Kidney transplant at what stage of renal failure. Kidney transplantation (transplantation): where and how the operation is performed. When transfer is prohibited

43 925 14.03.2019

Video and transcript of the webinar by Lyudmila Kondrashova, Chairman of the Board of the interregional public organization of nephrological patients “NEFRO-LIGA” - diagnosis, routing, quota

Lyudmila Kondrashov

Hello, dear friends! Today we have a webinar dedicated to transplantation. They sent me quite a lot of questions in advance. I have a short presentation. It’s small because making a presentation consisting of only text is very boring; as for transplantation, there aren’t many pictures. And I can voice the main questions that were asked to me for now without a presentation. Whenever possible and necessary, I will include a presentation in my story.

Indications for kidney transplantation

Indications for kidney transplantation are the terminal stages of any kidney disease because, unfortunately, regardless of the treatment of the disease, its occurrence - sooner or later, a patient with a serious kidney disease comes to dialysis, and then the question arises of how to get off dialysis. Either he must remain on dialysis for life because his kidneys are not working, or he is seeking a transplant if it is possible for him.

What does end stage mean? This means that the kidneys lose their main functions, primarily water excretion and the function of cleansing toxins. They also participate in the body's hormonal metabolism. They produce a hormone that is responsible for the production of red blood cells, that is, our blood.

Another question: could there be a situation where a transplant is prescribed without proper indications or, conversely, is not prescribed, although it is indicated for the patient?

Answer: No, this is impossible. The point is that you need to understand that there is a global problem of an acute shortage of donor organs, especially in Russia. Therefore, even those patients who are indicated for transplantation and who do not have serious contraindications to it, not all will be transplanted. If a patient has indications for a kidney transplant and has the opportunity to undergo this transplant, he will naturally be transplanted. If the patient has serious contraindications, then, unfortunately, transplantation is not possible for him. In particular, I am such a patient; I have many serious contraindications. I will never be transplanted and will remain on dialysis for the rest of my life.

Features of transplantation

Kidney transplantation is a surgical operation that involves transplanting a healthy organ from one donor person to another person who needs a kidney transplant that is not performing its function - the recipient. The new kidney usually works for both kidneys that have lost their function.

A kidney is being transplanted, contrary to many ideas of those who are far from transplantation - I heard something by chance in the media, a neighbor said something, someone said something on a bench - in fact, it is not transplanted backwards, not to the side, yes, a little backwards and to the side where the kidneys are located healthy person, - and into the peritoneum. It is transplanted either to the right or to the left side peritoneum, depending on which donor kidney the transplantologist has - right or left. This place is good because it is protected by the pelvic bones on one side. Here the vessels feeding the kidney come close. It is quite easy to suture a new kidney, its ureter to the bladder. And this place is very convenient for further monitoring of how the donor organ lives and feels after the transplant. Well, and, accordingly, a person with a donor kidney.

Preparation for transplantation

In fact, for a person who has lost kidney function, preparing for a transplant consists of only one thing - you must approach the transplant as intact as possible. That is, your main task is to follow the doctor’s recommendations and strictly follow the treatment plan that is prescribed to you. If it is hemodialysis, there are no omissions or shortcuts to the procedure. If this is the prescription of drugs that prevent complications from occurring when you are on hemodialysis, this is the steady use of these drugs. It is also about adhering to dietary restrictions, as dialysis patients have dietary restrictions that may affect the patient's condition. This is compliance with the sleep, wakefulness and work schedule if the patient continues to work. That is, your task is to preserve yourself in the best possible way before the transplant, let’s say, to approach the transplant in the best possible way.

Contraindications for transplantation

They are divided into two groups - absolute and relative.

Absolute:

• This is low adherence to therapy. If a patient is not responsive and adherent to therapy, this is usually discovered when he is still on dialysis and not even eligible for transplantation. And with a high degree of probability we can understand that when he is transplanted, he will also violate the treatment regimen, medication compliance, and so on.
• This is a malignant neoplasm. Those with a malignant neoplasm are not eligible for transplantation. This is absolutely true.
• Metabolic disorders (oxalosis). I'll explain it to you. Oxalosis is the intense formation of kidney stones on such a scale that the kidneys die from such an abundance of stones. Unfortunately, this is a pathology that returns in the graft after surgery, and returns in one hundred percent of cases. Therefore, several years ago, transplantologists completely abandoned transplantation of children who have this kind of disease, since all the transplantations they performed were unsuccessful. After some time, the transplanted kidney died again due to intensive formation of stones. This is one hundred percent, and there were no exceptions, so, unfortunately, this disease is not transplanted.
• Metabolic disease.
• Active AIDS and hepatitis. Well it is clear.
• Active tuberculosis.
• End stage of another disease. If, for example, a person has pulmonary hypertension in the last stage, his lungs are seriously affected, then what is the point of having a kidney transplanted if he simply does not survive, he will not even survive the operation itself.
• Severe vascular pathology, since the blood supply to a new organ, that is, a transplanted kidney, requires good blood flow, good blood circulation.
• Drug addiction.
• The patient's predicted life expectancy is less than five years. Let's just say this, in my opinion, is a rather controversial position. But according to our law, people over 65 years of age are not transplanted. Because the likelihood that a person will live for a fairly long period exceeding five years, unfortunately, in our country is not so great.

There are relative contraindications. There are also quite a lot of them, but they are called relative because a lot depends on the clinic where you are going to have the transplant. There are clinics with very large capabilities that remove these relative contraindications before performing a transplant on a patient.

• For example, a patient comes in with stomach bleeding and has a serious ulcer. He is operated on, the ulcer is sutured, the patient is put in order, in this sense everything is normalized, and he is, in principle, ready for transplantation. That is, this problem has been removed, and he no longer has any contraindications to transplantation.
• This chronic infection urinary tract, difficult to treat. The fact is that a transplanted kidney has a shorter ureter than a normal one, since it sits in the peritoneum and sits closer to the bladder, so any infection that occurs in urinary tract, rises more easily to the transplanted kidney. There is a higher risk of infection of the organ itself.
• This is uncompensated diabetes mellitus. I think you know that uncompensated diabetes mellitus itself leads to kidney damage, chronic renal failure.
• Infectious diseases in the acute phase with a pronounced clinical picture
• Untreatable malignant tumors. But, this is understandable.
• Serious comorbidities that either pose a risk to the transplant patient or compromise the long-term success of the transplant. I have my own concomitant diseases, which, unfortunately, are a contraindication for transplantation for me.
• The patient’s emotional instability and serious mental disorders, because after transplantation, taking drugs that prevent organ rejection requires a lot of internal discipline from the patient. The drugs are administered on an hourly basis, skipping them is unacceptable, and there are even quite strict dietary restrictions that the patient must comply with either for the rest of his life or until his new kidney functions.

Question: Can the views of different specialists regarding relative and absolute contraindications differ? That is, one clinic does not accept a patient, but another agrees to operate.

Answer: I'll tell you this. If some clinic is going to operate on you with absolute contraindications, this means that it wants to make money from you because it is high-tech health care, which includes transplantation, is paid from the federal budget in full. As soon as the patient gets on the waiting list, this money is, conditionally, reserved for him. And as soon as the operation is carried out, the institution receives this money.

This is especially true for those companies that say: “Oh, they didn’t hire you - they just don’t know how. And you pay us, a hundred thousand dollars, and we’ll transplant everything for you.” Yes. Only here questions arise - the survival rate of the organ, how conscientiously this will be done, what will be the selection of the donor organ. Therefore, as a rule, serious transplantologists with absolute contraindications do not accept transplantation.

Relative contraindications, with proper work by doctors, can be removed to a sufficiently large extent, to such a level that a person can go for a transplant and be able to be transplanted.

How to determine if a donor kidney is suitable

There are actually three options. Blood type, but now this is not as important as it was, say, ten years ago because modern techniques make it possible to transplant an organ without taking into account the blood type. The technique of immunosuppression now allows us to treat this factor more tolerantly. The second factor is HLA, which stands for “human leukocyte antigen” - a genetic marker located on the surface of leukocytes, white blood cells. As a rule, we receive three markers from the mother and three from the father. The higher the compatibility of these markers between the donor kidney and you, the longer the kidney will serve you after transplantation.

And another factor is antibodies. The immune system, as a rule, produces antibodies to any foreign organ. Sometimes in very large quantities, sometimes almost nothing. During the first transplant, a special test is done, that is, the donor’s blood and the recipient’s blood are mixed, and if no reaction occurs, it is considered that the organ is completely suitable for transplantation, and here we should not expect any surprises in terms of organ rejection or non-survival. These are the three main parameters that determine whether a kidney is suitable for transplantation.

