A kidney transplant is the transplantation of a kidney from a healthy person to a patient who has kidney disease and has lost kidney function. A kidney transplant is also commonly referred to as a kidney transplant. A kidney transplant involves the implantation of a healthy kidney into the iliac fossa of the patient’s lower right abdomen. Because the vessels in the right iliac fossa are shallow, they are easily connected to the new kidney vessels during surgery. If the right internal iliac artery has atherosclerosis and narrow lumen, it can also be anastomosed with the patient’s external iliac artery for fear of insufficient blood flow after surgery. After the vascular anastomosis, the vascular clamp that blocks all the vessels is released, and when the new kidney has a good blood supply, the abdominal wall is sutured layer by layer to complete the surgery. A kidney transplant is not an exchange of a new kidney with an old one.
The human body has two kidneys, right and left, and usually one kidney can support normal metabolic needs. When both kidneys lose function, a kidney transplant is usually the ideal treatment. Lifelong anti-transplant rejection therapy is usually required after kidney transplantation. Open heart surgery is an effective treatment for chronic renal failure. Kidney transplantation is divided into autologous kidney transplantation, allogeneic nephrectomy transplantation, and allogeneic kidney transplantation depending on the source of its donor kidney. It is customary to refer to allogeneic kidney transplantation as “autologous” kidney transplantation. Two types of kidney transplantation are referred to as “autologous” or “allogeneic”. Generally speaking, kidney transplantation is the most ideal treatment for chronic renal insufficiency, so all chronic renal insufficiency to end-stage can be treated with kidney transplantation. Although age is not the main indicator for selection, young adults between 15 and 55 years old are preferred.
Is it necessary to remove the diseased kidney before kidney transplantation? Currently, kidney transplantation is only a procedure to implant a healthy kidney into the abdominal cavity, and it is no longer recommended to remove both kidneys before transplantation unless it is very necessary. By necessary, it means that the continued existence of the existing kidney disease will directly endanger the patient’s health or further spread the disease. For example, in severe renal tuberculosis, the function of the kidney itself has been lost and the presence of tuberculosis lesions will spread everywhere; also, the presence of multiple cast stones with stubborn bacterial infection can easily lead to life-threatening complications such as sepsis, pelvic pus and perinephric sores; in addition, there are cases such as renal tumors, huge polycystic kidneys, and large amount of hematuria, etc. Nephrectomy is also considered first and then kidney transplantation after recovery, not both. Not both surgeries are performed at the same time. Except for the above diseases, it is not recommended to deal with the original kidney.
Domestic Development History
The first human kidney transplant was first performed by academician Wu Jieping in 1960, and kidney transplantation was officially launched nationwide in the 1970s. Since 1989, more than 1,000 cases have been performed each year, with a total of 13,594 cases by the end of 1994. The number of kidney transplant hospitals increased from 77 in 1991 to 95 in 1993. By the end of 1993, the 1-year survival rate increased from 86.7% in 1984 to 93.7%, and the long-term survival rate also increased year by year. By the end of 1998, the number of units carrying out kidney transplantation nationwide had reached 80, and the total number of kidney transplants reached more than 20,000 cases.
In May 2000, the total number of kidney transplants in China has reached more than 25,300, and China performs more than 4,000 kidney transplants every year, ranking first in Asia, with the longest healthy survival of 23 years. At present, 91 hospitals in China are capable of performing clinical kidney transplantation.
On March 20, 2005, the first autologous kidney transplantation in China was successfully completed in Wuhan General Hospital.
In October 2009, China has accumulated more than 100,000 organ transplants, becoming the second largest organ transplantation country after the United States. In this situation, clinicians should not only pay attention to the latest progress in this field at home and abroad, but also how to regulate organ transplantation is particularly important. Therefore, at the recent 7th Asian Transplantation Immunization Forum (ATIF), participating experts not only discussed topics such as new advances in the field of organ transplantation and the management of transplant rejection, but also focused on issues such as the regulation of kidney transplantation. China performs about 6,000 kidney transplants each year, and the 10-year survival rate of kidney transplant patients has exceeded 60%, with the longest survival time up to 32 years. The reason why the transplantation survival rate has been greatly improved is that the transplantation techniques of doctors have been greatly improved; the second is that the reasonable application of immunosuppression after transplantation can guarantee the long-term survival of the transplant recipient and the transplanted organ. Immunosuppressive regimens should be considered in terms of both efficacy and safety. Among the commonly used immunosuppressive agents, the efficacy and safety of primaquine have been confirmed, and more than 1.5 million patients have benefited from it.
