How Do Kidney Transplants Work

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A kidney transplant or ral transplant is an organ transplant from a kidney in a patient with end-stage kidney disease (ESRD). Kidney transplantation is usually classified as either a deceased donor (formerly known as a deceased) or a living donor transplant, depending on the origin of the donor’s organ. Living donor kidney transplants are further classified as either genetically related (living related) or unrelated (not living related) transplants, depending on whether there is a biological relationship between the donor and the recipient.

How Do Kidney Transplants Work

How Do Kidney Transplants Work

Before receiving a kidney transplant, a person with ESRD must undergo a thorough medical evaluation to ensure that they are eligible for transplant surgery. If they are considered good candidates, they may be placed on a waiting list to receive a kidney from a deceased donor.

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Once on the waiting list, they may receive a new kidney very quickly, or they may have to wait many years; In the United States, the average wait is three to five years.

During transplant surgery, the new kidney is usually placed in the lower abdomen (abdomen); the person’s two native kidneys are usually not removed unless there is a medical reason to do so.

People with ESRD who receive a kidney transplant usually live longer and may have a better quality of life than people with ESRD who are on dialysis.

However, kidney transplant recipients must remain on immunosuppressants (drugs to suppress the immune system) for life to prevent the body from rejecting the new kidney.

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Kidney transplant rejection can be classified as cellular rejection or antibody-mediated rejection. Antibody-mediated rejection can be classified as hyperacute, acute, or chronic, depending on how long after transplantation. If rejection is suspected, a kidney biopsy should be performed.

It is important to regularly monitor the function of the new kidney by measuring serum creatinine and other laboratory tests; this should be done at least once every three months for the rest of the person’s life.

The first successful kidney transplant was performed by Joseph Murray in 1954; Murray received the Nobel Prize in Physiology or Medicine in 1990 for his work on organ transplantation.

How Do Kidney Transplants Work

One of the first mentions of the possibility of a kidney transplant came from the American medical researcher Simon Flexner, who declared that it would be possible in 1907 at the University of Chicago reading his work on “Tdecies in Pathology”. the future of diseased human organs replaced with healthy organs through surgery, including arteries, stomach, kidneys and heart.

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In 1933, surgeon Yuriy Vorony of Kherson, Ukraine, attempted the first human kidney transplant, using a kidney taken six hours earlier from a deceased donor to be reinserted into the thigh. He measured kidney function using a connection between the kidney and the skin. His first patient died two days later because the graft was incompatible with the recipient’s blood group and was rejected.

It wasn’t until June 17, 1950 that Dr. Richard Lawler performed a successful transplant on Ruth Tucker, a 44-year-old woman with polycystic kidney disease.

At the Little Company of Mary Hospital in Evergre Park, Illinois. Although the donated kidney was rejected three months later because immunosuppressive therapy was not available at the time (development of effective anti-rejection drugs was years away), the intervening time gave Tucker time to recover his remaining kidney and live another five years.

Dr. John P. Merrill (left) explains the workings of a new machine called an artificial kidney to Richard Herrick (center) and his brother Ronald (right). The Herrick twins were the subjects of the world’s first successful kidney transplant, with Ronald as the donor.

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A kidney transplant between living patients was performed in 1952 at the Necker Hospital in Paris by Jean Hamburger, although the kidney failed after three weeks.

The first successful transplant of this type took place in 1954 in Boston. The Boston transplant, performed at Brigham Hospital on December 23, 1954, was performed by Joseph Murray, J. Hartwell Harrison, John P. Merrill, and others. The procedure was performed on twins Ronald and Richard Herrick and it reduced immune reaction problems. For this and subsequent work, Murray was awarded the Nobel Prize in Medicine in 1990. The recipient, Richard Herrick, died eight years after the transplant from complications of the donor kidney unrelated to the transplant.

In 1955, Charles Rob, William James “Jim” Dempster (St Marys and Hammersmith, London) performed the first deceased donor transplant in the UK, which was unsuccessful.

