Kidney transplantation is a surgical procedure that replaces the function of severely diseased kidneys by transplanting a healthy kidney from another person, called a donor.
The main functions of the kidneys are to control the volume and composition of fluids in the body, and to eliminate harmful substances produced by metabolism.
The extent of kidney function can be measured using formulas that estimate the blood filtration capacity of the kidneys; this is defined as “glomerular filtration rate” (GFR), and is expressed in millilitres (ml, thousandths of a liter) of blood purified in one minute (min).
When the kidneys are functioning normally, the glomerular filtration rate (GFR) is between 90 and 120 ml/min. Below 90 ml/min. we speak of renal failure.
Who is the ideal candidate for a kidney transplant?
Not everyone with severe chronic kidney disease can receive a kidney transplant; to be considered a suitable candidate for surgery, a person must meet at least three conditions:
Be in such a state of health that you are able to manage a major surgical procedure such as that required for a kidney transplant.
This first requirement excludes: those suffering from cancer or with a recent history of cancer; those suffering from a serious infection (e.g. AIDS, tuberculosis, osteomyelitis, hepatitis); those suffering from serious heart or liver disease.
Be available, once the transplant has been received, to undertake prolonged immunosuppressive therapy and to undergo the required periodic check-ups.
Lead a healthy lifestyle, in particular by not smoking, abusing alcohol or taking drugs.
The presence of these three requirements means that there is a concrete possibility of a successful transplant.
As we shall see more fully later, to find out whether he or she is an ideal candidate for a kidney transplant, a person must undergo a series of medical examinations and checks designed to assess the three requirements listed above.
What types of kidney transplant are there?
Since, at present, only human kidneys can be transplanted into humans, all kidney transplants require a donor. Let’s take a look at the two types of kidney donor below.
Living donor – Kidney donation from a living donor is normally performed by a related or unrelated family member. For the donor, kidney harvesting carries the same risks as any surgical procedure under general anaesthetic. The remaining kidney can also do the work of the donated kidney. Living donors have a perfectly normal life expectancy, and kidney donation entails no restrictions on lifestyle or physical activity.
Deceased donor – A deceased donor is a person with irreversible brain damage who has been declared dead. Kidneys from deceased donors are allocated. Recipients are selected from patients on the waiting list on the basis of blood (AB0 group) and tissue (HLA) compatibility, age class and waiting time on the list.
Many factors can contribute to determining the best choice in each individual case. The Transplant Center’s group of surgeons and nephrologists will evaluate all aspects of the different options with the patient to arrive at the best choice.
Is one kidney enough to ensure adequate renal function?
In most cases, a single kidney is sufficient to ensure adequate function. However, in recent years, the use of older or marginally older donors has led to the simultaneous transplantation of both kidneys (double kidney transplantation), achieving highly satisfactory results thanks to the transplantation of a more functional kidney mass.
Where to start
The decision to undergo a kidney transplant must take into account your personal convictions, your state of health and your age. Generally speaking, kidney transplantation guarantees a better quality of life than dialysis treatment, as well as longer survival. However, transplantation involves many medical, emotional and lifestyle aspects that you and your family will need to consider carefully. The members of the Turquie Santé team will help you assess the risks and benefits of a transplant, success rates and possible complications.
Generally speaking, a kidney transplant is a major operation carried out without advance notice, as is the case for elective operations; consequently, we can’t talk about real preparation, because we don’t have the time.
However, there are certain behaviors that the patient must implement, to facilitate the whole procedure and speed up its implementation; here are those:
Once you receive a call that a new kidney is available, the patient should avoid eating and drinking. The ideal situation would involve fasting for at least 6 to 8 hours, but this is not always possible.
After being placed on the waiting list, the patient should prepare a suitcase containing everything needed for the post-operative stay in hospital, so that it is ready for any subsequent calls.
It is the patient’s responsibility to inform the National Transplant Center of any significant change in his or her state of health, and to remember to communicate any change of telephone number to the same technical-scientific body.
Kidney transplantation: the procedure
The kidney transplant procedure in Turkey is divided into two main phases: a first phase dedicated to general anaesthesia, and a second phase dedicated to the transplant work itself.
General anaesthesia
Performed by an anaesthetist, general anaesthesia ensures that the patient feels no pain during the operation.
The patient is put to sleep and remains unconscious for the duration of the operation.
Kidney transplant operation
Performed by a specialized surgical team, the kidney transplant operation involves :
Making an incision in the lower abdomen.
- Placing the new kidney with its ureter in the abdominal cavity and connecting the arterial and venous vessels of the transplanted organ to the patient’s vascular system (in particular to the vessels of the lower abdomen); this second step enables vascularization of the new kidney.
- Connecting the ureter of the new kidney to the bladder. Sometimes, a small stent is temporarily inserted into the ureter to prevent its narrowing (removal of the stent usually takes place 6 to 12 weeks after transplantation).
- Unless the old kidneys are causing stones, pain, hypertension or infection, the operating surgeon leaves them in place and does not remove them.
Once the new ureter has been connected to the bladder, the operation is complete, and the incision is closed with stitches.
Don’t forget that throughout the operation, the medical team monitors the patient’s vital parameters (heart rate, blood pressure, oxygen saturation, etc.).