Here I have written down the procedure for contacting the Transplant Center. Any citizen of the Russian Federation who is indicated for transplantation can receive a consultation at the transplant center. As a rule, the procedure for registering for a consultation is on the website of any serious center. This is the Federal Scientific Center for Transplantology and Artificial Organs named after Academician V.I. Shumakov, Moscow City Research Institute of Emergency Medicine named after N.V. Sklifosovsky, Russian Scientific Center for Surgery named after Academician B.V. Petrovsky. They always have a certain order. You can call and make an appointment for a consultation. There is a list of documents that you need to have with you when you come for a consultation. I don't think it's worth reading them out. Probably everyone can read. And then, as I was told, the presentations will be made publicly available, and I have nothing against it. People can just read it carefully and figure it out. There is a procedure for registering for a consultation. You need to get an extract. If you are on dialysis, see your dialysis doctor. If you are still at the pre-dialysis stage and are being observed by a nephrologist, then by a nephrologist. Therefore, in principle, you begin to move towards transplantation from your attending physician.

Then you turn to someone who provides high-tech medical care at the clinic. Usually, the doctor writing your statement indicates that you are recommended for transplantation, that is, high-tech medical care. With this, you already go to the clinic, usually at your place of residence. There is usually a person responsible for high-tech medical care; you do some of the research that will be needed in order for your documents to be submitted to the commission of the regional health authority, which makes a decision that you need to be issued a referral for high-tech medical care. This, in fact, means that money is already reserved for you, that you will be transplanted, and that you can get on the waiting list and everything is in order. That is, your task now is to wait for a suitable kidney to appear.

What is VMP

This is high-tech medical care. It is part of specialized medical care and is usually associated with the use of new technologies and resources, as well as high-resource treatment methods.

Many people ask, what is a quota? A quota is a fixed amount of finance and services that cannot be exceeded and is allocated by the state, which controls the distribution of this service to its citizens. In this case, we are talking about controlling the allocation of quotas for kidney transplantation. Quota is not quite the right name. In fact, this means that the person will receive a kidney transplant for free, this time. And secondly, according to the quota, anyone can be treated with us. The grounds for obtaining a quota are indications for this type of treatment, and not just desire.

The grandmother on the bench had a headache and she said, “I’ll go and get some treatment for the VMP.” No, it won’t work like that, it won’t work like that. A referral to receive high medical aid can be considered synonymous with receiving a quota. Quota is a name, so to speak, that is universal to humanity, and not strictly medical and not exactly legal. The quota is issued by a coupon-referral for the provision of high-tech medical care, allocated from the federal budget. High-tech medical care is always the federal budget.

There is a list of high-tech medical care, which is approved by the Ministry of Health of the Russian Federation. You can always consult this list. If you have doubts about any other type of treatment: is this medical care high-tech? Is it right for you? Is it free under the federal quota? You can always open this list, find your problem or disease and see if it is on this list. Transplantation is included in this list.

The referral procedure is determined in our country by Order of the Ministry of Health of December 29, 2014 No. 931. I will not read out, as it is called, these legal things, they are all quite tedious.

Procedure for obtaining a quota

To receive a coupon referral for VMP, you need to go to the clinic at your place of residence, as I said, after your attending physician. The clinic sends your documents to the regional health authority. And the decision on the need to open a coupon for high-tech medical care must be made by the regional health authority within ten days after the documents were submitted.

Here's a small diagram. It is more visual, more memorable. Because when I made this presentation, it turned out to be a lot of text and it seemed to me that it would be better for people to see this simple diagram - it’s easier to remember: first the attending physician, then the clinic, then the regional authority of the healthcare institution. This is what you need to fill out documents for high-tech medical care, get a referral for it and boldly get on the waiting list. Here are the documents required to apply for a quota:

• Conclusion of the commission. The regional authority of the healthcare institution will necessarily have a commission to select patients for the provision of high-tech medical care. This decision is formalized in a protocol.
• Patient's passport.
• Birth certificate if these are children.
• Medical insurance policy.
• Pension insurance policy.
• Certificate of disability, if available.

Who can be a kidney donor

Any adult healthy person who is related to you by blood can be a donor. This is a mandatory condition because we do not have the so-called emotional donation, which exists in many countries, for example, in Europe. When, say, a friend can give a kidney to a friend with whom she has been together for many years. We can either have a lifetime donation from a blood relative, or a posthumous donation from a deceased person.

The donation process occurs as follows. If this is a related transplantation, it has an advantage over posthumous donation because it does not bind the person to the waiting period for a donor organ. That is, you can always decide with your relative at what point you are both ready for surgery. Moreover, a person, a relative who is ready to donate his organ to you for transplantation, can refuse this at any second, and no one - neither the doctors nor the patient himself, who needed this organ, has the right to object since this is a completely voluntary act, it is the gift of humanity, the gift of life from one person to another. This is a very serious decision, therefore, usually, during related transplantations, even if a mother gives a kidney to her son, for example, or a daughter, a child, a psychologist must talk to the person before the operation itself in order to understand what considerations he is guided by, whether he has changed his mind, whether Was there any pressure or some circumstances that he may have misjudged? After all, when a child or your loved one is sick, it is not always possible to make an adequate decision because you are nervous, nervous, and overwhelmed by the situation. Therefore, at the very last stage before the operation, the psychologist must talk with your related donor.

Posthumous donation

There are two options. The first is cardiac arrest due to some pathology, for example, a massive heart attack. Only if in a given medical institution there is a team that is engaged in the removal of donor organs, it can remove donor organs within thirty minutes. After the death of the heart, its death, there are only 30 minutes to ensure that the remaining organs do not die from lack of oxygen and blood supply. If this is brain death, the second option, due to a massive stroke, severe head injury, and so on - there are many circumstances - then artificial blood supply is maintained, artificial respiration, and there is a certain time for the removal of donor organs. That is, the lungs must be removed no later than four hours. Now, at modern methods preservation and maintenance of vital functions, the kidney can wait, in fact, a day. But the problem is that this process is not fast. Brain death is determined by a whole council of doctors, which includes doctors from such specialties as neurologists, pathophysiologists, and therapists. Under no circumstances does this include people who do transplants themselves. Transplantologists are not included in this commission. That is, it works and gives its conclusion regardless of the transplant service. And only when this commission, having carried out all the tests, which say with one hundred percent certainty that - yes, this person’s brain is completely dead, then can the removal of donor organs occur. De jure and de facto, complete, one hundred percent brain death is considered the death of a person.

Currently, we still have a 1992 law in force, which stipulates the presumption of consent. That is, a person who did not write a refusal to donate during his lifetime, by default, can be used as a potential donor. But in fact, we don’t have many such cases and we only learn about them when some scandal arises on this topic. Unfortunately, I personally had the opportunity to attend various events and programs where relatives of those who received organs for transplantation were invited. I’m not deceiving you, the question was often posed like this: if you take it for free, then we go to court, and this is a scandal; pay us and take what you want. Unfortunately, this is the case.

In fact, voluntary donation is an ethically very complex issue. Since 2014, we have been promoting a project that was written by two of my regional leaders. Both of them are transplanted. It's called “Transplantation. I am for". He must create a positive attitude towards transplantation and organ donation in society, which we do not have. In our country, this branch of medicine is surrounded by such an insane number of horror stories, myths, monstrous speculations that when we come across just ordinary people at an event that we hold as part of the project, sometimes it is simply creepy to listen to what they say. For example, one lady told me a terrible story about how black transplantologists cut out a kidney from a cat and transplanted it into a person for money. Well, I couldn’t comment on this in any way. I found it very funny, I tried not to laugh too hard. A person doesn’t even include the head, what size a cat’s kidney is and what size it is in a person.

This means that the donor kidney can be stored. We have a booklet that you open, unfold, and inside there is a poster on which it is written step by step, in a very clear form, how the transplant is carried out. Here below is the scale (on the poster) - how long does a donor organ live? These are the materials we made as part of our project. We still have some big posters that we hand out to transplant surgeons from time to time. They love them very much. Here, usually, the heart, lungs - 4-6 hours, liver - 12 hours, well, the kidney is now up to 24 hours. This is, of course, due to the improvement of conservation technologies. Although I’ll tell you honestly, there are a lot of subtleties. In principle, the survival rate of an organ even depends on how often it was handled before being transplanted. There are subtleties that are not always told and, in fact, there is no need for that. But it's just interesting in itself.