How Do Kidney Transplants Work

In July 1959, “Fred” Peter Raper (Leeds) performed the first successful deceased donor transplant in the UK (8 months). A year later, in 1960, the UK’s first successful live kidney transplant took place, and Michael Woodruff joined two twins in Edinburgh.

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In November 1994, Sultan Qaboos University Hospital in Oman successfully performed the world’s youngest deceased kidney transplant. Lana has survived from a 33-week-old newborn for 22 years to a 17-month recipient (thanks to a pair of transplanted organs).

Until the use of drugs to prevent and treat acute rejection in 1964, transplants from deceased donors were not performed. The kidney was the easiest organ to transplant: tissue typing was easy; the organ was relatively easy to remove and place; direct donors could be used without difficulty; and in case of failure, renal dialysis was available from the 1940s onwards.

The biggest obstacle to organ transplantation among non-idiopathic patients was the recipient’s immune system, which would treat the transplanted kidney as “self” and immediately or chronically reject it. So having drugs to suppress the immune system was essential. However, suppressing an individual’s immune system increases the risk of infection and cancer (especially skin cancer and lymphoma), in addition to medication side effects.

The mainstay of most immunosuppressive regimens is prednisolone, a corticosteroid. Prednisolone suppresses the immune system, but prolonged use in high doses causes many side effects, including glucose intolerance and diabetes, weight gain, osteoporosis, muscle weakness, hypercholesterolemia, and cataract formation. Prednisolone alone is not enough to reject the transplanted kidney. Thus, immunosuppressive agents other than steroids are needed, which also allow for lower doses of prednisolone. These include: azathioprine and mycofolate, and cyclosporine and tacrolimus.

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The indication for kidney transplantation is stage d disease (ESRD), regardless of the underlying cause. This is defined as a glomerular filtration rate below 15 ml/min/1.73 m

🇧🇷 Common diseases that cause ESRD include vascular disease, infection, diabetes mellitus, and autoimmune conditions such as chronic glomerulonephritis and lupus; Genetic causes include polycystic kidney disease and inborn errors of metabolism. The most common “cause” is idiopathic (ie, unknown).

Diabetes is the most common cause of kidney transplants, accounting for approximately 25% of cases in the United States. Most transplant recipients are on dialysis (peritoneal dialysis or hemodialysis) at the time of transplantation. However, people with chronic kidney disease who have a live donor available can have a pre-transplant before they need dialysis. If a patient is placed on the waiting list for an early deceased donor transplant, it can happen even before dialysis.

How Do Kidney Transplants Work

Contraindications to receiving a kidney transplant include heart and lung failure, as well as liver disease and some cancers. Smoking and morbid obesity are also among the indicators that increase the risk of surgical complications.

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Kidney transplant requirements vary from program to program and country to country. Many programs have age restrictions (for example, a person must be under one year of age to end the waiting list) and require them to be in good health (except for kidney disease). Significant cardiovascular disease, incurable terminal illness, and cancer are often exclusion criteria for transplantation. In addition, candidates are often screened to determine compliance with their medications, which is critical to transplant survival. Individuals with comorbidities and/or significant ongoing substance abuse problems may be excluded.

HIV was once considered an absolute contraindication to transplantation. There were fears that immunosuppressing someone with a weakened immune system would cause the disease to progress. However, some studies seem to suggest that immunosuppressive and antiretroviral drugs may act synergistically to prevent HIV viral load/CD4 cell count and active rejection.

As candidates for significant elective surgery, potential kidney donors are carefully screened to ensure good long-term outcomes. The competition includes medical and psychosocial components. Sometimes donors can be successfully smoothed out in a few months, but the process can take longer, especially if test results indicate that additional testing is needed. A complete acceptance time of less than six months has been identified as an important goal for transplant providers to avoid missed opportunities for kidney transplants (eg, too sick to transplant while the donor is being evaluated).[1]

Psychosocial screening attempts to determine the psychosocial profile

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