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  1. 1. Ellis 1 Cameron Ellis Allyson Puskar English III 29 April 2013 Kidney Transplant Process For someone considering a kidney transplant, it is important to understand all steps of the process. A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood. The reasons for this procedure would be repeated urinary infections, kidney failure caused by diabetes or high blood pressure, polycystic kidney disease or other inherited disorders, such as glomerulonephritis, which is inflammation of the kidney‟s filtering unit. The risks of the procedure consist of: bleeding, infection, blockage of the blood vessels to the new kidney, leakage of urine or blockage of urine in the ureter. In order to receive a kidney from an organ donor who has died (cadaver), a recipient must be placed on a waiting list of the United Network for Organ Sharing (UNOS). Extensive testing must be done before an individual can be placed on the transplant list (Kidney Transplant Procedure). When asked about the procedure, Kimberly Ellis stated, “The doctors started off with withdrawing blood to check for the blood type. Then urine samples were needed. Doctors then said that the kidney was a match. Then got set up for a renal procedure to check which kidney to remove.” Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor‟s remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complications. But kidney
  2. 2. Ellis 2 donors have the same life expectancy, general health and kidney function as others. Potential barriers to living donors are age (one must be eighteen years old unless the person arean emancipated minor), uncontrollable hypertension, history of pulmonary embolism or recurrent thrombosis, bleeding disorders, uncontrollable psychiatric illness, morbid obesity, uncontrollable cardiovascular disease, or HIV infection. After surgery, the patient will be transferred to the recovery room. Once the anesthesia has worn off, the patient will be transferred back to the transplant unit. The amount of time a patient is in the hospital after kidney transplant surgery varies. It can be as little as two days, barring complications. The kidney function will be closely monitored for the first several months after you leave the hospital. The follow-up visits will be more flexible when: wound is healed, kidney functions normal, medication dose is adequate. About the healing process after surgery, when asked, Kimberly Ellis stated, “Two and a half months.”At this time, the patient also may have your blood tests done at a location closer to your home. „Were there any infections, blockages, or internal bleeding while healing, when asked, Kimberly Ellis stated, “No there were not.”Exercise and diet after transplant are very important factors in feeling healthy again. It is very unhealthy for the patient, the new kidney and general will-being to put on excessive weight. Exercise for transplant patients has been shown to: increase endurance, increase muscle strength, enhance bone remodeling, and reduce the need for ant-hypertension medication. The process of matching donor organs to patients waiting for transplantation is based on a point system. Points are given for several factors: time on the waiting list, antibody level (PRA), common antigens with the donor tissue type, location of the donor. (Roberts) (Ellis) One of the most common complications following a kidney transplant is rejection. Rejection is your body‟s way of not accepting the new kidney. Although rejection is most
  3. 3. Ellis 3 common in the first six months after surgery, it can occur at any time. It is vital for the patient to be aware of the possible signs of kidney rejection- fever over 100 degrees; “Flu-like” symptoms, such as chills, aches, headache, dizziness, nausea and /or vomiting; new pain or tenderness around the kidney; sudden weight gain greater than two to four pounds within a twenty four - hour period, and significant decrease in urine output(Roberts). Kimberly Ellis stated, That the kidney was accepted for about three days then the recipients body tried rejecting it and had to go on an anti-rejection medication. Kimberly Ellis stated, the medications that were prescribed after the procedure were a narcotic and an antibiotic. Kimberly Ellis stated, the effects of the pain medication that were prescribed were that she was physically impaired and relaxed.Doctors may test a kidney for rejection by doing a kidney biopsy. A kidney biopsy is a procedure in which a small sample of kidney tissue is removed and tested. A kidney biopsy is usually performed on an outpatient base. „What surgical instruments were used during the procedure, when asked, Kimberly Ellis stated, “Doctors used a scalpel, scissors, swabs, body glue, and internal stitches.”The actual biopsy generally takes twenty to thirty minutes. The patient will be required to lie flat for two hours following the procedure to prevent bleeding. Kimberly Ellis stated, “It took over an hour to prepare for the surgery and the surgery took five hours.” If rejection develops, the patient‟s physician will prescribe medications to treat rejection and prevent continued complications. In order to control the rejection, the patient may need to be admitted to the hospital, or the patient may receive care in an outpatient setting. The medications used to treat a kidney rejection episode are strong drugs. The first few doses could cause the following side effects: fever, chills, headaches, nausea, vomiting, weakness, diarrhea, and general flu-like symptoms. This graph shows what kind and what percent of donors donate their kidney to help someone who needs it.