Transplantation abroad

Yes, transplantations can be done abroad. But unlike Russia, transplantation for our citizens abroad is paid. Moreover, there are very strict waiting periods for a donor kidney. That is, if you come and want to get a kidney transplant for money, this does not mean that you will be operated on out of turn. No. On average in Germany the wait for a donor organ is 5-7 years. Until they operate on all of their people who were in line before you, you will have to wait - and it will come to you in 5-7 years. Moreover, Germany, unlike many other European countries, does not have a very high number of donor organs per million population. In Spain, this process occurs somewhat faster, but the prices are quite high - it is somewhere from 250 to 750 thousand, in this case, dollars, euros, depending on where you are having the operation.

This operation is paid. We must not forget that in this case, unfortunately, not only the operation itself is paid, but also the stay in the hospital, which you will need while you are being operated on, and so on. If you do not know the language, you will need to pay for a translator, you definitely need someone who will help you in the first postoperative period because kidney transplantation is actually not an easy matter.

Side effects

As I say, in order to undergo a transplant, you have to be an extremely healthy person. For the first six months, there is a large number of immunosuppressions, which are taken to prevent the donor organ from being rejected. There is such an illusion that he changed the transplant and ran healthy. No, that's not true. The disease that was there is not going away. Unfortunately, there is a return of the underlying disease in the transplant, but not in all cases and not in all forms of the disease. Then, the kidney is regarded by the body as something foreign, an intruder, and its task is to destroy this foreign thing. In order to suppress the body's immune response, a person is forced to take a fairly large amount of drugs that suppress his immunity; in order to compensate for some of the harmful effects of these drugs, he, as a rule, also takes hormones in large dosages. And hormones have their own back side. They can cause steroid diabetes and so on. That is, a person may have his own problems after transplantation.

I’ll say right away that from my own experience, our organization has existed for more than ten years. Since it's been around, two-thirds of those we've had on dialysis have been transplanted. Plus, we communicate with a huge number of transplant patients. Of course, transplantation is best tolerated by young people. Young people have nothing to do with dialysis. They tolerate transplantation well, and they easily tolerate the side effects that may occur with post-transplant medications. That is, the body has enough resources to somehow neutralize these effects. I have a guy in therapy, 23 years old, with congenital liver pathology, who underwent a transplant two years ago. He recently brought me documents and walked in on crooked legs. I say: “Maxim, what happened?” - Oh, Lyudmila Mikhailovna, I thought, probably, 10 km is still too much for me to run, I need a little less. I say: - Well, you give it! He says: “You know, sometimes I sit and think: did all this really happen to me?” Over these two years, he says, I have already gotten used to being a healthy person. Moreover, you can’t tell from him that he had any serious problems.

Hemodialysis while awaiting transplantation

It is not always the case that a patient is on hemodialysis while awaiting a transplant. The ideal option is when a patient who has already approached hemodialysis in terminal stage kidney failure is transplanted. As a rule, this is a related transplant; there is no waiting period for a donor organ. That is, we agreed, decided everything, and transplanted. This is ideal. Because when a patient goes on dialysis, unfortunately, the kidneys work 24 hours a day, and dialysis purifies the blood for 12 to 15 hours a week. And this is clearly not enough, complications accumulate, the body loses its resource. The longer you are on dialysis, the less likely you are to have a transplant. Therefore, the faster the transplantation process occurs, the better.

Nephrotoxicity

Question: How long does a person live after transplantation and what are the features of patient monitoring?

Answer: I’ll tell you right away how long a person will live after a transplant - it’s completely unpredictable, absolutely. I personally know people who have crossed the 20-year mark and I know one person who is approaching the 30-year mark. Unfortunately, the immunosuppression that a person must take after a kidney transplant to suppress organ rejection is also toxic to the kidney itself. Nephrotoxicity, as doctors say. There is a term called “chronic post-transplant rejection.” That is, the body chronically tries to reject the organ, and the medicine chronically tries to suppress this rejection. And this struggle that occurs in the kidney, in the body, it negatively affects the kidney, it (the kidney) gradually loses its function, slowly fading away.

For some, the processes can occur quite quickly, but this does not even depend on immunosuppression. It depends on the person’s body. It depends on what organ he got. Often, even with control of donor organs, it is unpredictable how he may behave. I know quite a few cases where my own kidneys were transplanted, a kidney was sutured and it began to work on the operating table. That is, they didn’t even have time to stitch the person up yet, but the kidney was already working. And there is a delayed function, when a person has been operated on, everything seems to go smoothly, everything is fine, and the tests are good, and according to ultrasound everything is normal, and other studies say that everything is fine, but there is no urine output and that’s it. And this delayed function, it can last a month, maybe two. I know a man who waited two months for his kidney to start working. This is a woman, quite young.

Lifespan

Of course, a lot depends on the discipline of the person himself: does he comply with dietary restrictions, does he take medications on time, does he see the doctor at the right time, does he do the examination prescribed for him? It depends on so many factors. In general, to be honest, it is usually unpredictable. But if only the person who was transplanted drank constantly, then yes, we can say that she will not live with him for long. In other cases, it is unpredictable.

In young people, as a rule, the kidney lives longer. I have had many young people undergo transplants and they are all doing very well. First of all, they are able to work, then the vast majority of them gave birth to children immediately after that. At our Shumakov Institute we deal specifically with women after transplantation who give birth healthy children. As for young men, there are no problems at all. The wife bears the child, the wife gives birth. Many of them have children, one couple has a baby, she is already 4-4 years old, they live in the Moscow region, and I also have a completely unique couple, they live in Smolensk, and he and she are transplanted, and their baby is probably already , about five years old. We fought for a very long time so that they did not receive generic replacements, but received original drugs. There are many generics on the market now. Everyone is adapting as best they can, because, unfortunately, the problem of generics is not going away in Russia.

Many Russian companies, under the import substitution program, rushed to make generic replacements, which, unfortunately, work very poorly, or do not work at all, give many side effects and are quite toxic. This is not my opinion, this is the opinion of transplantologists with whom I communicate very closely. In particular, at the Petrovsky Research Center for Surgery, the Institute of Surgery, they monitor their transplanted patients - who is on what medications after transplantation, what they are dispensing in the regions. There are a lot of transplant patients here who come from the regions. And for some of our companies they have very negative reviews. Therefore, there are many desirability factors, but good conditions, the kidney functions well and flawlessly for years and years. My good friend’s kidney worked for 24 years. Unfortunately, she rejected it - it was a situation associated with very severe stress. And this also has an effect. It affects the whole body, like all of us, including the transplanted organ.

Therapy after surgery

Question: Do I understand correctly that the therapy prescribed to a patient after a transplant is paid for by the state, but these are often generics, and this is where the help of charitable foundations could be needed in purchasing original drugs.

Answer: Yes, especially for children. Sorry, I'll interrupt you. Especially for children.

Question: How long does this therapy last?

Answer: For life. The only case in which this therapy is not needed is if your identical twin gave you a kidney. This is an extremely rare case. By the way, the first successful long-term transplantation in the world was done from an identical twin to an identical twin.

Question: If it is necessary to re-transplant, do such cases occur, is it done, and is it paid for from the budget?

Answer: Yes, it is paid for from the budget, if it was not because the person was injecting drugs, drinking, falling from the tenth floor and came back for another kidney transplant. If the transplant fails naturally, then yes, they all apply and, as a rule, get back on the waiting list. It's a completely different life, believe me. I see them, they are all before my eyes. We have a lot of transplanted people, especially young people - they are completely different. Firstly, you are not chained to the device artificial kidney three times a week. You are free, you can work, you can go wherever you want. And, of course, when they live this life, after being confined to dialysis, they want to transplant again in order to live a normal life. Moreover, as a rule, when they are young, they already have families, have children, they want to continue with their family, with their children, to live fully and feel all this joy of life.

Life on dialysis

What government guarantees are there for delivery to the hospital, is this observed everywhere, and what kind of help might a patient who lives on dialysis need?

Delivery and transportation of the patient to the place of the procedure and back has been our initial headache since we were formed ten years ago. The fact is that ten years ago, when nephrology appeared, I had already been on dialysis for three years. I went on dialysis in 2005 at a very in serious condition, completely by accident, because there was a catastrophic shortage of dialysis places, and they took me only because my mother did a great job for the Sechenov clinic. She is a healthcare facility designer. That's the only reason they took me for dialysis to the Clinic of Rheumatology, Nephrology and Occupational Pathology named after. EAT. Tareeva. When they brought me to the clinic, I looked like a thinking water balloon. And they pulled me out of this for at least 2.5 months, and within six months I came to my senses and became like a person.

