Renal Transplant

Renal Transplant

Renal Transplant is a surgical procedure commonly employed in the case of patients suffering from severe, typically end-stage kidney disease. In most cases, these patients are already undergoing dialysis (peritoneal dialysis, hemodialysis or hemofiltration), due to the severely decreased glomerular filtration rate (up to 25% of the normal rate).

There are several affections which may become severe enough to require a Renal Transplant intervention. The most common of these is diabetes, which accounts for roughly 25% of the total number of kidney transplantation operations in the United States. Also, certain congenital, renal obstructive disorders may lead to hydronephrosis (for example vesicoureteal reflux, prune belly syndrome, posterior urethral valves, ureteropelvic junction obstruction or megaureter); these conditions may also require a transplant operation. Other affections which may cause the patient to require such a surgical operation include the Alport syndrome, the nail-patella syndrome, the hemolytic uremic syndrome, the Goodpasture syndrome, congenital nephrotic syndrome, Wegener granulomatosis, Henoch-Schönlein purpura, glomerulonephritis, Berger disease, polycystic kidney disease, juvenile and nephropathic cystinosis.

Patients suffering from the above affections may find themselves in need of undergoing a kidney transplant operation. However, this is not required in all cases, as for many patients the disease can be controlled through alternative therapeutic methods. It is strongly recommended that the patient discusses the benefits and risks of each of the treatment options available with his or her personal physician, in order to determine which would be the best course of action to follow.

Also, there are certain situations in which such a Renal Transplant surgical intervention is contraindicated, for example, pulmonary or cardiac insufficiency, or liver disorders. Also, morbid obesity, recent cancer, tobacco use, substance abuse may cause an individual to not be able to undergo a transplant operation, as may the failure to follow a prescribed dietary regimen. The specialized health care provider will ultimately determine if the patient is able to safely undergo such a procedure.

Renal Transplant Description

Before the Renal Transplant operation can proceed, a number of tests will be run in order to gather information regarding the patient’s health condition and to check the compatibility between the new kidney and the recipient’s organism. The patient will also undergo several psychological tests.

Blood tests are commonly performed to check the patient’s general health condition as well as to determine how urgent it is for the patient to receive a new kidney. Also, these tests will be used to determine whether or not the patient’s organism will be compatible with the available donors’. The most commonly performed blood tests include blood chemistries (serum creatinine, cholesterol, electrolytes and tests of the liver functions), clotting studies (partial thromboplastin time and prothrombin time) and blood type tests – which are performed to ensure that the donor and the recipient have the same blood type, in order to avoid the allergic reaction which would trigger otherwise. Also, panel reactive antibody and human leukocyte antigens tests may be performed in order to determine the chances of a successful Renal Transplant to be performed – antibodies are produced as a reaction to the presence of foreign material inside the organism, and transplanted organs may be identified as such and attacked; in order to decrease the immune response, patients undergoing transplantation operations will receive immunosuppressive medication. Viral studies may also be performed, as certain viruses may increase the risks of transplant rejection (for example cytomegalovirus).

Diagnostic tests are performed in order to fully investigate the patient’s health state. The specific tests that will be performed are determined on a case by case basis; the most commonly performed are renal ultrasound, kidney biopsy or intravenous pyelogram. Renal ultrasound and IVP are imaging tests, which allow a visual examination of the kidneys; they are used to detect tumors, stones, cysts or any other abnormalities or obstructions, while the biopsy involves the removal of tissues samples (either during surgery or by using a needle) which are examined under a microscope, to investigate the presence of abnormal or malignant cells.

During Renal Transplant operations, the patient’s dysfunctional kidneys are not removed as this may increase surgical morbidity. The new kidney is implanted in the iliac fossa or another location in the lower abdomen, and a different blood supply may be used (the external iliac artery and vein).

Renal Transplant Related Medication

One of the most severe complications of a Renal Transplant operation is the rejection of the transplanted kidney. In order to reduce the chances of this happening, the specialized health care professionals usually prescribe the patient a treatment with immunosuppressive medication. The therapeutic options and agents employed vary from one patient to another, as they largely depend on the patient’s general health condition and the particularities of the case.

The medication most commonly used for patients undergoing Renal Transplant include Cyclosporin, Azathioprine, Tacrolimus, OKT3, Prednisone, Antithymocyte Ig and Mycophenolate Mofetil, but these are not the only medicines that may be used in such situations. Apart from the existing immunosuppressive agents, new anti-rejection pharmaceutical preparations become available as research continues. As such, your physician may prescribe you a treatment course with a medicine not listed here. It is also possible for the physician to prescribe several medicines at once initially, and may change the doses during the course of the therapy. This may happen frequently, and is done to ensure the best results of the therapy, as your response to the treatment is being observed.

Individuals taking immunosuppressive medication are more susceptible to infections; as such, the supervising health care professionals may carefully balance the medication dosages in order to prevent both rejection and infections. This is accomplished by closely monitoring the patient’s condition through regular blood analysis after a Renal Transplant operation, as an important indicator of the patient’s need for medication is his or her current white cell count. The patient’s risk of developing infections is highest during the course of the initial treatment, as higher doses of immunosuppressive agents are being employed. The doses are being decreased in time, however the patient may need to take anti-rejection medicines for the rest of his or her life.