What long-term care is required for kidney transplantation?

kidney transplantation

About kidney transplantation

 Regarding end-stage renal failure, you will have to choose one of the three types of “renal replacement therapy”: kidney transplantation, hemodialysis, and peritoneal dialysis. Transplantation is the treatment that best improves kidney function and daily life and provides the best prognosis for life.

Transplantation is a treatment that replaces a diseased kidney with a donated healthy kidney and is currently the only radical treatment for end-stage kidney disease (kidney failure). Kidney transplantation frees you from dialysis treatment, relaxes your diet, makes you feel better, and greatly improves your general condition. Pregnancy and childbirth are possible for females, and children can grow almost normally.

The introductory period after kidneytransplant

During the introductory period(up to 3-4 months later), rejection (acute rejection) is likely to occur, and because the immunosuppressive drugs are taken in large amounts, the immune system is weakened, and infectious diseases such as pneumonia and cytomegalovirus are likely to occur. After 3-4 months, renal function stabilizes, and the number of immunosuppressive drugs can be reduced.

When you recover your physical strength, you will return to work or school. However, due to chronic rejection, recurrence of the original disease, and renal damage due to drug toxicity, it is still necessary to pay attention to infectious diseases.

What is rejection?

Rejection is a reaction that attempts to eliminate a transplanted kidney as a foreign body (non-self). Our bodies have a mechanism to eliminate any foreign matter that comes in. This is an essential mechanism for immunity protecting the body from foreign enemies.

 The transplanted kidney is nothing more than a foreign body to the person receiving the transplant, so the immune system tries to destroy and remove this kidney. This is called rejection.

 The transplanted kidney is nothing more than a foreign body to the person receiving the transplant, so the immune system tries to destroy and remove this kidney. This is called rejection.

How rejection occurs

When the kidney is transplanted, macrophages, which act as immune guards, find it and notify the T lymphocytes (helper T lymphocytes), the commander of immunity, of the invasion of foreign substances. The helper T lymphocytes that have obtained this information mobilize other T lymphocytes (cytotoxic T lymphocytes) that can destroy foreign substances to invade and attack the transplanted kidney (acute rejection). Helper T lymphocytes also encourage B lymphocytes to make an antibody. Antibodies attach to and destroy blood vessels in the transplanted kidney (chronic rejection). If strong rejection occurs, the kidneys transplanted in this way will be destroyed.

Acute rejection

When acute rejection occurs, kidney function suddenly declines (serum creatinine spikes). You may have a fever, low urine output, high blood pressure, and sometimes swelling of the kidneys. Early detection and treatment are important because leaving the kidneys in a weakened state can result in the loss of the transplanted kidney. Don’t miss regular visits and contact your doctor if you have any physical problems. If a blood test does not diagnose, a kidney biopsy is done to take a portion of the kidney tissue. Most can be treated with drugs if the acute rejection is detected early.

Chronic rejection

Serum creatinine gradually rises when chronic rejection occurs. Urinary protein is produced, blood pressure increases, anemia, and swelling progress. Chronic rejection is caused by an antibody (DSA) that reacts specifically with the donor’s cells. Blood tests and renal biopsies can also diagnose chronic rejection. Therefore, it is essential not to neglect regular medical examinations, even in the case of chronic refusal. If an antibody called DSA is produced, there are treatments for it, but it may not be compelling enough. The current situation is that contemporary medicine cannot fully control chronic rejection.

Long term care after kidneytransplant

Infectious diseases after kidneytransplantation

Infectious diseases are diseases in which microorganisms such as bacteria, viruses, and fungi (molds) enter the body and cause damage to various organs and the whole body. In a healthy state, when microorganisms enter the body, they are removed by the immune system and do not cause illness, but when receiving immunosuppressive therapy, they can cause various infections. Infectious diseases can be caused by microorganisms that are originally in your body or have been newly transmitted from the outside.

Especially during the introductory period, immunosuppression is strongly performed, so it is easy to get various infectious diseases such as respiratory, urinary tract, and enteritis. It is also easy to get serious, so you need to be careful. The amount of immunosuppressive drugs decreases during the maintenance phase, and the immune system recovers. But infections with antibiotic-resistant bacteria, pneumonia lead to severe interstitial pneumonia and cytomegalovirus. If you have a fever of 38 ° C or higher, please return to the outpatient department immediately.

How do they recover?

Most infectious diseases can be recovered by administering antibiotics and antiviral drugs. In some cases, it reduces the number of immunosuppressive medications.  

  • Prevention is the priority for infectious disease control.
  • It is necessary to avoid crowds during the introduction period and gargle and wash hands when returning home.
  • If you have a fever, cough, or a rash on your skin, return to the outpatient department immediately.
  • Visit your doctor regularly, contact your doctor if you have any problems.
  • Complications associated with the side effects of immunosuppressive drugs can be dangerous if left untreated, but many can be controlled or cured with appropriate treatment. You mustn’t miss regular visits.
  • If you think something is wrong, you should consult your doctor and receive proper treatment, and never stop or reduce your medication at your discretion.

However, immunosuppressants should always be taken orally while the transplanted kidney functions, regardless of physical condition. It differs from many other medicines in that daily oral administration is essential no matter how well you are.

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In hemodialysis, blood is removed from the body, filtered through a machine, and the filtered blood is returned to the body.

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Our staff will help coordinate if you need to be admitted or other hospital services.

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Consult with our registered dietician for meal plans, nutritional goals, and how to integrate healthy eating into your lifestyle. These appointments can also be done over telemedicine.

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We are happy to assist with transplant and surgery referrals and coordination. These appointments can also be done over telemedicine.

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In peritoneal dialysis, a cleansing fluid flows through a catheter to the lining of your abdomen which acts as a filter and removes waste products from your blood.

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