Dialysis began to develop rapidly when it was included in compulsory medical insurance. For example, an investor came and said: “I want to build a dialysis center here.” Head of the region: “Okay, good. Give me half you, half the region.” Now they don't want to do that. There has been no money in the regions for a long time. And even if they exist, they still don’t want to give them. As a rule, now an investor who wants to build a dialysis center does it with his own money, but he receives payment for the procedure performed on the patient from the compulsory medical insurance fund. As soon as businessmen realized that this was guaranteed money - you did the procedure and received the money guaranteed, everyone who was not too lazy stomped their feet into dialysis, even those who before that had no idea what “medicine” was, let alone “dialysis” "

Our dialysis centers began to grow like mushrooms, and partly eliminated the problem of transportation. Because before, if dialysis existed somewhere, then, as a rule, in some region, large or small, it was located in one single regional city, where people had to get as they wanted. There was no transportation. On foot, by bus, by train, you leave at five in the morning, or at night, and you need a day or a little more to get just the procedure, since you travel back and forth for eight hours - no one cared. We took up this topic very seriously after our patient died in the Murmansk region, who lived two hundred kilometers from the dialysis center, and he was physically unable to travel under his own power to dialysis three times a week.

Unfortunately, dialysis is a life-saving procedure, and if a person misses a week (maximum two), he dies. He missed several treatments because he was physically unable to get to dialysis. He died. We then filed a lawsuit and received a decision from the Supreme Court, which recognized transportation as an integral part of the hemodialysis procedure. But we don’t have case law, so, unfortunately, we litigate a lot regarding transportation, we win half of the ships, we lose half, it all depends on the region, I’ll tell you honestly.

But last year, after one of the members of our organization, Klavdiya Startseva, addressed the president on a direct line, somehow broke through, there was an order from the president to find financial resources in the regions to transport dialysis patients. Now something has shifted. In some regions they actually allocate transport and start transporting people. Somewhere, everything continues the same: there is no transportation, at least somehow legalized by some kind of local act. But transportation was included in the Program of State Guarantees of Free Medical Care to Citizens for 2018-2020. And since it was included in the state guarantee program, this means that for the first time in all this time it was recognized as a truly integral part of the medical service.

So far this is all we have managed to get through with our heads. Then we'll see how everything develops. As for the dialysis itself, three times a week, for a minimum of four hours, because dialysis for less than four hours is not considered adequate. Well, five hours maximum. There are different types of dialysis. There is for especially severe patients who are still associated with oncology - there is round-the-clock dialysis. There is a special doctor there who spends the night with the patient, who is spinning and spinning on the artificial kidney machine. I receive dialysis for five hours three times a week. I just don’t wash myself at four.

Question: Is it, so to speak, no longer possible to get off dialysis?

Answer: No, you need to understand one thing clearly: if you are on dialysis, your kidneys are dead. Coming off dialysis is such a myth, yes, but not an entirely accurate expression. There are acute kidney injuries that are reversible. They are therefore divided into acute and chronic. Acute, this means that, for example, a person drank too much, in simple terms, or drank the wrong liquid that he and his friends planned to drink. Or he suddenly ate fungi, and some kind of fungus turned out to be wildly toxic. And kidney damage occurred.

In these cases, the person is taken for dialysis, and in such a situation nothing prevents the kidney from recovering. With these types of damage, as a rule, the kidneys recover, but the person must remain on dialysis for some time. On average, let's say, if after three weeks they have not begun to recover, then there is nothing to catch there. If, after three weeks, recovery processes have begun - diuresis has increased, tests have improved, and so on - the kidneys are restored almost completely, and the person leaves dialysis. But there are not very many such cases. I know of one unique case when a person was - my first dialysis doctor told me this, he is one of the luminaries of our dialysis - was on dialysis for 8 years, and his kidneys did not recover due to thrombosis of the renal arteries. They lost their blood supply, they stopped, he ended up on dialysis. And dialysis is carried out using heparin, since your blood is in the external circuit all these hours, passes through a cleansing dialyzer, runs through the system - to prevent thrombosis from occurring, it is done using heparin. Since this man had been doing the procedure with heparin for 8 years, his blood clots resolved and his kidneys suddenly began to work, and the blood supply improved. The man left dialysis after a few years. But this is a unique case.

Patient Schools

Question: You said that the longer a person is on dialysis, the less opportunity he has for a kidney transplant. How many years do you need to be on dialysis before a transplant becomes impossible?

Answer: You know, at our conferences and schools, patients very often, almost always have serious transplantologists, and to the question of one of my regional leaders - she was on dialysis for 19 years: “Do I have a chance to be transplanted?” he said, "No." But 19 years on dialysis is long term. At the same time, I must say, I know two people: one girl I had a transplant, she was on dialysis for 11 years, and last year my friend was transplanted, he was on dialysis for 15 years. Now he is raising his second granddaughter.

Question: Is it possible for representatives of the non-profit sector to contact your organization if they suddenly receive or receive requests from patients with problems of renal failure?

Answer: Yes, of course, we help regardless of the organization's membership. It doesn't matter to us. We actually, de jure, don’t have that many members themselves. But we work throughout Russia, in fact, from Kaliningrad to Vladivostok. We hold a lot of promotions. For example, to world day We have kidney campaigns in at least 25 regions. Moreover, this is not just one action. That's three or four. These include the patient's schools. We have five large social projects underway. The first is “Healthy Kidneys for All.” This is for all absolutely healthy citizens, adults and children, for parents with children.

That is, we are trying to create some kind of alertness among parents in terms of kidney diseases because they often creep up unnoticed, and some signs that an educated parent in this matter may notice in a child may not be noticed by another. We teach young children what is good and what is bad for the kidneys. We have a fairy tale for the little ones called “The Journey of the Kidneys”; volunteers show it in kindergartens. There is a charity program - my regional leaders visit shelters and orphanages. As part of, again, this project, we did several screenings of the population for early detection predisposition to kidney diseases. As a result of this screening, several people immediately got to see a nephrologist, and several people should have been on dialysis the day before yesterday, but people didn’t even know about it. There is a “Literate Patient”. This includes our school for dialysis and transplant patients. Activities on World Kidney Day. Our conferences are annual. "Transplantation. I am for!". I have already mentioned this project. You've seen his materials.

Now we have completely new project, it is again related to transplantation, it is called “Sport for Life”. Our guys, transplanted dialysis patients, have been going to sports competitions since last year and bringing back medals. The last time they brought two silvers and four bronzes from Malaga. They were at competitions in Poland and also won a bunch of medals. We attended competitions in friendly Kazakhstan. This direction is now very much developing.

Then, my regional leaders are very proactive, they now from time to time hold interregional sports tournaments - for example, “Ekaterinburg vs. Izhevsk”. They organize everything there themselves. They inform me like this: “Here, we will hold a tournament there.” Well, please do it. And we also have such a project, it’s called “Congratulate a sick child - get a child’s smile.” Usually on Kidney Day and New Year we visit children. First of all, in St. Petersburg. Our regional leader Tatyana Tarasova is very actively involved in this. We visit children in pediatric nephrology departments. And, as a rule, we arrange some kind of holidays, concerts, gifts for them, and so on. Because, in any case, I know what it’s like to be a sick child.

Question: Did you want to show the video?

Answer: These are our coordinates (on the screen), if anyone needs them. This is the first thing - this is our website, nephrologists, coordinates and my phone, which is also the phone number of the organization. And the second is the name of our project related to transplantation and the coordinates of the site specifically associated with this transplantation project. By the way, there is also a lot of good information there. You can also go there and read some things about transplantation if you need to know something.

00:55:12 - 00:56:42 animated film about transplantation from the project “Transplantation. I am for!"

Kidney transplantation is used for end-stage renal disease (ESRD). The criterion is a decrease in glomerular filtration rate of less than 15 ml/min; in this case, the condition is characterized by uremia, which requires program hemodialysis or kidney transplantation.

A little history: the first attempts to transplant a kidney were carried out on animals at the beginning of the 20th century. A successful operation was performed by D. Murray in 1954; a related kidney transplant was performed on a terminally ill patient with chronic renal failure, after which he lived for 9 years. Further, transplantology, as a science, developed rapidly: this was facilitated by the invention of preservatives, the discovery of drugs with a cytostatic effect, the accumulation of knowledge about blood compatibility parameters and the use of artificial purification methods - hemodialysis and peritoneal dialysis.

A kidney transplant is a necessary measure, without blood purification, against the background of uremia, death occurs. Hemodialysis, the artificial purification of blood, can be considered as palliative therapy for patients awaiting organ transplantation.

We list the diseases that lead to the development of end-stage renal diseaseinsufficiency:

• Decompensated for a long time existing.
• Malignant hypertension.
• Glomerulosclerosis.
• Some types of nephropathy.
• Autoimmune pathologies.
• Recurrent.

