This is a process used to remove wastes and other substances from the blood. Remove urea and liquid waste from the blood in the form of urine. Urea is made when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the blood to the kidneys. Balance salts, electrolytes, such as potassium and sodium, and other substances in the blood.
Regulate fluid and acid-base balance in the body to keep it neutral. This is needed for normal function of many processes within the body. Kidney failure caused by diabetes or high blood pressure. Polycystic kidney disease or other inherited disorders. Lupus and other diseases of the immune system. Other conditions, such as congenital defects of the kidneys, may result in the need for a kidney transplant. The new kidney may be rejected.
Rejection is a normal reaction of the body to a foreign object or tissue. When a new kidney is transplanted into a recipient's body, the immune system reacts to what it thinks as a threat and attacks the new organ. For a transplanted organ to survive, medicines must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object.
The medicines used to prevent or treat rejection have side effects. The exact side effects will depend on the specific medicines that are taken. Serious conditions other than kidney disease that would not get better after transplantation. There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your transplant team before the procedure.
Could you give a kidney to a stranger? How can donating one kidney help four people across the country? Read more. Extensive testing must be done before you can be placed on the transplant list. A transplant team carries out the evaluation process for a kidney. The team includes a transplant surgeon, a transplant nephrologist healthcare provider specializing in the treatment of the kidneys , one or more transplant nurses, a social worker, and a psychiatrist or psychologist.
Mental health evaluation. These issues can greatly affect the outcome of a transplant. The same kind of evaluation is done for a living donor. Blood tests. Blood tests are done to help find a good donor match, to check your priority on the donor list, and to help the chances that the donor organ will not be rejected.
Diagnostic tests. Diagnostic tests may be done to check your kidneys as well as your overall health status. These tests may include X-rays, ultrasound, kidney biopsy, and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.
The transplant team will weigh all the facts from interviews, your medical history, physical exam, and tests to determine your eligibility for kidney transplantation. Once you have been accepted as a transplant candidate, you will be placed on the UNOS list. When a donor organ becomes available, you will be notified and told to come to the hospital right away.
If you are to get a kidney from a living family member living-related transplant , the transplant may be done at a planned time. The donor must have a compatible blood type and be in good health. You may need a kidney transplant if you have end-stage renal disease ESRD. This is a permanent condition of kidney failure. It often needs dialysis. This is a process used to remove wastes and other substances from the blood.
Remove urea and liquid waste from the blood in the form of urine. Urea is made when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the blood to the kidneys. Balance salts, electrolytes, such as potassium and sodium, and other substances in the blood.
Regulate fluid and acid-base balance in the body to keep it neutral. This is needed for normal function of many processes within the body. Other conditions, such as congenital defects of the kidneys, may result in the need for a kidney transplant.
There may be other reasons for your healthcare provider to recommend a kidney transplant. The new kidney may be rejected. Rejection is a normal reaction of the body to a foreign object or tissue. When a new kidney is transplanted into a recipient's body, the immune system reacts to what it thinks is a threat and attacks the new organ. For a transplanted organ to survive, medicines must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object.
The medicines used to prevent or treat rejection have side effects. The exact side effects will depend on the specific medicines that are taken. Not everyone is a candidate for a kidney transplant. You may not be eligible if you have:. Serious conditions other than kidney disease that would not get better after the transplant.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your transplant team before the procedure. Extensive testing must be done before you can be placed on the transplant list. A transplant team carries out the evaluation process for a kidney. The team includes a transplant surgeon, a transplant nephrologist healthcare provider specializing in the treatment of the kidneys , 1 or more transplant nurses, a social worker, and a psychiatrist or psychologist.
Other team members may include a dietitian, a chaplain, your primary care provider, and an anesthesiologist or nurse anesthetist. Mental health evaluation. Psychological and social issues involved in an organ transplant, such as stress, financial issues, and support by family and significant others are assessed.
These issues can greatly affect the outcome of a transplant. The same kind of evaluation is done for a living donor. Blood tests. Blood tests are done to help find a good donor match, to check your priority on the donor list, and to help the chances that the donor organ will not be rejected. Diagnostic tests. Diagnostic tests may be done to check your kidneys as well as your overall health status. These tests may include X-rays, CT scan, ultrasound, kidney biopsy, and dental exams.
