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Kidney Transplantation

What is kidney transplantation?

Kidney transplantation is the process of changing the kidney which developed renal failure with a kidney which is taken from a living person or a cadaver and ensuring the continuation of the kidney functions of the taker.

Our kidneys are vital organs. Chronic renal failure means the permanent deterioration of the kidneys. The only known treatment of chronic renal failure today is kidney transplant, which is the most frequent transplantation. Kidney transplant may also be done in the situations like acute kidney failure which demands urgency. Kidney transplantation enables the patient to get well with a single operation. Because dialysis can only perform a part of the kidney functions (partially), it should not be considered as an alternative for kidney transplantation. Besides, there are many disadvantages like strict diets, water limit, travel barrier, isolation from social life, postponement of business or education and retarded development of children. Patients in dialysis have to take an overload of medication because they are deprived of many functions which kidneys perform (blood pressure or blood restoration medications etc.). Because of this reason, it is known that the patients who had kidney transplantation have a better quality of life and duration in comparison with the dialysis patients. The patients may live as healthy persons with an after-operation tracking thanks to successful kidney transplantation.

On which diseases is kidney transplant applied?

Kidney transplant is applied in case of end stage renal failure. Renal failure which is one of the most insidious diseases of our times without giving any symptoms has been spreading rapidly day by day. The most significant reasons of chronic renal failure are diabetes, high blood pressure and nephritis. The disease which advances with no symptom stars to give signals with the fall of filtering function below 30 per cent which should normally be 85-100 per cent. Some of the most important symptoms are swelling under eyelids in the morning, a light oedema in hands and feet, feeling of weakness and extreme foaming while urinating. A serious amount of protein in urine causes foamy urine. Normally, protein under 150 mg may be found in urine. Excessive protein in urine is an abnormal situation and it is known as proteinuria or microalbuminuria. Foaming in urine means the beginning, even advancement of the disease.

The disease which has advanced because of not taking the necessary precautions may disrupt the function of the kidney which may otherwise function normally for one or two decades in 2-3 years. Dropping of filtering function speed under 15 makes the chance of living harder without any supportive care for the chronic renal failure patients. Generally, kidney transplant is recommended for the patients who have no choice other than dialysis or transplant in order to enhance quality of life and provide a permanent healing. Acute renal failure is also a loss of function which happens in a short period and it sometimes has a chance to be taken back. However, a transplant should be planned in the losses of function which have no return.

What are done before kidney transplant?

Initially, the patients are examined by branches like nephrology, surgery, cardiology, immunology, radiology, nuclear medicine, pulmonology, urology, gynaecology, biochemistry and organ transplant coordination. Then a pre-assessment takes place. In this pre-assessment, it is decided whether a kidney transplant is necessary or not with evaluating all the examinations of the patients. Then the chance of finding the kidney from either a related person or a cadaver is assessed. In any case, the kidney transplant preparation starts within 2 or 3 days. After the initial process, the period of preparation for the operation begins. During this period, 6 branch examinations and more than 40 tests are done, and then the vital decisions for the kidney transplant which is a quite important turn of patients’ life are taken. The patient is examined for diabetes, high blood pressure and inflammation before the operation. Also the tissue compatibility of donor and taker is assessed if the kidney is to be taken from a living donor. If everything is fine, CT angiography and renal scintigraphy is made for the kidneys. There are also many blood and urine tests during this process. If the patient had a coronary bypass, the kidney transplant has to wait for almost 3 months.

How is a kidney transplant done?

In spite of many efforts paid all around the world, the cadaver transplants which are done from the persons with cerebral death are not enough and this amount is rising too slowly within time. The kidney transplants which are made from living donors have become the main topic of conversation as a solution for organ failure.

Donor Operation

Taking the kidney with the closed surgery method (laparoscopic method) is quite common when the health and after-operation comfort of the living donor is taken into consideration. With the closed surgery, the operation is done via small holes opened in the abdomen of the patient instead of opening a big cut on the body. With this method, the operation is done from 3 holes in size of 0.5-1 cm and the kidney is taken from a 5-6 cm cut on the pubic of the patient at the end of the operation. In comparison with open surgery, the patients have less pain after the operation, stay less at the hospital and return their routine faster. The unwanted side effects of open surgery, like herniation, numbness, and wound infection in the operation spot are nearly extinct. This operation which is done only by opening 3 holes and a small cut also provides more successful cosmetic results than the open surgery. The donors, who start to drink, eat and walk in the evening of the operation may be discharged from the hospital after 2 days. The stitches are hidden and aesthetic and they do not need to be taken after the operation.

Taker Operation

Kidney transplant is an operation which is done via reaching pelvic vessels from outside of the peritoneum. In the kidney transplant operations, the kidney is not placed on its original position; instead, it is transplanted into left or right of the pelvic area. The vessels of donor kidney are bonded with the pelvic vessels of the taker, and the urinary tract of the donor kidney is also united with the bladder of the taker via the help of stitches. The dysfunctional kidney of taker is not taken except some rare conditions.

The healing period after the kidney transplant is significantly rapid. Because there is no contact with the intestines, the patient starts to take nutrition after a very short period. The catheter of the patients whose urination is tracked is taken off on the 4th day.

If the kidney is transplanted from a living donor, the patient is generally discharged from the hospital on the 5th day because the kidney starts to run immediately. However, if the transplant is done from a cadaver, the kidney will start to run within a few days or weeks, so the patient may require staying at hospital longer.

Robotic kidney transplant

In the most advanced stage of kidney transplantation, the kidney may also be placed in the taker with Da Vinci Robotic Surgery. This method has significant advantages especially for the patients with overweight.

What should be watched after kidney transplant?

After kidney transplant, patients stay at hospital for 10 days on average. On the discharge day, a detailed training is given for the patients about what to do at home and medications. A tracking program is held and detailed blood and urine tests are demanded, this process is monitored by nephrology specialists. The risk of infection should be avoided and the patient should not be in crowded, closed places because no close contact is desired. Also the nutrition issue is regulated by the nephrology specialists. People who do not work under heavy conditions may continue their normal business after the transplantation. The first control of the patient is after 2 days from the discharge, and blood and urine tests are done twice a week. In everything is under control, the tracking program is changed to be once a week, then once a month, and finally once in three months. The immunosuppressant medications and the periods of blood giving are also adjusted according to the blood levels, so the blood tests are vital. Drinking 2 litres of water on a daily basis is necessary for urinating. The patients need to take medications within the recommended periods and they should not skip any of them.

Why should I have my kidney transplant in Memorial Health Group?

Thanks to the multi-disciplinary team organization in the Memorial Şişli Hospital, where all the scientific branches regarding organ transplant take place, every patient who has organ transplant is provided a large-scale care. The team which consists of experienced physicians like transplant surgeons and infection specialists is working diligently for the progress of the treatment processes of the patients. The fact that the centre also transplants kidney, liver and bone marrow transplantation and has an advantage on the transplantation lists enhance the chances of the patients who wait for transplant. In the Memorial Şişli Hospital where kidney transplant has been done since 2dn of April 2004, the branch provides services for their patients for 7 days 24 hours.

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