Indications for kidney transplantation

The indication for donor organ transplantation is end-stage renal failure. Let's take a closer look at how the loss of kidney function manifests itself.

Characteristic symptoms and signs of end-stage chronic renal failure:

Children suffering from a disease that leads to a complication in the form of loss of kidney function are characterized by retardation in growth and psychomotor development.

Unfortunately, a donor organ transplant is not feasible for all patients suffering from end-stage chronic renal failure.

The fact is that not every kidney is suitable for a particular person. In addition to compatibility problems, there are a number of contraindications to transplantation of a donor kidney.

These include:

• Severe forms and in which it is impossible to administer anesthesia (anesthesia).
• Liver diseases in the stage of decompensation.
• Oncology (some types).
• Significant cardiovascular pathology (in acute form).
• Autoimmune diseases.
• Psychiatric diseases.

Kidney transplant in India

Kidney transplantation in India will cost much less, but only a living relative is considered as a recipient. This condition is stipulated by the legislation of the country. Surgeries are also performed on patients with concomitant HIV infection or viral hepatitis C. There are several centers in India that deal with this problem. They are located in major cities: in Delhi, Mumbai, Indore, etc.

What complications can there be after a kidney transplant?

The most serious complication is kidney transplant rejection. After the operation, some time must pass for the patient’s well-being to return to normal.

Early complications include the following:

• anastomotic failure, which leads to bleeding, hematoma;
• addition of infection;
• complications from the blood coagulation system (thrombosis, thrombophlebitis).

Patients with a transplanted kidney often develop disorders of erythropoiesis and calcium metabolism.

In addition, there are allergic reactions, problems with respiratory system, reactions of late transplant rejection.

Highly qualified personnel, strict adherence to all recommendations, high-quality and well-chosen drugs help minimize risks and increase the success of the operation.

If we look at the statistics, 80% survive the 5-year mark; patients after a kidney transplant significantly improve their quality and life expectancy (up to 15–20 years). Some women give birth to children.

How to eat properly after a kidney transplant

Proper nutrition can reduce the load on the transplanted kidney, which contributes to its better engraftment. At the same time, it is important to ensure sufficient potassium intake from food. Chronic normal operation intestines helps the body remove toxins.

On the first day after surgery, you can drink still water; the patient receives all the necessary nutrients through parenteral nutrition. In the future, pureed vegetarian soups are allowed. The diet is gradually expanded; the list of allowed foods after a kidney transplant looks like this:

• lean varieties of meat, fish and poultry;
• vegetables and fruits;
• natural dairy products With reduced content fat, but with a maximum content of bifidobacteria and lactobacilli;
• durum pasta;
• olive oil;
• legumes;
• various nuts;
• dried fruits.

What not to eat after kidney transplant

The following products are prohibited:

• smoked meats and marinades;
• hot seasonings and spices;
• full-fat milk, sour cream, cream;
• sharp varieties of cheese (cheese made from cottage cheese can be eaten);
• sausages, sausages and offal;
• pork, lard, shish kebab.

Carbonated drinks and alcohol, including beer, are strictly prohibited.

The patient with a kidney transplant should be under constant monitoring. In addition, you need to learn to control diuresis and blood pressure.

Medicines, without which there is a high risk of kidney rejection, suppress the immune system, which means susceptibility to infections and cancer increases significantly. Therefore, even if you feel well, it is important not to miss visits to the doctor and periodically undergo complete instrumental and laboratory diagnostics.

Victoria Mishina, urologist, medical columnist

On modern stage development medical technologies transplantation, or kidney transplantation, is one of the most successful types of radical surgical interventions in transplantology. Transplanting a kidney from a donor to a recipient allows the patient to be spared numerous dialysis sessions, which are very difficult for health, especially for people weakened by diseases. When end-stage renal failure develops, creatinine, a metabolite that causes toxic damage nervous tissue, which can be fatal.

Kidney transplantation in transplantology

Kidney transplantation is the most common and, in scientific and practical terms, the most studied operation in the field of transplantology throughout the world. Kidney transplant surgery is the most effective in combating chronic diseases human urinary system. It can significantly improve not only the patient’s health, but also the quality of life.

Kidney transplantation can be performed either with or without preliminary nephroadrenalectomy, by planting an additional donor kidney in the area of ​​the edge of the ilium.

The first kidney transplant took place back in 1902. Then, in an experiment, a kidney was transplanted into a dog by Hungarian surgeons, but a series of experimental operations were unsuccessful, and the research was stopped. This direction received new life only in the mid-50s of the last century, when in 1954 the first successful transplantation of a donor cadaveric kidney to a living person was carried out.

For what diseases does a patient need a transplant?

A kidney transplant may be required in the most various diseases urinary system. Almost all of them cause chronic renal failure and progress slowly, leading to the development of varying degrees of chronic renal failure. A patient with kidney disease who is in the end stage of renal failure is the main candidate for a kidney transplant, because the disease decompensates and the kidneys can no longer perform their function, leading to serious and life-threatening complications.

End-stage renal failure may develop due to improper treatment or aggressive course of such diseases:

• chronic pyelonephritis;
• chronic glomerulonephritis;
• diabetic angio- and nephropathy;
• polycystic kidney disease;
• congenital malformations of the urinary system;
• traumatic kidney damage;
• systemic autoimmune diseases.

All of the above diseases invariably lead to the development of chronic renal failure. If a patient is diagnosed with such a condition, he is placed on a special list - a waiting list for a kidney transplant. While a person is on this list, he is systematically given replacement therapy using hardware dialysis methods. Renal replacement therapy allows you to maintain the disease in the compensated stage and saves the patient’s life until the transplantation stage.

Compared to systematic machine dialysis and other types of renal replacement therapy, transplantation is radical method treatment and allows you to increase life expectancy for diseases of the urinary system up to 2 times.

This is what a modern case for transporting an organ looks like

Contraindications for transplantation

Kidney transplantation is a complex, high-tech operation that requires not only exceptional skill during the operation, but also a detailed study of the histological compatibility of donor and recipient tissues according to the human leukocyte antigen or HLA system. Determining the histocompatibility of tissues is the most important step in the transplantation of any organ, including the kidney. The first and absolute contraindication to surgery is histogenic incompatibility of biological tissues of the potential donor and recipient.

Contraindications to kidney transplantation include:

• Cross immunological reaction with donor lymphocytes. Identification of this factor is an absolute contraindication to kidney transplantation. A cross-immunological reaction can cause acute transplant rejection with death.
• The recipient has cancer. A history of malignant neoplasm or one diagnosed at the stage of preliminary diagnosis before transplantation does not allow performing further procedure transplantation, as it is an impractical procedure due to the high risk of unfavorable outcome. Only after radical treatment malignant neoplasm, after 2 years, the patient may be eligible for a transplant.
• Chronic infectious diseases in the active phase (exacerbation). It is prohibited to perform a transplant if the patient has diseases such as tuberculosis, HIV infection, viral hepatitis B and C. The patient can be admitted for a transplant if these diseases are in an inactive form and there is no clinical manifestation of the disease; for this, the patient is observed in the transplant center for at least a year.
• Failure to comply with the medical recommendations of the attending physician. Ignoring medical prescriptions is a relative contraindication, and if this cause is excluded, transplantation becomes possible.
• Mental illnesses. Personality changes and psychoses are also relative contraindications. Peer review of a patient with a mental disability is required for approval to be placed on the waitlist.

Until recently, diabetes mellitus was also included in the list of contraindications, but this moment diabetes is no longer a contraindication, since with timely treatment it does not reduce graft survival in the long-term postoperative period.

Three-pack system for effective organ preservation

Transplant procedure

When a suitable donor becomes available, a specialized team of transplantologists is assembled to carry out the collection. biological material(organs) with subsequent sending of the organs to the transplant center or transplant department. Donor kidney transplantation can be carried out from relatives with their consent. An urgent study of the histological properties of donor organs is carried out according to the human leukocyte antigen system. The most suitable candidate for surgical treatment is selected from the waiting list.

The operation must begin no later than 6 hours from the moment of organ removal, since tissue viability is lost in the later stages due to lack of trophism (nutrition). When a patient in need of a donor kidney is in the department, he is prepared for surgery, for this purpose the blood type, Rh factor and others are determined. biochemical tests. The patient is transferred to the operating room, where a team of transplant surgeons, after administering anesthesia, creates access to the retroperitoneal tissue.

Before the actual start of the transplantation, the donor kidney complex is pre-prepared, non-viable surrounding tissues are separated, the size of the vessel site is adjusted to create an anastomosis, and the donor ureter undergoes a similar procedure. Perinephric tissue is removed.