Women may get a Pap test, gynecology evaluation, and a mammogram. The transplant team will weigh all the facts from interviews, your medical history, physical exam, and tests to determine your eligibility for a kidney transplant. Once you have been accepted as a transplant candidate, you will be placed on the UNOS list. Some patients may benefit, others are disadvantaged, and a delicate balance must be struck between fairness and equality.
On one hand, organs are a scarce resource and could be given to patients who would maximize the duration of the transplanted organ. In contrast organs are a societal resource that could be distributed to all potential patients based on waiting time. These two views represent utility versus equity in organ allocation.
The final decision regarding the allocation policy will likely fall somewhere in between the two viewpoints. Even with creative ways to utilize more living and deceased donors, another source of kidneys is most likely necessary. Xenotransplantation has already occurred from non-human primate donors such as chimpanzees, monkeys and baboons. However these animals are endangered species and the size and blood type differences as well as the concern of transmission of infectious diseases has led to a ban of these transplants by the Food and Drug Administration.
Currently most of the research in this field is centered on the pig as the potential xenograft donor. Pigs have desirable characteristics: multiple offspring, rapid maturity to adult age, lower risk of transmissible infectious diseases and appropriate size. The many barriers to successful xenotransplantation are under study and continued advances may lead to this type of transplantation solving the organ shortage crisis.
With the short supply of organs and long waiting times, patients are now traveling outside of the United States to receive a kidney transplant. Commercialism and poor regulation can undermine the true nature of transplantation and put patient's lives at risk. Lifelong immunosuppression is a tremendous burden on patients.
Tolerance, or the ability of the body to "accept" an organ without daily anti-rejection medication has been the "Holy Grail" of transplantation. Many animal models as well as isolated reports of patients being withdrawn from these medications are encouraging. Most of the successful models incorporate intensive medication at the time of transplant with bone marrow infusions from the donor that supplied the organ. The recipient incorporates the bone marrow cells, becomes "chimeric" and the new bone marrow cells re-educate the recipient to accept the organ.
There are many issues to be refined in human transplantation but scientists and clinicians are working together to eliminate the need for lifelong immunosuppression.
Continued advances in our understanding of the mechanisms involved in the acceptance of a kidney transplant has led to new and exciting medications. After testing the new medications in animal models, these drugs move into human clinical trials. The great success of transplantation has occurred as a result of basic science research, careful testing of innovative medications and patients' willingness to participate in controlled studies of new medications.
Even tolerance protocols will require short term administration of new immunosuppressive medication. The cooperation and participation of patients in clinical trials is essential to keep the field of kidney transplantation moving forward. They provided insight, guidance, writing and production of the educational materials produced for patients and families undergoing kidney transplantation at UCSF.
These educational materials provided the framework for this article. Nancy L. Ascher, M. Deborah Adey, M. Sandy Feng, M. Chris Friese, M. Ryutaro Hirose, M. Sang Mo Kang, M. D Andrew Posselt, M. D Eric Savransky, M. Peter G. Stock, M. Flavio Vincenti, M. John Roberts, M. Julie Yabu, M. Amer J Transplant ; 7[Suppl 1]: Am J Transplant ; 6: Am J Transplant ; 7[Suppl 1]: Delmonico F; Council of the Transplantation Society. A report of the Amsterdam Forum on the care of the live kidney donor: data and medical guidelines.
Transplantation ; 79 [6 Suppl]: S Living donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol ; Nephrol Dial Transplant ; Lancet ; Transplantation ; Kidney Transplant Chronic kidney disease is a major health concern in this country afflicting more than eight million Americans.
Normal Kidney Function The kidneys are organs whose function is essential to maintain life. Filtration of the blood to remove waste products from normal body functions, passing the waste from the body as urine, and returning water and chemicals back to the body as necessary. Regulation of the blood pressure by releasing several hormones. Stimulation of production of red blood cells by releasing the hormone erythropoietin. Kidney Disease When the kidneys stop working, renal failure occurs.
