Kidney Transplantation Research Paper

Abstract:

Kidney Transplantation is the organ transplant of a kidney into a patient with ESRD (end stage renal disease). ESRD is the result of many diseases like Diabetes Mellitus, Glomerulonephritides, Oxalosis, Urological problems, Cystic Kidney diseases (Polycystic Kidney disease, Medullary Cystic Kidney disease) and others. Some Kidney malignancies are also treated by Kidney Transplantation (Wilm’s Tumors in children, Renal Cell Carcinoma in adults) provided the patients remain tumor free for at least 2 years after removal of the tumor.

ESRD is diagnosed when the GFR drops below 15 ml/min/1.73m2. At this stage patients need Renal Replacement Treatment either with Transplantation or Dialysis (Hemodialysis or Peritoneal dialysis).

History:

Further progress, including anti–T cell antibodies ( monoclonal and polyclonal ), and other maintenance immunosuppressants , have made a significant impact on both patient and graft survival. Currently, 1-year patient and graft survival rates overpass 90% in most of the transplantations

Advantages of Kidney transplantation versus Dialysis :

Patients with ESRD can be treated either by Dialysis (Hemodialysis of Peritoneal Dialysis) or by Kidney Transplantation.

Hemodialysis and Peritoneal dialysis are associated with many dietary restrictions for the patients (restriction of fluids, Potassium and Phosphate containing foods, many visits to the dialysis center (that is true for hemodialysis) and an inferior quality of Life. There are consequently more limitations for their jobs and many patients either lose their jobs or miss many working days.

Kidney transplantations can offer better quality and life expectancy compared to dialysis.

However, not all patients are transplantable. Advanced age, severe Cardiac Failure, coexistence of Malignancy or chronic infection excludes patients from

However, with the new immunosuppressives, Tissue typing became less important and in the case of Cadaveric Kidney transplantation this is not done.

• Shortage of organs

• Complications (Surgical or Medical)

Complications after transplantation may be related to the anesthetic, the surgery itself, bleeding, infections, vascular thrombosis and urinary complications.

Transplantation is not possible without immunosupression drugs , except in identical twins and this makes the recipients vulnerable to infections (bacterial, viral, parasitic and fungi). There are also very vulnerable to opportunistic infections. Herpes zoster and CMV (Cytomegalovirus) are common among transplanted patients as other infections. Pseudocystis Carinii is also seen (Cause of Pneumonia).

Due to the long term, continous immunosuppresion (as long as the graft functions) there is also high incidence of Malignancies (lymphomas and other malignancies, especially skin cancers and Kaposi Sarcoma).

Prednisolone is an important immunosuppressive agent and the long term use of it is associated with increased incidence of Diabetes Mellitus, Catarracts, hyperlipidemia, gastric ulceration, obesity, osteoporosis and others.