Kidney transplantation ( kidney transplant ) - Causes, Symptoms and Treatment .MF .
Kidney transplantation is by far the most effective treatment for end-stage chronic renal failure.Moreover, the cost per patient had undergone kidney transplantation, much lower than the cost of treatment of the patient on hemodialysis and peritoneal dialysis.The annual growth rate of patients with the final stage of chronic renal nedostatatochnostyu, according to countries such as Japan, USA, is 230-300 people per 1 million inhabitants.Therefore, the problem of security cases donor organs is particularly acute.At present, many unresolved legal and ethical issues of transplantation of human organs.
Legal aspects of transplantation of organs and tissues are set out in the "Code of the fundamental principles of transplantation of human organs", approved by 44 of WHO session in 1991 and "for the Protection of Human Rights and Dignity of the Convention in relation to the Application of Biology and Medicine", which entered intoforce on 24 January 2002 in Strasbourg.
The key problem of organ and tissue tran
In contrast, in the "informed consent system", the removal of organs is carried out only with the written consent of the donor, as well as if the family after his death, also expressed their consent.
In today's world, both common law model of organ transplantation, with the consent of the presumption operates in Belgium, France, Austria, Poland, Latvia, Finland, Estonia, Lithuania, Russia and Belarus.Informed consent is mandatory in the UK, USA, Canada, Holland, Switzerland, Germany.In any case, before the removal of organs, doctors are obliged to inform the relatives of the deceased on the possibility of carrying out this operation, and perform the operation only if they consent.However, the Swedish laws allow "minor" removal of organs and tissues such as the pituitary gland, the cornea, without the consent of the deceased or his relatives.
First we need to define the basic concepts in transplantation.Donor - a person, an organ or tissue is transplanted to another person.Recipient - the person receiving from the donor organ or tissue.Transplant - organ or tissue donor who receives from the recipient.Sensitization - the special sensitivity of the body to foreign substances, leading to the development of a number of allergic reactions.
Preparation for kidney transplantation
When planning a kidney transplant is very important to consider the immunological aspects of this method of treatment.First, the compatibility of donor and recipient depends transplant operation.Secondly, the low compatibility organ donor promotes sensitization that with repeated transplantations leads to more frequent rejection of organs.To evaluate the compatibility bodies being identified HLA molecules (human leukocyte antigens), which in the human body are MHC (major histocompatibility complex).These parameters determine the donor and the recipient.In case of insufficient compatibility of the graft after transplantation rejection reactions develop.
The following types of rejection reaction:
• hyperacute rejection - developed after 1 hour after transplantation.Associated with damage to a kidney existing antibodies in the recipient.These antibodies are usually formed due to a failed previous transplant, blood transfusion or pregnancy.
• acute rejection occurs after 5-21 days after kidney transplantation.This reaction is due to the fact that, in response to a hit in the graft body produces antibodies that are designed to protect the body against foreign body.These antibodies cause the death of the transplant.
• chronic rejection occurs in long-term period.The reason it can be an infection or not fully healed acute rejection reaction.
One of the main methods of determining the compatibility of the donor-recipient is holding a straight cross-sample (cross-match).Using this test defined in recipient serum preexisting potentially harmful antibodies which may damage the transplant.As monitoring patients awaiting kidney transplantation, it is necessary once every three months to provide blood to the laboratory for determination of hazardous antibodies, which may be formed, for example following blood transfusion.When a donor is carried out cross-match test.
After transplantation is also performed cross-match test that becomes positive in the case of transplant rejection.Antibodies are defined to graft at week 1,2 and 4 after transplantation, then every 3 months.
All donors are divided into 2 types - the living and cadaveric.Living donors - is a person who voluntarily grant an organ or part of an organ for transplantation.Cadaveric donors - is dead donors whose organs are removed in a timely manner.
transplantation from a living donor has a number of advantages:
1. The results of the operation better as a living donor organs more compatible with the recipient's body.In this regard, after the transplantation is used more sparing immunosuppressive (suppress the immune reaction) therapy.
2. Presence of a living donor can reduce time spent on dialysis recipient.In some cases, there is a predialysis transplantation, that is, soon after the diagnosis of end-stage renal failure.In addition, organ transplantation from a living donor, usually a planned operation, which allows the recipient to maintain a high quality of life.
First of all, it is important in the selection of the donor testing for compatibility.In case of positive results conducted a comprehensive inspection of the identification of the donor contraindications.Kidney donation is contraindicated:
• in diseases of the urinary system;
• decompensated severe diseases of the cardiovascular system;
• malignant tumors of any localization;
• thromboembolic disease;
• alcoholism, and mental illness system.
for kidney donation requires that the remaining kidney was completely healthy.Therefore donor organs urinary system should be carefully examined.
Removing the kidney donor is an important and dangerous operation.The risks associated with this operation are divided into two parts:
• earlier associated with surgery and the early postoperative period.
• Late associated with later life in a lack of a kidney.
studying late risk donors, researchers conducted one large study.Two groups evaluated.For the control group included individuals who had a kidney removed due to trauma or tumors.The investigated group consisted of live kidney donors after a successful organ removal.After 20 years after the removal of the kidneys, scientists analyzed the causes of death and quality of life of patients.It was found that the differences between the control and study group almost was not.This allowed the authors to call his research "kidney donation prolongs life."
kidney removal operation is carried out at the donor, usually open way.
fragment kidney donor withdrawal operations.
postoperatively shows the early activation of the donor, the prevention of thromboembolic complications.
cadaveric donors are persons who died from traumatic brain injury, stroke, brain aneurysm ruptures, as well as brain tumors without metastasis.If you have a known kidney disease, age older than 65 years, HIV, hepatitis B and C, bacterial sepsis, blood donation is contraindicated.organ removal is carried out only after ascertaining brain death.
After removal prior to transfer to the recipient kidney in a state of ischemia (lack of oxygen supply).Therefore it is necessary a series of activities aimed at the maintenance of body functioning.These activities include the body as long as possible to maintain the normal functioning of the donor, preservation of kidney removal in a special environment, and as soon as possible to the recipient holding operation.
container for storage of transplant.
After kidney transplantation
After the operation within a week the recipient is in the intensive care unit, which provides continuous monitoring of vital signs.Under favorable conditions, while he spends in the hospital, then sent to outpatient treatment under the supervision of a nephrologist.At the same time, tests are regularly held for compatibility assessment of graft function.
used immunosuppressive therapy to suppress the formation of antibodies to the graft.It includes cytostatics (Sandimmun, tacrolimus), drugs mikrofenolovoy acid (Myfortic), as well as hormonal drugs (methylprednisolone) in a specific pattern.Antibacterial and antifungal agents can be used if necessary.
kidney transplantation promotes the survival and improve the quality of life of patients with end-stage renal failure.American scientists found that the risk of death in recipients after surgery compared with patients on dialysis awaiting transplantation and above for only 100 days after surgery.After this time, the risk of death is reduced almost by half.Therefore, at the present time from all types of renal replacement therapy, kidney transplantation is becoming a top priority.
physician therapist, nephrologist Sirotkin EV