liver donation). Therefore, a person who wants to donate a kidney must be consulted, donate a kidney at a hospital that specializes in nephrology and kidney transplant and must be determined to be a completely healthy person (the Ministry of Health stipulates that they should be under 60 years old).

Indications for kidney transplant Renal transplantation is indicated for people with stage IIIb - IV chronic renal failure who wish to receive a kidney transplant. These patients must have a relatively good general condition, stable blood pressure, normal pelvic vascular condition to be able to undergo kidney transplant surgery, and best age under 60. No indications. Kidney transplant for people with cancer, acute infections, mental disorders, unstable hyperthyroidism, cirrhosis or active chronic hepatitis, HIV infection, syphilis, tuberculosis, lupus erythematosus. Patients with diabetes should be carefully considered.

What tests are needed for a kidney transplant? Upon initial eligibility for kidney transplant and donor selection, both the recipient and the donor will undergo tests to determine the match between the recipient and the donor (blood type, HLA, serum cross-measurement, recipient's pre-sensitization), general health of both (biochemistry, hematology, coagulation, bacterial, viral, parasitic...), anatomical and functional vascular status donor renal blood vessels and recipient pelvic blood vessels. If all the tests meet the requirements of receiving and donating a kidney, and are approved by the hospital's expert panel, then the kidney transplant surgery and kidney transplant surgery will be performed at the same time. After a week, the donor can be discharged from the hospital and recover almost completely after 1 month. For kidney recipients, it takes a longer time to monitor and guide drug use before being discharged from the hospital. This process can be completed in 2 to 3 weeks.
Because a kidney recipient - receiving a kidney from another person is considered "foreign", so even if it is a kidney from a donor with the same bloodline (parents, siblings), the recipient's body always tends to direction of "rejection" from the body, in other words, causing the newly transplanted kidney to lose function. Therefore, in order for the newly transplanted kidney to work properly, the recipient must be injected and taken with some drugs called "anti-rejection drugs" right before and during the surgery. Depending on each specific case, the type of anti-rejection drug, the number of drugs that must be used at the same time, the dose of each drug, the duration of each drug... . Normally, after a kidney transplant, patients have to take 2-3 types of anti-rejection drugs every day and have to take them for the rest of their lives. However, the cost to maintain good kidney transplant function is not more expensive than treatment with hemodialysis or peritoneal dialysis and if the patient has a health insurance card, it will be largely covered.

Notes after kidney transplant

After a kidney transplant, although the kidney transplant function is good, the patient returns to a healthy life like a normal person, but the patients always need to keep in mind a few things below:
Always remember to take adequate medicine every day As prescribed by a specialist, after a kidney transplant, the patient still has a potential risk of complications such as: acute rejection (rejection of the graft, especially in the first year): due to the decrease in anti-rejection drugs. The body's immunity makes the patient susceptible to infections caused by bacteria (bronchopneumonia, urinary tract infections, tuberculosis), viruses (common viruses, chickenpox, shingles, CMV, EBV) , fungi... On the other hand, the drugs can also cause other side effects such as: round face, more hair growth, enlarged gums (especially in the early stages), high blood pressure, diabetes. .. Therefore, patients after kidney transplant need to be periodically re-examined at the request of a specialist to check the appropriate post-transplant immunosuppressive drug concentration.
Kidney transplant in particular, organ transplant in general has brought a very good quality of life to transplant patients, bringing benefits, happiness, smiles to them, to their families and to society.