Only after this preparatory procedure can the actual transplantation begin. It is important to note that the right donor kidney is transplanted to the left side, and similarly on the other side. Thanks to this, the physiological location of the ureter is preserved, which allows the graft to function better in the future. Transplant surgeons form arterial and venous anastomoses, after which blood flow is allowed through them and their tightness is checked, as well as the functioning of the transplanted kidney.

After this stage, the ureter from the donor cadaveric kidney is sutured to the patient’s own ureter or bladder. The tightness of the ureteral anastomosis is checked in the same way. Intraoperative complications can be avoided thanks to the well-coordinated work of the surgical team and the high level of transplantation services in our country.

Where is this operation performed?

The transplant can be performed at a wide variety of clinical sites throughout Russia. Kidney transplantation in the Russian Federation is carried out at the Research Institute of Transplantology named after. Sklifasovsky. The center for kidney transplantation in the Russian Federation is the Russian Scientific Center of Surgery of the Russian Scientific Center for Surgery named after. Academician B.V. Petrovsky. The kidney transplant department is headed by Dr. medical sciences. Professor Kaabak Mikhail Mikhailovich. This center performs kidney transplants not only for adults, but also for children, because... specialized medical care for a child may not be provided in all regions of the Russian Federation.

Despite the widespread use of such surgical interventions in our country, transplantation is performed in Kazakhstan, Israel and other countries where transplantation is at a high level. It is worth noting that the Volga federal district has a developed transplantology center, on the basis of which kidney transplant operations have been carried out for more than 10 years. Once again, it is worth noting that only people in need of transplantation and included in the waiting list can be referred to specialized departments and transplant centers in the Russian Federation.

Postoperative period

After surgical intervention associated with organ transplantation, the patient must take lifelong medications that inhibit the lymphocytic activity of their own immunity. This is very important point, since only by taking immunosuppressants can kidney transplant rejection be avoided. Rehabilitation after surgery takes from several months to 2-3 years, depending on the individual characteristics of the recipient’s body and the speed with which the kidney transplant takes root.

During the first week, the patient who has undergone a transplant is in the intensive care unit, where his health condition and basic vital signs are carefully monitored. Only after the attending physician is convinced of the engraftment and functioning of the transplant, the patient will be transferred to a regular department, where he will continue treatment.

Life after a kidney transplant is not easy, since, in addition to constantly taking specialized medications, the patient is placed on mandatory registration and must visit the transplant center once every 3 months to monitor his own condition and monitor how the transplanted graft behaves. The patient must constantly follow a diet after a kidney transplant. The nutrition of patients is aimed at reducing the load on the urinary system. The patient is prescribed special diet after a kidney transplant, which includes food that does not create a load on the urinary system, including the donor kidney.

Kidney transplantation does not affect existing disability, since the patient remains on lifelong drug therapy, and his standard of living turns out to be undoubtedly lower than that of a healthy person. However, this operation can significantly prolong the life of a patient with diseases of the urinary system in the terminal phase.

The content of the article:

Kidney transplantation is performed when a patient is diagnosed with end-stage chronic renal failure (CRF). In this condition, the glomerular filtration rate (GFR) is less than 15 ml/min, which means that the kidneys are not fully capable of clearing toxins from the blood. In Russia, kidney transplants are performed only in public clinics and at the same time free of charge (compulsory medical insurance). However, since the queue for transplantation is very long, people who have money can transfer abroad. The price for this operation greatly depends on the country and clinic and varies from 30 to 120 thousand dollars.

A donor can be either a living person or a deceased person who, during his lifetime, agreed to the use of his organs after death by signing a special agreement. Living donors are classified into individuals who are genetically related to the recipient and those who are not, depending on the relationship factor. Behind Lately the number of related kidney transplants has increased significantly. In this case, the risk of organ rejection is reduced.

Why and when is a kidney transplant needed?

Kidney transplantation is a necessary measure if the filtration capacity of the organ is reduced, which risks leading to death for the patient. If this paired organ does not fulfill its natural purpose, toxins accumulate in the blood and poison the body.

Chronic renal failure requires connection to hemodialysis - an artificial kidney machine. The entire procedure takes about 3 hours. Hemodialysis is also an alternative life support option for people waiting in line for surgery. If the “artificial kidney” is an effective way to rehabilitate the ability of an organ in the first three stages of chronic failure, then in the terminal stage, no other method except transplantation will help.

Pathologies due to which chronic renal failure rapidly reaches the terminal stage:

1. Diabetes mellitus is the most common reason(causes chronic renal failure in 25% of cases).
2. Malignant hypertension.
3. Focal segmental glomerulosclerosis.
4. Polycystic kidney disease.
5. A number of inborn errors of metabolism.
6. Autoimmune diseases, such as lupus (the immune system does not recognize its own kidney and attacks it as a foreign infection).

If emergency measures are not taken in case of chronic renal failure, death occurs within three months.

Indications for adults and children

Some conditions in adult patients are indications for healthy kidney transplantation. Among these phenomena:

Psycho-emotional instability;
biorhythms change - the patient sleeps during the day, and at night suffers from insomnia;
the face acquires a characteristic waxy color;
imaginary burning sensation on the body;
massive hair loss;
no appetite, body weight decreases to 20% per month;
the timbre of the voice changes;
intestinal upset occurs almost every day, the stool has an extremely unpleasant odor and is dark in color;
frequent vomiting;
heart failure develops;
Memory decreases.

In addition to the listed symptoms, the patient experiences an unpleasant odor of the body and oral cavity - a specific odor of urine.

Unfortunately, in pediatrics there are also conditions in which the only way To save the child's life is to transplant him a healthy kidney.

To the number emergency situations applies:

1. Significant increase in diuresis.
2. Edema ankle joints, faces.
3. Deformation of the limbs.
4. A burning sensation on the pads of the fingers and toes.
5. Muscle atrophy.
6. Increasing weakness, increasing every hour.
7. Dry mucous membranes; bitterness, bad taste in the mouth.
8. Severe pain syndrome.
9. Frequently recurring attacks of seizures, which is not associated with epilepsy and indicates a deficiency of potassium in the body.
10. Persistent increase in blood pressure.
11. Reduced body resistance to infections, high susceptibility of the child to diseases.
12. A decrease in hemoglobin levels to critical levels, resulting in the development of iron deficiency anemia.

Noteworthy is the fact that the child is severely stunted and does not correspond to his age.

Contraindications for transplantation

Even modern medical capabilities make it possible to transplant a healthy organ not with all the characteristics of the body. Although the list of limiting factors is reduced every year, some contraindications remain unchanged, since there is no doubt about creating a threat to the patient’s life during the operation.

Circumstances and diseases under which a kidney transplant cannot be performed include:

1. Cardiac or pulmonary failure, which eliminates the possibility of providing anesthesia and ventilation.
2. Liver diseases.
3. Tuberculosis of the lungs and/or urinary system.
4. Some forms of malignant neoplasms.
5. Malignant hypertension, since this condition is characterized by a short-term increase in blood pressure levels to critical levels. During anesthesia, the patient is at risk of developing a stroke or heart attack.
6. Autoimmune diseases.
7. Mental disorders and advanced stages of drug addiction.

Until recently, HIV was considered one of the contraindications to surgery. There was concern that taking certain drugs with immunosuppressive properties could lead to disease progression due to weak immune system. However, after a number of studies, it became clear that immunosuppressive drugs and antiretroviral drugs can be selected in such a way that they act synergistically. Then it will be possible to maintain the required amount immune cells, preventing organ rejection.

How is the operation performed (kidney collection from a donor)

When performing a traditional open nephrectomy, the kidney donor undergoes general anesthesia. A 15 to 25 cm incision is made on the side or front of the abdomen. The blood vessels connecting the donor's kidneys are excised and clamped. The ureters connecting the bladder and kidneys are also excised and then clamped. The surgeon may reduce the length of the ureters, the volume of the adrenal gland, and/or surrounding tissue. Along with the kidney, the blood vessels and ureter are removed, then these structures are bandaged, surgeons suture the surgical wound and apply a sterile bandage.

The intervention takes 3 hours (the duration varies depending on many factors). If the pancreas is transplanted along with the kidney, the duration of the procedure increases by another 3 hours. If a patient is on the waiting list for a deceased donor kidney transplant too early, the operation can be performed at as soon as possible before the need for dialysis.

Kidney transplant in Russia, India, Israel

Kidney transplant in Russia

In Russia, about 20 thousand people are waiting for donor organs. You can spend several years on the waiting list for a transplant. The operation is performed only in special kidney transplant centers located in 22 regions of the country. The number of operations performed varies from 1000 to 1500 per year. If we compare these data with similar US practices, they are 10 times higher.

