RENAL TRANSPLANTATION

The process of kidney graft rejection is a serious one, it means failure of the whole transplant surgery.

What are the criteria of a rejected kidney graft?

The process of kidney graft rejection is a serious one, it means failure of the whole transplant surgery. Patient (recipient) may express fever, painful/tender graft, rigors, decreased urine output and elevation of blood pressure. Kidney function tests will be declined also, and by time patient unfortunately will return to dialysis again. However, the full-blown picture with its dramatic manifestation is rare now owing to the great advancement in genetic studies and tissue typing. Moreover, the advent of the newly introduced anti-rejection medications led to a great decline in the graft rejection rates. Another important factor that allow the patient’s immune system to attack the foreign graft, it the patient’s compliance and how much he/she is adherent to the treating team.

 

ALLOGRAFT

What are the common causes of kidney graft rejection?

Sure, the poor preparation, bad choosing of donors (donor selection) and non-adherence to the treating physician are all augmenting factors that can induce and progress the process of allograft rejection. Difference in blood groping is a major factor for rejection, however, recent advances in the process of removing or modulating hypersensitivity (desensitization) protocols, particularly in Japan, have led to bypass this obstacle. Another vital factor of rejection is that seen in teenagers, who are usually non-compliant and less adherent to their physicians. Compliance to the immunosuppressive protocols is also pivotal in keeping the kidney graft in a stable condition. Some of these medications needs to be adjusted according to their blood levels, over dosage will lead to drug toxicity, whilst under dosing will result in rejection, the latter can go unnoticed in a prolonged rejection process called chronic rejection that may be manifest after years. The risk of rejection has been recognized by nephrologists as a high risk and a low risk patient, according to the nature of the current risk factors. However, two important factors have been considered on the long run to increase the kidney graft longevity

1.   Adjustment of blood pressure (the lower the better
2.     Optimization of the lipid profile to keep kidney vessels in a healthy states

 

Can my original disease recur in my new kidney?

The answer is yes, but not all original kidney diseases can recur to your kidney. For example, diabetes mellitus, IgA disease and membranous nephropathy can recur but their recurrence may be modified by the current immunosuppressive medications. Actually glomerular (active portion of the kidney tissue) diseases can occur de novo (newly occurring) or may be recurrent diseases. To differentiate both entities, patient should have clear details as regard his original disease, unfortunately, this may not be available for all patients. Many patients commenced on dialysis and proceed to a kidney transplant with no clear cause of kidney failure. A kidney biopsy should be available, an intervention that may be refused by many patients. However, a full detailed history and serial serology and other laboratory investigations may help determine the current situation

https://www.researchgate.net/publication/328430921_Complement-mediated_renal_diseases_after_ kidney_transplantation_-_current_diagnostic_and_therapeutic_options_in_de_novo_and_recurrent_ diseases

 

If rejection occur, can we implant another one?

Recent series have should that kidney transplantation can be performed for the second, third even the fourth time. Of course, precaution and preparation, particularly surgical issues will be different every time in regard to location of the graft and operative inlets.

 

Is kidney transplantation available at any time?

Kidney transplantation is the best therapeutic option for a patient with a kidney failure. A perfect preparation to the recipient and good selection of the donated kidney will allow better longevity to the implanted graft. Unfortunately, the donated kidney is not available all the time or for every subject. Some patients may be offered a kidney from partner, a friend, and “transplant tourism” or may be urged to an illegal maneuver and buy a kidney. The latter maneuver is very serious, as there are usually no specific safe protocols to proceed in transplantation.

However, in view of the shortage of the offered kidneys and the prolonged waiting lists, nephrologists admitted a new strategy to expand the pool of kidney donation that is called “Extended donor criteria” or “EDC”. This protocol made the criteria of kidney donation less restricted as regard the age, basal renal function and other associated condition. However, this expansion will be on the expense of graft survival and outcome. On the other hand, some centers may proceed in kidney transplant by implantation of two kidneys that is called “Dual kidney transplant”. All these trials to compensate with the shortage of the offered kidneys, either living or cadaveric (deceased or dead donor).  However, some governments manage the all steps of kidney transplantation to be on health authority’s supervision. In this situation both donor and recipient did not know each other and the authority manage all the necessary steps without any interference. Another maneuver have been admitted in the transplant field that is concerned with cooperation between transplant centers using a large scale of data base, so that an offered organs can be exchanged between centers according to the current criteria of genetic data.

 

Is there any new hope to cope with this shortage?

Actually, current research workup is directed to the new field of “Stem cell transplantation”. It is a promising field in organ transplant with an acceptable success in “islets of Langerhans” transplant for treating diabetes mellitus. In regard to the kidney, the journey still long.