Part Three
- Kidney transplantation
introduction:
Kidney transplantation is considered the best treatment for chronic kidney failure, as the transplanted kidney performs the functions of the original kidneys, while dialysis performs a limited function by ridding the body of metabolic waste and excess fluids than the body needs. The operation is performed by a specialized surgical team, and the kidney is obtained from a living or deceased donor. The kidney is usually implanted in the right side of the lower abdominal cavity, where it is connected to the right pelvic artery and vein. The ureter is also connected to the urinary bladder in a process that usually takes about three hours. It is expected that urine production will begin immediately after the kidney taken from a living donor is connected, while the kidney taken from a deceased person may need some time to begin working fully efficiently. The patient undergoes intensive medical and surgical supervision after the operation to control the levels of fluids, salts, and immune medications in the blood. He remains in the hospital from one to two weeks, and after his discharge, he remains under the ongoing supervision of kidney transplant doctors.
Obtaining a new college:
A patient with chronic kidney failure can obtain a new kidney for transplantation from one of the following sources:
First: Living relative donors. In order for a relative to be considered a suitable donor, he must meet the following conditions:
He must be of legal age (21 years) according to the law.
He must have full mental faculties, be responsible for his actions, and be well-versed in the procedures, results, and even complications that accompany the kidney donation process.
The necessary medical examinations and tests must prove that he is medically fit. It is also important that he does not suffer from any chronic diseases, such as diabetes, high blood pressure, or hepatitis.
He must be immunologically suitable according to the results of blood type and tissue analyses.
Second: Living donors who are not relatives:
A large number of people apply to the Organ Transplant Center with their desire to donate one of their kidneys to patients with chronic renal failure. In order for their desire to donate to be approved, it must be ensured that The following is available:
All conditions mentioned for related donors must be met.
There is no suspicion of trafficking or taking money for money.
The donation must not be made under the influence of threats or blackmail.
The donation must be approved by the special committee to interview these donors, which was formed by a ministerial decision.
It is worth noting that some people travel to some Asian countries to buy a kidney, but as a result of performing the operation in unqualified centers whose primary goal is financial gain, the resulting rate of complications is unacceptable and sometimes dangerous for patients.
Third: Obtaining a kidney from deceased people:
◾ Chronic kidney failure patients are registered in special lists according to blood type. When a kidney from a deceased donor is available, a number of these patients are summoned in order of priority to the organ transplantation department, where they are medically examined, in addition to some analyzes and examinations, as well as immunological tests. Patients are selected according to a points system given to patients registered on the waiting list, and it takes into account the patient’s age, the period of dialysis treatment, medical fitness, and histological compatibility.
Preparing for a kidney transplant:
Kidney transplantation is considered the ideal treatment for patients with chronic kidney failure because kidney transplantation:
◾ It gives the patient a longer life span and a better quality of life.
◾ Lowest cost treatment method.
◾ For children, it is the only means that:
◾ It gives them the opportunity for normal physical and mental development.
◾ It gives them a better opportunity for school attendance and academic achievement.
◾ Avoid the frequent (psychological and health) suffering associated with dialysis.
Procedures to be completed before kidney transplantation:
Obtain a detailed medical report from the treating physician in the patient’s kidney disease unit. This report includes the following:
◾ Medical history of the patient referred for a kidney transplant.
◾ Results of the clinical medical examination.
◾ Results of laboratory tests, especially hepatitis viral tests.
◾ Results of endoscopic examinations of the esophagus, stomach and duodenum.
◾ Examination of the bladder and urethra using color x-rays, and sometimes, if necessary, or conducting special tests for the function of the urinary bladder and examining the bladder endoscopically.
◾ The absence of chronic inflammatory sites such as tooth decay and tuberculosis (which require a chest x-ray and skin tuberculosis examination).
◾ Results of tests that indicate the fitness of the heart to perform a kidney transplant (planning, ultrasound, and nuclear rays).
◾ The patient is free of any non-benign tumors
◾ Mammogram for women over forty
◾ The patient’s medical report is reviewed by the organ transplant surgeon and nephrology consultant at the organ transplant center, a medical examination is signed on it, and any missing tests and analyzes are completed.
◾ Conducting immunological tests between the patient and his accompanying donor.
Determine the date of admission to the hospital and performing the kidney transplant operation well before the operation.
Kidney transplant process:
The kidney transplant operation is performed under general anesthesia and usually takes (3-4) hours. The kidney is placed on the right or left side of the pelvis, outside the peritoneal cavity. The blood vessels of the kidney are connected to those in the pelvis, and the ureter of the new kidney is transplanted into the esophageal bladder. Z.
The patient stays in the hospital after the kidney transplant for one to two weeks, during which he:
o Close monitoring of the patient’s health condition.
o Giving intravenous solutions of appropriate types and sizes.
o Giving immunosuppressive medications and regulating the doses according to the patient’s need.