The number of living and deceased donors for kidney transplantation varies widely among countries. Thus, in the USA and Israel now one out of three donors is living. And in Spain this figure is only 3% (data for 2006).

The intervention in question is carried out in the Russian Federation only if the recipient passes strict restrictions not only on age, but also on health status, which should be above average. The purpose of selection is to minimize the risk of transplant rejection and death. In the same place where a kidney transplant is subsequently performed, they undergo preliminary diagnostics. After all laboratory and instrumental studies, it becomes known which medications will be appropriate for better kidney engraftment. Cardiopulmonary functional ability A candidate for a kidney transplant must be fully functional, and the presence of other pathologies that limit life expectancy is also unacceptable.

Kidney transplant in Israel

The popularity of the operation in question in this country is increasing every day along with the shortage of donor organs, coming mainly from living people. Although a transplant here costs a lot of money, the costs are justified by the professionalism of the doctors, thanks to which the patient has every chance of full life after operation.

The success of the intervention depends on the patient’s blood and the immune properties of his body. Therefore, the primary task of doctors is to eliminate antibodies, because their action is directed against the tissue antigens of the transplanted organ and contributes to its rejection. The process of preparing for surgery is multi-stage, mandatory item which involves plasmaphoresis. This procedure separates antibodies from the blood, thereby preventing excessive immune activity and organ rejection. Accompanying techniques for neutralizing antibodies may include blood transfusion and taking certain medicinal drugs aimed at suppressing the rejection reaction.

The created national database of donors and recipients helps resolve cases of incompatible couples. To do this, it is enough to swap donors and neutralize the antibodies in the recipient’s blood, after which a kidney transplant operation occurs.

Israeli surgeons made a breakthrough in the field of transplantology by starting, as an experiment, to transplant kidneys from a donor whose blood type does not match that of the patient. In this case, even the fact of a relationship does not reduce much risk. The innovative method spread to other countries. Its essence is based on changes in blood composition.

Kidney transplant in India

The operation in this country is affordable while simultaneously being effective. There are entire transplantation centers equipped here, where multi-organ operations are easily carried out - simultaneously engrafting the liver and kidney, kidney and pancreas. There are no contraindications for transplantation such as the presence of HIV or hepatitis C. According to the country's legislation, only related kidney transplantation for children and adults is allowed. Another important point is that only a living person can act as a donor. Clinics are located in Delhi, Chennai, Mumbai, Bangalore, Indore.

What are the disadvantages of the operation

An undiscussed benefit of the intervention is how long people live after a kidney transplant. But besides the advantages, the operation also has several negative aspects. Since the process of kidney engraftment takes more than one day, it is a matter of normalization hormonal levels– up to six months, there is a risk of developing complications such as a decrease in the intensity of erythropoiesis and leaching of calcium from the bones. If timely measures are not taken and the condition is not corrected, large arteries begin to resemble old rusty pipes in appearance. How this affects your overall well-being is anyone’s guess.

The situation is aggravated by the fact that it is very difficult to find a donor for a kidney transplant. The organs of even close relatives are not always suitable.

Other disadvantages of kidney transplantation include breathing problems, the risk of an allergic reaction to medications, and the possibility of wound infection. Smoking and obesity may cause surgical complications. Therefore, the requirements for transplant candidates are quite high and depend on the country where the operation is performed.

Nutrition after surgery

The diet after a kidney transplant is aimed at minimizing the load on the surviving organ. At the same time, it is necessary to increase the concentration of potassium, magnesium and phosphorus in the blood. Also through proper nutrition it is necessary to prevent the development of constipation, which is extremely undesirable for the intestines of the operated person. Stagnation of feces not only adds pain, which already accompanies the patient in the postoperative period. It acts as a favorable environment for the development of intestinal infection. Since there is a fresh wound in the body, it is necessary to promote timely bowel movements.

In the first hours after surgery, eating and drinking is prohibited - only wipe your lips with a slice of lemon or a napkin soaked in water.

12 hours after recovering from anesthesia, you are allowed to drink water (still), starting with a few sips.

Subsequently, the doctor draws up a list of permitted and prohibited foods and dishes. You can eat:

Vegetarian soups.
Lean veal, chicken breast.
Seafood.
River fish.
Cottage cheese, matsoni.
Legumes.
All types of nuts, dried fruits (due to high content they contain magnesium and potassium).
Cabbage, potatoes.
Pasta (hard variety).
Fermented milk products (fat content should not exceed 2.5%).

You can eat baked goods, sweets and watermelon no more than once a week.

You will also have to limit the amount of salt, give up spices, alcoholic beverages, whole milk, and canned food. It is contraindicated to include fatty meat, sausage, instant coffee, and strong tea in the diet. Absolute contraindication on the consumption of carbonated drinks, cheeses, butter, kvass, sauerkraut.

Dishes need to be baked, stewed, and an equally useful method of food processing is steaming.

Behavior after transplant surgery

Life after a kidney transplant involves changes in physical activity and nutrition.

1. In the first few weeks after discharge from the hospital, the surgeon evaluates the patient's condition, orders blood tests and adjusts medication dosages.
2. The patient is taught to measure blood pressure, temperature, and urine output at home.
3. An ultrasound of the transplanted kidney is performed (to exclude structural abnormalities indicating the onset of organ rejection).
4. To determine the quality of blood circulation in the transplanted kidney, an arteriogram will be required.
5. The patient should not lift more than 1.5 kg or make sudden movements.

It is also important to come to your appointment on the appointed day so that the surgeon can examine you and, if there are signs of rejection, stop them immediately. During this period, carry out regular blood and urine tests to identify any signs of multiple organ failure.

Rejection of a transplanted kidney - why it occurs and how it manifests itself

The immune system recognizes the transplanted organ as a foreign object, and therefore tries to rid the body of it. For this reason, the patient should be aware of the warning signs and symptoms of rejection. Among these phenomena:

Hypertonic disease.
Swelling or swelling, usually in the arms, legs, or face.
Decreased diuresis.
Increased body temperature.
Stomach ache.

The patient should contact the transplant service immediately if any of these symptoms develop. Special medications taken after surgery will help prevent rejection. This is called immunosuppressive therapy. The purpose of such medicines– weakening of the immune system, which allows the body to accept the transplanted organ.

If the patient takes drugs that reduce the body's resistance, he must be regularly examined for infections, measure blood pressure, and take tests for glucose and tumor markers in order to be able to avoid the development of diabetes and cancer.

The kidney is on the list of the most transplanted organs. Therefore, transplantologists from all countries closely monitor the latest developments in this area. The object of their attention is not only alternative equipment capable of supporting the patient’s life processes during his operation. Surgeons focus on searching effective methods aimed at ensuring that the transplanted kidney is not rejected. Scientific inventions in this area have prompted not only the creation of hemodialysis machines, but also confirmed the possibility of creating a kidney from the body's own cells. This technology is being developed in scientific centers Russia and abroad.

Kidney transplantation is complex surgery, during which an organ taken from another person is transplanted into the patient. A healthy kidney can come from either a living or deceased donor. This radical method of treating chronic renal failure is by far the most reliable and effective.

When is a kidney transplant required - indications and contraindications for kidney transplantation

All kidney transplants performed in the world account for half of all surgical interventions, related to any organ transplantation. At the beginning of the last century, scientists first began to look for operative method treatment of end-stage chronic renal failure.

The first experiments by surgeons in Hungary and France were carried out on animals. In the forties of the 20th century, attempts were already made to transplant kidneys from animals or from deceased people to a sick person.

In 1954, American surgeons performed a successful kidney transplant operation on his brother's terminally ill patient Ronald Herrick. Ronald, who received a new kidney, lived for nine years. His twin brother Richard, who donated the organ, is 56 years old. This operation, recognized by surgeons around the world as the first successful organ transplantation, marked the beginning new era in the history of surgery.

Today, in many countries around the world, patients in need of transplantation have long waiting lists. In particular, as of 2009, there were more than 80 thousand patients in the United States awaiting a kidney transplant. Moreover, in the previous year, 2008, American doctors managed to perform slightly less than 20,000 such operations.

Far Not all kidney patients can undergo a donor kidney transplant. The determining factor in this process is the compatibility of the donor and recipient tissues. It is also important that the patient in need of a given organ transplant has sufficient young and that he has no history systemic diseases.

There is only one indication for kidney transplantation – end-stage chronic renal failure (CRF)!

This irreversible process develops against the background of:

Compared with renal replacement therapy methods such as peritoneal dialysis and chronic organ transplantation, organ transplantation prolongs the patient's life twice as long. Patients who receive a new kidney live with it for 10-15 years.

