What is a Kidney Transplant?

Kidney transplantation (renal transplantation) is also commonly referred to as kidney transplantation, which is the transplantation of kidneys from healthy people to patients with kidney disease and loss of kidney function. The human body has two left and right kidneys, usually one kidney can support normal metabolic needs. When bilateral kidney function is lost, kidney transplantation is the most ideal treatment method. When chronic renal insufficiency develops to the end stage, kidney transplantation can be used. treatment. Kidney transplantation is divided into autologous kidney transplantation, allogeneic kidney transplantation and xenogeneic kidney transplantation because of different donor kidney sources. It is customary to refer to allogeneic kidney transplantation simply as kidney transplantation. The other two kidney transplants are distinguished by "autologous" or "xenogeneic" kidney transplants.

Basic Information

Chinese name

Kidney transplant

Foreign name

Kidney Transplantation

nickname

Change kidney

Related diseases

Glomerulonephritis, chronic pyelonephritis, etc.

Specialty classification

Urology

Indication

5 to 60 years old, patients with glomerulonephritis

Contraindications

Active hepatitis, coronary heart disease, peptic ulcer

complication

Renal graft failure, renal insufficiency in early postoperative period, etc.

Kidney transplant indication

1. Types of primary disease

Glomerulonephritis, chronic pyelonephritis, interstitial nephritis, cystic nephropathy and nephrosclerosis, diabetic nephropathy.

2. Age of the patient

It can be between 5 and 60 years old, and it is generally considered to be better at 12 to 50 years old. The age range has expanded in recent years, and there is no absolutely clear age limit. Patients up to 80 years of age have received reports of successful kidney transplantation. However, careful consideration must be given to the patient's cardiovascular condition and patient life expectancy.

Kidney transplant contraindications

After kidney transplantation, the quality of life of patients is obviously improved, and kidney transplantation is undoubtedly the best way to treat chronic renal failure. However, not all patients with renal failure can well tolerate transplant surgery and high-dose hormone and immunosuppressant treatment after surgery. Before kidney transplantation, it is necessary to understand whether the case is suitable for kidney transplantation and what the prediction effect will be after surgery. Some patients even have severe life-threatening complications after surgery. In particular, patients with the following diseases must be cautious before considering transplantation:

1. Patients with active hepatitis should not undergo kidney transplantation. As for hepatitis virus carriers (hepatitis B virus surface antigen positive) is controversial, it is best to determine based on liver puncture results. Patients with diagnosed liver cirrhosis should not undergo kidney transplantation.

2. For patients with coronary heart disease and unstable angina pectoris, it is generally not appropriate to perform kidney transplantation immediately. For patients with obvious coronary heart disease, coronary angiography should be evaluated first, and if necessary, bypass surgery will be accepted before renal transplantation.

3. Patients with active peptic ulcer disease are not suitable for immediate transplantation. Because a large number of hormones are used after surgery, the ulcer must be cured before surgery.

4. Patients with active chronic infection lesions in the body should be treated systematically before stable transplantation before kidney transplantation.

5. Transplantation is contraindicated in patients whose malignant tumors have metastasized or are within two years of onset because immunosuppression may cause tumors to develop or recur.

Precautions after kidney transplantation

1. Medication attention

For kidney transplant patients, as long as the transplanted kidney is functional, they must take immunosuppressants for life (except for identical twins). Dosage forms and dosages should follow the doctor's order, and the dosage should be adjusted under the guidance of the doctor. Never increase or decrease by yourself. In addition to routinely taking hormones and immunosuppressants after surgery, if you want to use other drugs related to treatment, such as antihypertensive drugs, liver protection drugs, etc., you must obtain the consent of your doctor, and you must take them on time and in accordance with the doctor's instructions. Avoid using drugs that are toxic to the kidney, such as gentamicin, amikacin, and streptomycin. If necessary, it should be used for a short time under close observation and doctor's guidance. It is important to note that antibiotics do not need to be taken uniformly when catching a cold, because a cold is a viral infection and antibiotics have no effect. In the prevention of secondary bacterial infections, drugs with a short duration of action and a broad antibacterial spectrum should be selected, and they should drink plenty of water at the same time. Avoid the use of immune enhancers. These drugs generally have varying degrees of immune enhancement. The lighter can induce acute rejection, and the severer can lead to kidney failure. Immune enhancers mainly include: various nutritional supplements such as ginseng, royal jelly, various vaccination vaccines (such as vaccines, vaccines, etc.), various biological products such as placenta, immunoglobulins, interferons, transfer factors, etc.

2. Early life

Due to the effects of anesthesia after kidney transplantation, the function of the gastrointestinal tract will not recover quickly, and drinking water is forbidden at this time. The signs of gastrointestinal function recovery are bowel sound recovery and anal exhaust. The first food was porridge and egg custard, which was gradually transitioned to the ordinary diet. However, even if the normal diet is restored, it is not advisable to eat foods such as animal liver and stone.

At the early stage after kidney transplantation, care must be taken to keep the stool open, and soft stools 1 to 2 times per day are appropriate. If you have dry stools, you need to find a doctor to take measures in time, and you can't defecate with force, because early kidney transplantation and peri-renal tissue are still in edema state, forced defecation will obviously increase abdominal pressure, squeezing and transplanting the kidney may cause kidney rupture, The lighter ones will lose the transplanted kidneys and the more serious ones may be life threatening.

You need to stay in bed early after kidney transplantation. At this time, you should properly turn over to prevent bedsores, but avoid distortion of the body. You can get out of bed for 5 to 7 days after the operation. At this time, you should move slowly and try to avoid sudden squatting. Because the above conditions may squeeze or pull the kidneys and cause accidents.

