Kidney transplantation

Image:Kidtransplant.gif Kidney transplantation or renal transplantation is the organ transplantof a kidneyin a patient with end-stage renal failure. The main types are deceased and living donor transplant. In the former, the kidney originates from a deceased person. In the latter, the kidney is being donated by a living organ donor.

History

The first succesful kidney transplantations were done in 1954in Bostonand Paris. The transplantation was done between identical twins, to eliminate any problems of an immunereaction. It was actually the first successful human organ transplantin history. Until the routine use of medications to prevent and treat acute rejection, introduced in 1964, deceased donor transplantation was not performed. The kidney was the easiest organ to transplant, tissue-typing was simple, the organ was relatively easy to remove and implant, live donors could be used without difficulty, and in the event of failure, kidney dialysiswas available from the 1940s. Tissue-typingwas essential to the success, early attempts in the 1950son sufferers from Bright's diseasehad been very unsuccessful. The transplantation was done by Dr. Joseph E. Murray, who received the Nobel Prize for Medicinein 1990. The donor is still alive as of 2005, the recipient passed away eight years after the transplantation.

Kidney-pancreas transplant

Occasionally, the kidney is transplanted together with the pancreas. This is done in patients with diabetes mellitustype I, in whom the diabetes is due to destruction of the beta cellsof the pancreas and in whom the diabetes has caused renal failure (diabetic nephropathy). This is almost always a deceased donor transplant. Only a few living donor (partial) pancreas transplants have been done. For individuals with diabetes and renal failure, the advantages of earlier transplant from a living donor are approximately equal to the risks of continued dialysis until a combined kidney and pancreas are available from a deceased donor.

These procedures are commonly abbreviated as follows::

• "SKP transplant", for "simultaneous kidney-pancreas transplant"
• "PAK transplant", for "pancreas after kidney transplant"

(By contrast, "PTA" refers to "Pancreas transplant alone".)

Compatibility

The donor and recipient have to be ABO blood group compatible, and should ideally share as many HLA and "minor antigens" as possible. This decreases the risk of transplant rejectionand need for dialysisand a further transplant. The risk of rejection after transplant may be reduced if the donor and recipient share as many HLA antigens as possible, if the recipient is not already sensitized to potential donor HLA antigens, and if immunosuppressant levels are kept in an appropriate range. In the United States, up to 17% of all deceased donor kidney transplants have no HLA mismatch.

Complications

Problems after a transplant may include:

• Transplant rejection (hyperacute, acute or chronic)
• Infectionsand sepsisdue to the immunosuppressantdrugs that are required to decrease risk of rejection
• Post-transplant lymphoproliferative disorder(a form of lymphomadue to the immune suppressants)
• Imbalances in electrolytes including Calcium and Phosphate which can lead to bone problems amongst other things
• Other side effects of medications including gastrointestinal infammation and ulceration of the stomach and esophagus, hirsutism(excessive hair growth in a male-pattern distribution), hair loss, obesity, acne, diabetes mellitus(type 2), hypercholesterolemiaand others.

Kidney transplant statistics

References

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External links

• MedlinePlus Overviewkidneytransplantationfi:Munuaisensiirto

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Kidney+transplantation Wikipedia article Kidney transplantation.