Cross-immunological reaction with donor lymphocytes is an absolute prohibition for transplantation!

The main contraindications for surgery are:

• An infectious process occurring in the patient’s body, in particular HIV infection. Cured tuberculosis requires 12 months of observation. For hepatitis C and B, a transplant is performed.
• Heart failure, gastric ulcer or other systemic disease in the decompensation stage. In patients diabetes mellitus increased risk of transplanted organ survival. However, today they are undergoing kidney transplantation.
• Diseases associated with a possible change in a person’s personality (drug addiction, alcoholism, mental disorders).
• Old age of the recipient.
• Hypertonic disease.
• Cancer of any organ that has either not been treated at all or has not yet been treated for two years. If treatment for melanoma, breast or cervical cancer was carried out, the kidney transplant is postponed not for two years, but for five.

Renal oncology that has been effectively treated and has not relapsed is not considered a contraindication!

To prevent complications after a kidney transplant, patients must strictly comply with all the doctor’s instructions and prescriptions.

According to statistics, in approximately ten percent of cases, transplantation is not successful precisely because of the disobedience of the recipients!

Non-communicative interaction between the recipient and the doctor during preparation for surgery is considered a relative contraindication.

How to prepare for a kidney transplant - what tests and studies are needed?

Before kidney transplantation, it is necessary to conduct a complete clinical examination of the recipient, which includes:

An important preparatory measure before transplantation is hemodialysis, that is, connecting the patient to an artificial kidney machine. Providing a patient with hemodialysis allows him to be maximally prepared for surgery and to select a suitable donor kidney for him.

Children and adolescents whose mental and physical development is inhibited due to hemodialysis receive a kidney transplant as a matter of urgency!

During the preoperative preparation process, doctors do everything necessary to maximize the patient’s general condition.

Any found in the patient acute infection pre-cured!

A patient suffering from hypertension is prescribed to take antihypertensive medications before, during and after surgery. Patients with a history of coronary heart disease undergo angioplasty or revascularization.

Most patients with chronic renal failure have chronic anemia, in which the hemoglobin level does not exceed 80 g/l. Since such anemia is not an obstacle to anesthesia, blood transfusions are usually not prescribed before a kidney transplant.

During the preparation of the recipient for surgery in mandatory Immunological tests are done to check the compatibility of the donor kidney with the patient’s body!

Methods of obtaining a donor kidney for transplantation - features of kidney transplantation from relatives

Based on the type of donor organ, there are three main types of kidney transplantation:

• From a living relative of the patient who agrees to act as a donor. In this case, kinship is allowed up to the fourth generation.
• From a living person who is not a relative of the patient (this type of donation is rarely used).
• From a deceased donor. In this case, the kidney from the corpse must be removed in a timely manner.

Because a person normally has two kidneys, about a third of all patients who need a new kidney can receive one from a living donor. The selection of such a person is carried out according to the following criteria:

• The donor's age must be between 18 and 65 years.
• His gender, weight and age should be approximately the same as that of the patient.
• The potential donor must have good health(absence of systemic diseases and renal pathologies).
• The donor's blood type must match the recipient's blood group.

The donor's desire to donate a kidney to a terminally ill person must be voluntary and conscious. It is important that he has an understanding of the risks of donation for his health. A person should be aware of the possible consequences of living with one remaining kidney.

Contraindications to donation are:

• Any malignant disease (except brain tumor).
• Prolonged hypertension or ischemia after cardiac arrest.
• Lung pathology or cardiac abnormality.
• Hypertension.
• Subclinical diabetes.
• Any untreated infection - viral, bacterial or fungal. (If the disease has been cured, the person can be a donor).

Cadaveric organs are taken for transplantation from people who died in a disaster, since a deceased donor is allowed to die of his brain, but not his heart. It is important that the person is healthy before death. If a person's kidneys were sick or injured during life, then they cannot be used.

In case of cadaveric donation, an emergency operation is performed, since the removed organ should not suffer from ischemia!

A living transplant from a relative has a number of advantages over a cadaveric transplant. These include:

• The ability to carry out a planned operation, since both the donor and the sick person can be carefully and efficiently prepared for it. Planned surgery has the least complications.
• Receiving a functional and healthy organ from a donor.
• The use of “living” organs partially solves the problem of the ever-increasing number of people in need of transplantation, since kidneys taken from corpses are sorely in short supply.

How is a kidney transplant operation performed - stages of a kidney transplant

Kidney transplantation is carried out using one of two methods:

• Heterotopic.
• Orthotopic.

When using the first method, the kidney is transplanted into the iliac region to a place that is not typical for this tissue. Orthotopic transplantation is used much less frequently. It involves transplanting a kidney into the recipient's perinephric tissue. Since this area is susceptible to various types of infection, implantation of an organ in place of the patient’s own kidneys is associated with the danger of intraoperative and postoperative complications.

A living donor kidney transplant involves two surgical teams. One group of doctors works with the recipient, the other with the donor. Both operations occur in parallel and are performed under general anesthesia.

1. The donor type of surgery is a ureteronephrectomy, during which the kidney pedicle intertwined with the vessels is carefully cut off. The surgeon strives to make the cut as close as possible to the central vessels.
2. The ureter adjacent to the kidney is also separated for fifteen or twenty centimeters.
3. Then it, together with the removed kidney, is immersed for some time in a ready-made physiological solution, cooled to 4 degrees Celsius. This is necessary in order to perfuse the kidney placed in the solution. Heparin, novocaine and polyglucin are used for perfusion. The duration of the manipulation is from three to four minutes.

At the same time, the site for implantation is being prepared for the patient in need of a transplant.

1. For this purpose, the hypogastric artery is isolated, one end of which is ligated. The other end is connected to the renal artery.
2. The required part of the bladder for ureter transplantation is equally carefully prepared.
3. The next stage of the operation is that the renal and hypogastric arterial vessels are sutured together using an end-to-end anastomosis.
4. The renal vein then connects to iliac vein. In this case, the end-to-side vessel matching technique is used.
5. After carefully performed preparatory manipulations, the kidney is removed from the fibrous capsule.
6. Next, the ureter of the transplanted organ is connected to the patient’s bladder.
7. At the end of the operation, rubber drainage tubes are connected to the vascular connections and to the bladder, and the surgical wound is sutured.

Normal functioning of the kidney and ureters is achieved approximately seven to ten days after transplantation.

When transplanting a kidney, doctors try to adhere to the cross principle - the left kidney is implanted into the right iliac fossa, right kidney, on the contrary, is transplanted to the left iliac region. This is due to the peculiarities of the anatomical structure. Of necessity this order may be broken.

The peculiarity of kidney transplantation for women is the obligatory intersection of the round uterine ligament. As for men, it is not always possible to keep their spermatic cord intact.

If the material for transplantation is obtained from a corpse, renal artery separated along with part of the aorta.

Life after a kidney transplant - recovery and possible consequences, treatment and diet after kidney transplant

The lives of people with a successfully transplanted kidney change, of course, for the better. Most patients return to normal activities. It becomes possible for a woman of childbearing age to bear and give birth to a child.

Along with the there is a real risk of complications, which manifest themselves in the patient’s body’s rejection of the donor organ. To avoid this, a person who receives a new kidney must take immunosuppressive steroids and cytotoxic drugs on an ongoing basis immediately after surgery. Due to the use of such medications, the patient’s immunity is significantly reduced, so he can easily become infected with any infection. This is the reason for the ban on visiting kidney patients after surgery, even for his relatives and friends.

There are three types of rejection:

Hyperacute rejection occurs extremely rarely. It is sudden in nature and occurs either directly during the operation or immediately after it.

The most common is rejection acute type . It may occur within the first two months after surgery, or it may appear a year later.

Chronic rejection characterized by a gradual appearance and prolonged course, stretched over years. This type of complication is difficult to treat, since its cause remains unknown.

To avoid postoperative complications and keep the new organ functional, patients should follow simple rules:

• Take medications strictly in accordance with medical prescriptions.
• Regularly and timely take all necessary tests and undergo the necessary examinations.
• Monitor daily the main indicators of the body’s condition - weight, blood pressure, body temperature.
• Follow a diet and do physical exercises recommended by doctors.

During the first time after surgery, fatty, spicy and salty foods, as well as flour and sweets, should be excluded from the diet.

The basis of the postoperative diet is to supply the body with calcium and phosphates. The patient should be careful not to gain excess weight.

The life expectancy of people with a transplanted kidney can reach 15-20 years!

Proper nutrition helps reduce the risk of complications and establish optimal water and electrolyte balance in the body.