◾ Monitoring the function of the transplanted kidney.
o Teaching the patient about the different types of medications that he must take, especially the dosage and time to take the medication before leaving the hospital.
◾ After leaving the hospital, the patient must strictly adhere to the outpatient clinic appointment times that are given to him.
o The patient must visit the Organ Transplant Center
o When exposed to any disease symptom.
After the operation:
The patient stays in the hospital after the kidney transplant operation for one to two weeks, as he needs intensive care. He is given the required solutions and medications on a daily basis until his condition stabilizes. During this period, the patient’s family is requested to reduce visits to him, while following the instructions from the treating doctors and the nursing staff responsible for his care. The patient is so that he is not exposed to infections and infectious diseases from others, due to his extensive use of immunosuppressive drugs, which weaken the body’s resistance to these diseases.
The patient may need to stay in the hospital for a longer period than that, depending on the case. For some patients, their condition requires taking a sample from the transplanted kidney when temporary impairment of kidney function occurs, so that rejection or other cases can be diagnosed early and appropriate treatment given.
When the patient is discharged from the hospital, he gives detailed instructions about medications, diet, and appointments for review at the outpatient clinic, and is given the prescribed sick leave.
Medications to prevent kidney transplant rejection:
The human body has lines of defense that protect it from harmful influences, including the external line, such as the skin and mucous membranes lining many of the body’s systems, and the internal line of defense, which is what is known as the body’s immune system, which consists of white cells and antibodies secreted by some of these cells. We know that a kidney transplant patient needs to do many tissue compatibility tests before performing the operation, and despite these tests, the transplanted kidney is still considered a foreign organ to the body that the immune system must attack (i.e. reject). For the operation to be successful, the immune system must be suppressed, which is known as reducing immunity, so that it does not attack the transplanted kidney. Here, the section includes anti-rejection medications.
Immunosuppression requires two stages:
Qualification:
In which strong doses of these medications are given, usually intravenously, before the operation and sometimes during the first few days after the operation.
Continuity:
In it, oral medications are given daily to maintain a low performance rate of the immune system that allows the transplanted kidney to be accepted without exposing it to rejection, while maintaining a degree of the body’s immunity that works against many microbes to which it may be exposed.
Thanks to scientific development, many of these medications have been discovered, making it possible to give them according to the condition of each patient, after it was limited in the past to two or three medications given to all patients, which may negatively affect their health if side effects of these medications appear.
Among these medicines:
- Cortisone. Prednisolone
- Amuran. Imuran
- Alsalbet. Cellcept
- Neoral. Neoral
- Prograph. Prograf
- The Rapamites. Rapamune
The doses of these medications are gradually reduced to reach the lowest amount by the end of the first year after transplantation.
Preventing infectious infections in kidney transplants:
Anti-rejection medications suppress or reduce the body's immunity, which is necessary to prevent kidney rejection. At the same time, a degree of this immunity must be maintained to fight various microbes. Therefore, the treating physician performs departmental examinations to ensure the percentage of these medications in the blood and their effectiveness, and therefore tries to weigh the difficult equation to preserve the kidney and prevent infection. However, the patient may go through periods where his immunity decreases to a degree that may allow the infection to occur, for reasons that may be general, like any other person, such as cold attacks, changing seasons, and malnutrition, or for special reasons, such as raising the doses of medications due to suspicion or treatment of kidney rejection, or the necessity of using some medications. Which will increase the effect of anti-rejection medications on the immune system, and do not forget that some infections, especially viral ones, may significantly reduce the body’s immunity.
The body's immunity is at its lowest possible during the first six months after transplantation, so the patient is prescribed antiviral, antibacterial, and antifungal medications during this period that help reduce the possibility of infection. Patients are also generally advised to avoid mixing with people with contagious diseases, especially children, and to stay away from crowded, poor places. Ventilation, and eating fresh food prepared at home while staying away from ready-made meals available in the market, and taking care to consult a doctor immediately when epidemic diseases spread in the environment surrounding the patient.
It is not recommended to wear a mask on the face, and wearing it is limited only when there is a possibility of exposure to cases of infectious respiratory diseases through the breath or mouth spray, which requires staying away from these patients.
Vaccination and kidney transplantation:
Following vaccination schedules according to the advice of the treating physician is an essential element in preventing bacterial and viral diseases to which a kidney failure patient is exposed before and after the transplant. This is done in consultation with the treating physician and the preventive health department in hospitals. As a basic rule, vaccinations taken from a live, weakened (i.e. inactive) microbe cannot be given. Known in various vaccination centers.
