Kidney transplantation

Main article: Kidney diseases

Renal failure

Main article: Renal failure

If a person's kidneys fail, two types of treatment are possible: dialysis (hemodialysis or peritoneal dialysis) and kidney transplant.

How the graft works

A kidney transplant requires surgery to be transplanted into a healthy kidney patient's body from another person. After that, the transplanted kidney will perform the work of the damaged kidneys. The kidney is placed in the lower peritoneum and connected to the artery and vein. After that, the blood passes through the transplant and begins to produce urine.

The kidneys of their own are left in place unless they are a source of infection and other problems.

How to get on the list of transplant candidates

If you want to be a transplant candidate, you need to raise the issue in a conversation with your counselor. Your consultant will refer you to the organ transplant team for assessment. Such an assessment consists of clinic visits for outpatients and standard studies to determine your fitness for medical reasons. If it turns out that performing an organ transplant operation will be too risky for you compared to the possible benefit, then this will be discussed with you in the clinic for outpatients. If you are considered fit for such an operation, then your name will be included in the list of candidates for a kidney transplant, suitable for you by blood type and tissue type. This can happen just before the start dialysis and any time after you are already on dialysis.

Many patients assume that after a kidney transplant, their quality of life will be better than if they were on dialysis. Transplants provide more freedom because they no longer need to come for dialysis and follow a diet and limit their fluid intake. Kidney transplantation allows you to lead a life without dependence on the dialysis machine, the opportunity to eat what you want again, work, have fun and travel. In addition to feeling elated, many people report that the pre-transplant period generates new anxieties. While these experiences are normal and justified for such a situation, they are nonetheless not cause for undue concern. At the same time, it is important to restrain your desires and expectations regarding life after transplantation.

Full health recovery is not guaranteed. This depends on the personal characteristics of the patient and the transplanted organ. The restoration of health, unfortunately, does not occur automatically. We need to continue to take care of ourselves. The first six months after transplantation are very important. In order for the transplanted organ to be well received by the body and actively function, it is necessary to take special drugs that suppress immunity. In addition, a new functioning kidney and taking immunosuppressive drugs can change the physical condition of a patient who will have to get used to a new state and lifestyle.

Risks and complications

There is some risk associated with a kidney transplant. There is always a risk that your body will reject the transplanted organ. It's very hard to predict how long a transplant will last, but you can do a lot to reduce your risk by taking all the drugs prescribed. This includes special medications called immunosuppressants that help prevent your body from rejecting the transplant. These medicines can increase the risk of colds and infection, so it is very important to monitor yourself to reduce this risk. Some medications can change your appearance. Your face may blur; you may gain weight or you may develop acne or facial hair.

Even though transplants can last many years, there may come a point in the future when you need dialysis again.

Is it possible to get diseases from the transplanted kidney

It is impossible to guarantee that a person will not develop a disease transmitted to him from a transplanted organ. However, almost the same way as all blood donors are examined, all donor organs and the people from whom they come are checked for certain diseases. All donors have a medical and social history to find out if they are in the high-risk category for certain diseases, to make sure that they do not have cancer, tests for hepatitis, cytomegalovirus (CMV), HIV (AIDS virus), as well as syphilis and toxoplasmosis^[1].

Chronicle

2024

Recognition of safe kidney transplantation from HIV-infected donors

In late October 2024, researchers showed that kidney transplantation from deceased HIV-infected donors to HIV-infected patients is safe and comparable in results to kidney transplantation from HIV-free donors.

The new study involved 198 adults with HIV infection and end-stage renal disease who underwent a kidney transplant. The researchers compared the results of surgery in 99 participants whose donors were HIV-positive and 99 participants whose donors were not HIV-positive. The operations took place between April 2018 and September 2021, and then the recipients were monitored for three years. Results for overall survival, renal functionality after transplantation, and transplant rejection rates were comparable between the two groups.

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nih.gov

Kidney transplantation can significantly increase the life expectancy of patients with HIV and end-stage renal disease, but previously a lack of suitable donors has limited the possibilities of this therapy. In addition, HIV + patients have a higher risk of death while waiting for transplantation than non-HIV patients. To smooth out these differences, the Equal Policy for HIV + Organ Transplantation to Patients (HOPE) Act was passed in 2015, which legalized the possibility of transplantation between donors and recipients with HIV infection. Currently, such operations are carried out only in research institutions for a thorough assessment of survival and other characteristics, but the results of a new study, which proved no less effective kidney transplantation from HIV + donors, can lay the foundations for such operations in conventional transplant^[2]

A neural network was launched in Russia to assess the rejection of the transplanted kidney

Russian scientists have developed an artificial intelligence model to automatically assess kidney transplant rejection. The creation of an innovative neural network became known on October 17, 2024. Read more here

World's first man with transplanted pig kidney dies

On May 11, 2024, the Massachusetts Clinical Hospital reported the death of the world's first patient to receive a gene-modified pig kidney transplant. Richard Slayman died at the age of 62 - about two months after the operation. Read more here.