Common Causes of End-Stage Renal Disease Diabetes mellitus High blood pressure Glomerulonephritis Polycystic Kidney Disease Severe anatomical problems of the urinary tract Treatments for End-stage Renal Disease The treatments for end-stage renal disease are hemodialysis, a mechanical process of cleaning the blood of waste products; peritoneal dialysis, in which waste products are removed by passing chemical solutions through the abdominal cavity; and kidney transplantation.
Kidney Transplantation Kidneys for transplantation come from two different sources: a living donor or a deceased donor. The Living Donor Sometimes family members, including brothers, sisters, parents, children 18 years or older , uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. Deceased Donor A deceased donor kidney comes from a person who has suffered brain death. Transplant Evaluation Process Regardless of the type of kidney transplant-living donor or deceased donor-special blood tests are needed to find out what type of blood and tissue is present.
Blood Type Testing The first test establishes the blood type. Tissue Typing The second test, which is a blood test for human leukocyte antigens HLA , is called tissue typing.
Crossmatch Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Serology Testing is also done for viruses, such as HIV human immunodeficiency virus , hepatitis, and CMV cytomegalovirus to select the proper preventive medications after transplant. Phases of Transplant Pre-transplant Period This period refers to the time that a patient is on the deceased donor waiting list or prior to the completion of the evaluation of a potential living donor.
These may include, but are not limited to: General Health Maintenance: general metabolic laboratory tests, coagulation studies, complete blood count, colonoscopy, pap smear and mammogram women and prostate men Cardiovascular Evaluation: electrocardiogram, stress test, echocardiogram, cardiac catheterization Pulmonary Evaluation: chest x-ray, spirometry Potential Reasons of Excluding Transplant Recipient Uncorrectable cardiovascular disease History of metastatic cancer or ongoing chemotherapy Active systemic infections Uncontrollable psychiatric illness Current substance abuse Current neurological impairment with significant cognitive impairment and no surrogate decision maker Transplant Surgery The transplant surgery is performed under general anesthesia.
The following complications do not occur often but can include: Bleeding, infection, or wound healing problems. At first, you may need blood tests several times a week. One thing that you and your healthcare team will watch for is acute rejection, which means that your body is suddenly trying to reject the transplanted kidney.
A rejection episode may not have any clear signs or symptoms. That is why it is so important to have regular blood tests to check how well your kidney is working. Things you might notice that can let you know you are having rejection are fevers, decreased urine output, swelling, weight gain, and pain over your kidney. The chances of having a rejection episode are highest right after your surgery.
The longer you have the kidney, the lower the chance that this will happen. But even if a rejection episode happens, there are many ways to treat it so you do not lose your transplant. Letting your transplant team know right away that you think you have symptoms of rejection is very important. Rejections happen much less often nowadays. However, the risk of rejection is different for every person.
For most people, rejection can be stopped with special anti-rejection medicines. How soon you can return to work depends on your recovery, the kind of work you do, and your other medical conditions. Many people can return to work eight weeks or more after their transplant. Your transplant team will help you decide when you can go back to work.
People who have not had satisfactory sexual relations due to kidney disease may notice an improvement as they begin to feel better. In addition, fertility the ability to conceive children tends to increase. Men who have had a kidney transplant have fathered healthy children, and women with kidney transplants have had successful pregnancies.
Women should avoid becoming pregnant too soon after a transplant. Most centers want women to wait a year or more. All pregnancies must be planned. Certain medications that can harm a developing baby must be stopped six weeks before trying to get pregnant.
Birth control counseling may be helpful. Be sure to use protection during sexual activity. In general, transplant recipients should eat a heart-healthy diet low fat, low salt and drink plenty of fluids. If you have diabetes or other health problems, you may still have some dietary restrictions. A dietitian can help you plan meals that are right for you. Finding a Kidney.
Where do donated kidneys come from? A donated kidney may come from someone who died and donated a healthy kidney. A person who has died and donated a kidney is called a deceased donor. Donated kidneys also can come from a living donor. This person may be a blood relative like a brother or sister or non-blood relative like a husband or wife. They can also come from a friend or even a stranger.
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