Organ transplant is a procedure in which the organ which is damaged due to illness or accident is replaced by the organ of another person to recurred health.
The practice of kidney transplantation
If a patient wishes to have a transplant, we will first talk about transplanting in an outpatient setting. On top of that, if you still want to transplant, you will be asked to undergo a histocompatibility test next. This is a test that assesses the risk of a recipient’s rejection of a transplanted donor‘s kidney and only requires a blood draw. Although this test rarely determines that a transplant is not possible. Patients who are diagnosed with rejection are more likely to want to have enhanced immunosuppressive therapy.
Donors tests for kidney transplant
After completing the histocompatibility test, the donor will first see a kidney internal medicine doctor to see if a single kidney will interfere with his or her subsequent life. Then we do various tests for cancer and infections. Finally, check the general condition to see if the surgery can be performed safely. Recipients will also be checked for cancer and infections and, if there are no problems, check for surgery. The contents of the examination are wide-ranging, such as blood sampling, CT examination, echo examination, X-ray examination, endoscopy, gynaecological examination, and breast cancer examination.
Since many tests must be performed with the recipient and donor, it takes at least two months from the first visit to perform the transplant. Those who wish to have a kidney transplant are recommended to have an early consultation.
Once the surgery is decided, the recipient will be hospitalized one week before the surgery and start taking immunosuppressive drugs. Patients who have not yet undergone dialysis may undergo hemodialysis after admission. The day before surgery, donors are admitted to the hospital.
Recipient surgery for kidneytransplant
An incision is made in the lower right abdomen (sometimes on the left) and the kidney removed from the donor is transplanted. It connects the blood vessels of the donor‘s kidney with the blood vessels of the recipient. You can usually see urine coming out of the transplanted kidney in a few minutes. Then connect the ureter and the bladder. Finally, a drain is inserted inside the bladder so that accumulated fluid, blood, lymph, etc. can be drained from the body. The skin is sewn with a thread that does not require thread removal. The operation time is about 5 hours.
Surgery is performed with a laparoscope (endoscope). First, a tubular instrument called a trocar is placed in 3-4 places on the abdomen from a wound of 1-3 cm, and it is used to put in and take out the instrument used for endoscopic surgery. Then, the stomach is inflated with carbon dioxide so that the kidneys and ureters can be seen with an endoscope.
After removing the kidney and ureter from the surrounding area, make an incision about 5 cm above the pubis and insert a bag into the tummy. In that state, the arteries and veins of the kidney are cut; the kidney is put in a bag, and it is removed from the body. Drain is a thin tube. Drain may be inserted into the stomach from one of the wounds to prevent bleeding from the surgical site. Sew the skin with a thread that does not require thread removal to complete the surgery. The procedure takes roughly 3 hours.
After kidney transplant
After the operation, it will be managed in the intensive care unit for one day. If there is no problem, it will return to the general ward the next day. If the postoperative course is good, walking and eating will start the next day. The ureteral tube is removed on the 4th day after surgery. If there is no problem, remove the drain on the 5th day. After transplantation, blood will be collected every day and kidney echography will be performed to adjust the blood concentration of immunosuppressants and to detect rejection at an early stage. If the course is good, you will be discharged 2 weeks after the operation.
After the surgery, if there is no problem with the postoperative course, walking and eating will start the next day. The patient will be discharged 4 days after the operation at the earliest. After being discharged from the hospital, you will be treated at home, but depending on your recovery.
Progress after discharge
The frequency of hospital visits is twice a week for one month after discharge; once a week for the second month; once every two weeks for the third month, and once a month for up to six months. After that, it will be an outpatient examination once every 1-2 months. Three months and one year after the transplant, the patient will be hospitalized for one night and two days, and a biopsy of the transplanted kidney will be performed to check for rejection and side effects of immunosuppressive drugs.
You will be asked to go to the outpatient clinic once every 3-6 months to check the kidney function regularly.
The transplanted kidney is a “foreign body” to the recipient, and if nothing is done, the recipient will have an immune response, and white blood cells and antibodies in the blood will attack the donor‘s kidney. If this is a rejection reaction and nothing is done, the kidney will be destroyed by the rejection reaction immediately. Immunosuppressants are necessary drugs to suppress this rejection and should be continued only for the rest of the life after transplantation. The drugs taken for a long period are 2-4 drugs, each of which acts at different stages of the immune response, and when used in combination, are devised to suppress rejection more effectively. Besides, by combining drugs, the amount of each drug used can be reduced, and side effects can be reduced.
Risk of one donorkidney
It is undeniable that having one kidney may cause the kidneys to work poorly several years after the kidneys are donated. However, since the surgery is performed after fully confirming the “remaining kidney reserve capacity” before the surgery, there are no cases in which the donor has undergone hemodialysis. Donors who originally had good kidney function and had few comorbidities. They can maintain better kidney function by living with a healthier awareness than ever before because they have one kidney.