3. Dietary Attention

Kidney transplantation is the most effective treatment for end-stage renal disease. Due to the low protein diet and long-term hemodialysis before kidney transplantation, there are different degrees of malnutrition. The long-term use of immunosuppressants after transplantation also affects the body's metabolism to varying degrees, causing hypoalbuminemia, hyperlipidemia, diabetes, hypertension, and electrolyte disturbances, thereby aggravating the malnutrition of patients. Therefore, a reasonable diet arrangement for the kidneys Transplant patients are particularly important, not only to provide good nutritional requirements for kidney transplant patients, but also to greatly improve the survival rate of kidney transplant patients.

The basic principle of family diet conditioning for patients after kidney transplantation is to supplement appropriate amounts of high-quality protein, low fat, low cholesterol, low sugar, and low salt, and appropriate mineral and vitamin supplements.

(1) Supplementation with appropriate amount of high-quality protein should be comprehensively considered according to the patient's renal function tolerance to ensure that it can meet the needs of the body without increasing the burden on the transplanted kidney that has not restored function. Increasing protein supply early after kidney transplantation can minimize side effects caused by hormones and reduce consumption of muscle protein. The daily intake is 1.2 to 1.5 g / kg body weight. Three months after the operation, due to the decrease in the amount of hormones, the protein intake was adjusted to an adult daily intake of 0.6 to 1.0 g / kg body weight. If dialysis treatment is still required after transplantation, the protein requirement can be appropriately increased. High-quality proteins are mainly animal proteins, such as fish, eggs, milk, poultry, lean meat, and edible plant proteins such as peanuts, soybeans, and soy products should be reduced. Their metabolism will produce a large amount of amines and increase the burden on the kidneys.

(2) The incidence of hyperlipidemia after low-fat, low-cholesterol kidney transplantation reaches 60%, and there are many reasons that cause hyperlipidemia in postoperative patients, such as the use of corticosteroids, immunosuppressants, and poor renal function. Dietary factors and more. Therefore, the postoperative patient's diet should be light, mainly vegetable oil, lard, butter, etc. should be used as little as possible, and egg yolk should not be more than one per day. Pumpkin, potatoes, yam, and yam help lower cholesterol. Recommended to eat chicken, fish, etc., "red meat" such as cattle, sheep, pork, eat less. Avoid greasy, do not eat fried foods, limit high cholesterol foods, such as animal offal, egg yolk, crab yellow, fish roe, trotters, meat skin, chicken skin and other intake.

(3) After low-glucose kidney transplantation, the use of glucocorticoids often causes abnormal glucose metabolism and can also cause insulin-resistant diabetes. In addition, the lack of other nutrients can also increase the degree of diabetes in kidney transplant patients. Individual differences are also important factors. One, so the sugar intake after kidney transplantation should not be too high, pay attention to strengthen blood glucose monitoring.

(4) Supplementation of minerals and vitamins After kidney transplantation, it is easy to cause hypertension, hypocalcemia, hyperphosphatemia, and hyperkalemia. Therefore, the intake of sodium and potassium should be strictly restricted. Although kidney transplantation can correct the abnormal metabolism of parathyroid hormone, calcium, phosphorus, and vitamin D, since corticosteroids and immunosuppressive agents can still aggravate bone disease and reduce small bowel calcium conversion after kidney transplantation, some calcium should be taken orally However, high calcium intake will increase calcium formation in the kidneys. The general recommended calcium intake for adult kidney transplantation is 800mg / d. After kidney transplantation, the intake of phosphorus-containing foods needs to be increased, and the phosphorus intake should be based on the clinical test results. Phosphorus is rich in fish and bone soup and can be added in moderation. Should eat a variety of fresh vegetables and fruits to meet the needs of various vitamins. Avoid foods that improve immune function, such as white fungus, black fungus, shiitake mushrooms, tadpoles, red dates, royal jelly and so on.

Kidney transplant complications

Kidney transplant failure

Refers to no urinary discharge after the blood vessel is connected. The most common cause is superacute rejection, followed by acute tubular necrosis (ATN), other CsA poisoning (cyclosporine A poisoning), and surgical reasons. Patients with negative lymphotoxicity tests rarely have hyperacute rejection. Even if they occur, they are often found and diagnosed on the operating table. However, the treatment is difficult and usually requires immediate removal of the transplanted kidney. ATN rarely occurs in living kidney transplants, due to the short period of warm ischemia. However, if accidents occur in the operation, such as major bleeding, shock, severe sclerosis of the recipient's blood vessels, and suture difficulties, occasionally ATN may occur. The incidence of ATN in cadaveric kidney transplants reaches 40%, which is mainly related to kidney preservation techniques and methods, hot or cold ischemic time, vascular suture time, and surgical accidents.

2. Early renal insufficiency after kidney transplantation

It means that the transplanted kidney already has function after the operation, and the urine output decreases and the blood creatinine rises within 2 weeks of the observation period. Causes include pre-renal or post-renal, accelerated or acute rejection, CsA poisoning, and infection. Prerenal causes include cardiac insufficiency, hypotension, bleeding, and hypovolemia. Postrenal sex is mostly caused by urinary tract obstruction, such as ureteral necrosis or stenosis, hematoma around the kidney or compression of lymph cysts. In addition, cytomegalovirus (CMV) infection can also damage kidney function.

3. Advanced renal dysfunction after kidney transplantation

Refers to renal dysfunction that occurs more than 3 months after surgery. The main manifestation is a slow and progressive increase in serum creatinine, and most patients have normal urine output. The cause is more than 80% of chronic rejection and chronic CsA poisoning. The rest may be recurrence of the original kidney disease in the transplanted kidney, and the occurrence of new kidney diseases such as nephritis, infection, and stones.