History of development abroad
The first human allogeneic cadaveric kidney transplant was performed by the Ukrainian surgeon Voronoy in 1933, but it failed.
The first allogeneic kidney transplant was performed by Soviet surgeon Voronoy in 1936.
In 1947, Dr. Hume, an American physician, obtained short-term functional survival by transplanting a kidney into a vessel in the patient’s arm, allowing the patient to survive acute renal failure.
In 1954, at Brigham Hospital in Boston, USA, Joseph Murray was the first to perform a kidney transplant. In 1954, at Brigham Hospital in Boston, Dr. Joseph Murry performed the world’s first kidney transplant between pure twins, which was successful and opened a new era in organ transplantation and paved the way for transplantation of other organs such as liver, pancreas and heart.
The use of steroid hormones in kidney transplantation by American doctor Hume in 1955 led to a new advancement in allogeneic transplantation.
In 1960, British physician Calne used 6-thiopurine in kidney transplantation in dogs, but later discontinued its use when side effects were found in the clinic.
The clinical use of thiopurine in 1962 led to a dramatic increase in the success rate of kidney transplantation. The subsequent availability of lymphocyte immunoglobulin preparations and the use of splenectomy to inhibit rejection laid the foundation for successful transplantation.
From 1988 to 2000, 137,347 kidney transplants were performed worldwide, of which 30% were living kidney transplants.
Advantages and Disadvantages of Kidney Transplantation
Advantages
Kidney transplantation is a treatment option for patients with advanced uremia outside of dialysis treatment. Kidney transplantation is a procedure that has been relatively successful, but has some drawbacks.
A successful kidney transplant can eliminate the need for dialysis and is a more effective treatment for kidney failure than peritoneal dialysis or hemodialysis. A successful transplant of a kidney can provide up to 10 times more function than dialysis. Transplant patients are less limited and have a higher quality of life than dialysis patients. Most patients feel better and have more energy than on dialysis.
Disadvantages
The process of finding a suitable transplanted kidney is complex, with a variety of tests required to determine if the transplanted kidney is a good match for the recipient in terms of blood and tissue type.
Even well-matched patients are not always suitable recipients. Both the donor and the patient need to be free of infections and other medical problems that would complicate the patient’s recovery. Transplant patients must use immunosuppressive drugs to prevent rejection of the transplanted kidney. These medications have side effects and increase the risk of acquiring some infections, viruses and certain types of tumors. Transplant patients need to take the medications for the rest of their lives, or at least as long as the graft continues to work.
Conditions of kidney transplant patients
Not all patients with uremia are eligible for kidney transplantation, subject to the following conditions.
(1) The age range of uremic patients should preferably be between 12 and 65 years old; patients older than 65 years old but with normal heart, lung and liver organ functions, stable blood pressure and good mental status can also be considered for kidney transplantation.
(2) Patients with irreversible renal failure caused by chronic nephritis with end-stage uremia or other renal diseases.
(3) Patients with uremia in good general condition after hemodialysis or abdominal dialysis treatment, with no potential foci of infection in the body, and who can tolerate kidney transplantation.
(4) Patients with uremia who have no history of active ulcers, tumors, hepatitis and tuberculosis, and no history of psychiatric or neurological diseases.
With the development of modern research technology, the success rate of kidney transplantation has improved. Most kidney transplantation centers do not have an absolute age limit for transplant patients, and the decision to administer a kidney transplant is based mainly on the patient’s physical condition.
Kidney Transplant Survival Rate
The results of kidney transplantation are generally expressed in terms of kidney or human survival rates of one, three, five or ten years. By kidney survival, it means that the kidney is functional. The safety of kidney transplantation compared to hemodialysis therapy is a concern because the use of immunosuppressants is prone to comorbidities such as infections and side effects of drugs, and with the progress of medicine, kidney transplantation results have improved greatly and kidney transplantation is relatively safe. According to the 2008 Organ Transplantation Conference, the current one-year kidney survival rate of kidney transplantation in China is over 90%, five-year kidney survival rate reaches 90%, and ten-year reaches 60%. Compared with dialysis, the survival rate of human kidney is higher than that of kidney. In China, regardless of kidney transplantation or dialysis, the reason for the low survival rate is due in part to the technical gap, but most importantly due to the unaffordable medical costs. Kidney transplantation has low long-term comprehensive costs compared with dialysis, and successful kidney transplantation can alleviate or correct most of the comorbidities of uremia and dialysis, so the combination of kidney transplantation and dialysis therapy can extend the life span of uremic patients and improve the quality of life and living.