Food after kidney transplant:
There is no doubt that a patient with kidney failure faces a lot of suffering in what he eats or drinks, and therefore he feels that a kidney transplant will relieve him of this suffering. This is true to a large extent, as he will not need to be careful about drinking water, nor be afraid of drinking too much. Who eats fruits and vegetables because of the potassium, and he can eat whatever meat he wants, and that is in the best assumptions, that is, when there are no other obstacles to these types of foods and drinks.
But the following must be taken into consideration:
◾ Kidney patients often also suffer from high blood pressure, and this requires reducing the amount of salt they eat, especially found in canned cheeses, processed meats, and ready-made meals.
◾ He may also suffer from high blood cholesterol or triglycerides, which requires reducing the amount of fat he eats, which is often found in full-fat dairy products, meat, fried foods, chocolate, and nuts.
◾ Given the high rates of diabetes in our country, especially since it is one of the main causes of kidney failure, a significant percentage of kidney transplants suffer from this disease. Therefore, a special diet must be adhered to that prevents high blood sugar and, more importantly, prevents the emergence of new cases from those who are predisposed to this disease. Due to genetic factors or other health reasons.
◾ We must keep in mind that kidney transplant medications may be responsible for some nutritional problems, such as increased appetite, increased obesity, high blood pressure, and diabetes, and this can be controlled with the necessary diet for various types of these health problems. They may also cause Digestive system disorders resulting in dehydration or malnutrition.
Fasting after kidney transplant:
◾ Ramadan fasting is one of the beloved obligations of all Muslims, and the obligation of fasting is lifted from the sick until he recovers, the pregnant woman until she gives birth, and the traveler until he returns, and kidney transplants are the same as patients, they have a permit to break the fast (and God knows best), as they are in need of continuous medical follow-up and a special system in Eating, drinking, and taking medications. If this regime is compatible with fasting and his kidney functions are normal, he is permitted to fast after consulting his treating physician.
◾ The effect of fasting on the functions of the transplanted kidney was monitored in a number of patients who wished to fast - after reviewing their health condition - and compared to their counterparts who did not fast, and we did not find any differences between them. This allowed us to identify the conditions that enable kidney transplants Of fasting - God willing - without any problems, which are:
◾ Kidney functions must be stable for a period of no less than six months before fasting.
◾ The creatinine level should not exceed 200 micromol/L.
◾ The number of times you should take any of the essential medications should not exceed twice a day (that is, every 15 hours at least).
◾ He must not be suffering from kidney stones or acute or chronic stomach ulcers.
The following must be taken into account:
o Eat the suhoor meal and then take the morning medications 15 minutes before the dawn call to prayer with two cups of water.
o Drink water and dates or a little soup at the Maghrib call to prayer, then take evening medications and perform the Maghrib prayer (to give the opportunity for the medications to settle inside the stomach), and then eat breakfast.
o Make sure to drink plenty of water during breakfast.
o It is recommended to eat a light suhoor meal while reducing the amount of salt and proteins to avoid diuresis during fasting.
o It is recommended not to eat a lot of sugars, starches and fats, especially for diabetics, and to eat moderate meals in order to avoid stomach and digestive system problems.
o The basis is regularity in taking medications. If dawn calls and the patient has not taken his medication, he must break his fast to take the medication.
Sports after kidney transplant:
o A kidney transplant is performed to rehabilitate a chronic kidney failure patient so that he can perform his duties normally and participate effectively in public life. The patient begins to move out of bed on the second day of the operation, and when he leaves the hospital, he walks normally. After three months, he begins to exercise, which increases in strength, until he reaches full athletic activity six months after the operation.
Contraceptive medications:
◾ There are side effects of contraceptive medications that are not suitable for the kidney transplant patient and may cause her health problems, so she should refrain from using them except in limited cases with the approval of the treating nephrologist and it is recommended to use condoms.
Pregnancy after implantation:
◾ Kidney failure often leads to a decrease in fertility, and fertility does not recover completely after the transplant. However, the kidney transplant patient can get pregnant and give birth naturally after the transplant, and a period of stabilization of the medical condition lasts for one to two years after the operation, knowing that there is an increased possibility of kidney rejection with Pregnancy and childbirth, and preparation for this is done through regular follow-up in the women’s clinic and the transplant clinic, adjusting medications according to the development of the condition, and taking the required precautions before, during and after childbirth in arrangement with the obstetrician and gynecologist.
Protection of the transplanted kidney:
- A kidney transplant patient must protect his kidney from cases of rejection, starting from choosing the most suitable donor whose tissues are compatible with him, to completely regularly taking kidney transplant medications and others, especially immune-reducing medications and diabetes and blood pressure medications, and medical follow-up in the outpatient clinic according to the scheduled appointments, and performing departmental examinations for detection. On kidney function according to the advice of the treating physician, following his instructions and advice, not measuring his condition against the condition of other patients because the nature of the disease and his condition differs from one patient to another, and not taking any medication or performing large or small surgeries without consulting him.