2023

First artificial kidney successfully transplanted into animal

On August 29, 2023, researchers at the University of California, San Francisco, reported the development of an artificial kidney, a special implantable bioreactor capable of performing some key functions of said organ. In the future, the device is expected to eliminate the need for dialysis or aggressive drugs to suppress the immune system after transplantation. Read more here.

Scientists successfully transplanted a thawed organ into a rat for the first time

In late June 2023, researchers at the University of Minnesota restarted the kidney's biological clock, warming it up before being transplanted back into a live rat. In total, in the study, the results of which were published in June 2023 in the journal Nature Communications, five rats received vitrified and thawed kidneys. For the first time, scientists have shown the possibility of successful and multiple transplants of a viable mammal organ after it was removed from an icy metabolic arrest state. Third-party experts unequivocally called the results an important milestone in the field of organ conservation.

In the event that researchers ever successfully transfer these results to humans, experts at the University of Minnesota said, cryopreservation and re-warming of organs could revolutionize transplantology and potentially save tens of thousands of lives each year in the U.S. alone. At any time, about 100 thousand adults and children in the United States are awaiting organ replacement. In 2022, 41,225 people received them. Each of them was dictated primarily by time. For June 26, 2023, doctors must rush to obtain and then transplant organs within a short, hours-long period when organs can remain alive outside the human body.

University of Minnesota scientists successfully transplant thawed organ into rat

Even though the rats' reheated kidneys suffered some damage in the vitrification and reheating process, the University of Minnesota team said it could begin to refine and test the method on human organs as early as 2025. Clinical trials, they said, could take place by 2028. But it will take another scientific breakthrough to move from rats to humans, outside experts warn, and even so, it's unclear how cryopreserved organs will work compared to fresh counterparts. In addition, clinical trials of transplants, according to other outside experts, are unique in their complexity.

Even if researchers at the University of Minnesota succeed in science, the widespread rollout of a nationwide network of cryopreserved organ banks will take time and raise ethical questions about who gets one type or another of transplant, according to NYU bioethicist Art Kaplan.

In vitrification, scientists first inject magnetic nanoparticles and protective chemicals called cryoprotectors into an organ or tissue that serve as a kind of antifreeze. The researchers then quickly cool it down to -24 ° C per minute to avoid the formation of cell-destroying ice crystals and go straight into a glass-like state.

Researchers at the University of Minnesota said they plan to spend until early 2024 trying to extend their cryopreservation method to pig organs, where kidney size has changed from large grape (in rats) to pear (in pigs). As they work, they will continue to study whether warmed animal organs restore their original physiological, chemical and electrical properties. In the event that all goes well, it will be possible to create living cans where organs, skin, nerves, blood vessels, cartilage and stem cells will be stored in liquid nitrogen for many years until they are picked up for the right patients.^[3]

2022: Kidney transplantation in Russia is now carried out in 36 regions

In December 2022, the Khabarovsk Territory became the 36th region of Russia where kidney transplantation is carried out. Now such high-tech medical care can be obtained in 66 medical institutions of the country.

On December 8, 2022, at the Khabarovsk Regional Clinical Hospital No. 1 named after Professor Sergeyev, transplantologists performed the first kidney transplant in the region to a 38-year-old man. The operation was carried out by the head of the surgical department No. 1 of the National Medical Research Center of Transplantology and Artificial Organs named after Academician Shumakov Dzhabrail Saidulaev and the chief freelance transplant specialist of the Khabarovsk Territory Yevgeny Molchanov. It is noted that the kidney transplant was successful, the patient's condition is stable.

Kidney transplantation in the Russian Federation is carried out in 36 regions

To support colleagues, specialists from the National Medical Research Center of Transplantology and Artificial Organs named after Academician Shumakov arrived in Khabarovsk. Another transplant is also scheduled for December 9, 2022: doctors will conduct a related kidney transplant.

In July 2022, it became known that in St. Petersburg, the mother gave a kidney in order to save her son. The first related transplant took place at St. Luka Clinical Hospital.

At the end of September 2022, transplantologists of the Chelyabinsk Regional Clinical Hospital transplanted the kidney of a 62-year-old woman of her 39-year-old daughter Yulia Sagitova. The latter fell ill with polycystic kidney disease in 2002, was forced to go to dialysis, constantly felt weak and drank drugs for pressure. The situation worsened after the woman gave birth to a son.

I could not miss dialysis, and my son had to be left with someone when I went to dialysis, "the patient recalls. - On dialysis, my pressure rose to 200. I barely endured it, for pregnancy I lost 10 kilograms. I haven't even eaten the last week. The Malysh was in intensive care at first, then discharged home.[4]

2019

Kidney bioengineering

Scientists have created a functional replacement for human on the basis of rat kidney cells. 2019

Kidney transplantation using 3D equipment was carried out in Yakutsk

On June 27, 2019, it became known that Eduard Gallyamov, Doctor of Medical Sciences, Chief Surgeon of the Medical Center for the Administration of the Mayor and Government of Moscow and Professor of the Moscow Medical and Dental University, held a master class on endoscopic kidney transplantation with 3D imaging. The experience of working on it is adopted by Yakut doctors. Read more here.

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