  4. 4. Ellis 4 The Cadaver is at twenty two percent, the Living is at twenty five percent, the Non Living is at fifteen percent, the Donated is at thirty eight percent, but overall it all comes out to 100 percent and that‟s what matters. (Roberts) (Ellis) According to Kimberly Ellis, some physical difficulties after the procedure were, “There was not any lifting over three pounds and no pulling on anything for about four months.” Study results published in the New-England-Journal of Medicine, show that three -year graft survival is significantly greater in all transplanted kidneys machine perfused in the Life- Port Kidney Transporter compared to those stored in a traditional box of ice (static cold storage) (ninety one percent vs. eighty seven percent, p=0.04). The graft survival difference at three years was most pronounced for kidneys from expanded criteria donors (eighty six percent vs. seventy six percent, p=0.01). Expanded criteria donors are those over the age of sixty or those over fifty with health conditions such as high blood pressure, stroke or poor kidney function. Over the past Living 25% Donated 38% Non living 15% Cardiver 22% Living Donors
  5. 5. Ellis 5 decade, kidney donations from expanded criteria donors have increased considerably and today comprise nearly half of the deceased donor kidneys transplanted in the US and EU. (New- England-Journal of Medicine) When the results are analyzed by donor type, they show that three-year graft survival after machine perfusion compared to static cold storage was also significantly superior for kidneys donated after brain death (ninety percent vs. eighty six percent, p=0.02). Machine-perfused kidneys with delayed graft function (DGF) - a delay in the recovery of renal function that requires dialysis within the first week after transplantation - had better three -year graft survival (seventy seven percent) than cold stored kidneys with DGF (sixty two percent). "It is very interesting to see that the benefits in graft survival seen in this landmark study at one year with machine perfusion persist after three years compared to traditional cold storage methods," said lead author Cyril Moers, University Medical Center Groningen, The Netherlands. "Since a growing number of organs available for transplantation come from older donors or from people with more complex medical conditions, it is particularly welcome that machine perfusion offers significant improvements for 3-year graft survival in kidneys from these donors and is a real step forward in kidney transplantation. (Gruner) The Machine Preservation Trial was a landmark, investigator-driven study, run by an independent scientific steering committee across the Netherlands, Belgium and the German federal state of North Rhine Westphalia, in collaboration with the Deutsche Stiftung Organtransplantation and Euro- transplant International Foundation (the international organ exchange organization for Austria, Belgium, Croatia, Germany, Luxembourg, The Netherlands and Slovenia) as the central trial assistance desk. Principal investigators were RutgerPloeg (Oxford, United Kingdom and Groningen, The Netherlands), Andreas Paul (Essen, Germany) and Jacques
  6. 6. Ellis 6 Pirenne(Leuven, Belgium).The study was the first large randomized, prospective trial to compare machine perfusion with traditional cold static storage.(Gruner) Three-year follow-up data were collected on all 672 recipients of consecutive kidneys donated after brain death or after cardio-circulatory death in the main data set, as well as 164 recipients of kidneys donated after cardio- circulatory death in the extended data set. One kidney from each of the 336 pairs included was randomly assigned to machine preservation trial showed that transplanted kidneys preserved and transported in the lifeport kidney transporter had a forty eight percentage to fail within a year compared to those transported in the traditional box of ice. (New England Journal of Medicine) The LifeportKidney Transporter is designed to provide a sealed and sterile environment from the time of donation until the time of transplantation. Lifeport gently infuses a specifically formulated solution through-out the kidney, or referred to as Machine Perfusion. Machine Perfusion is and important contrast to the traditional method of storing and transporting kidneys in a box of ice (Gruner). When asked, Kimberly Ellis stated, “It felt wonderful to be able to give, or donate, an organ and would certainly do it again if needed too.”
  7. 7. Ellis 7 Works Cited Ellis, Kimberly.Personalinterveiw. June.3 2013 Gruner, Linda. “Elseiver”, New Tools Can Better Predict Successful Kidney Transplant Outcomesn.d. Web. 26 April. 2013. http://www.elsevier.com/about/press-releases/research-and-journals/new-tools-can- better-predict-successful-kidney-transplant-outcomes “Kidney Transplantation Procedure”.HealthLibrary.John Hopkins Medicine, n.d. Web. 28 Feb. 2013. http://www.hopkinsmedicine.org?health/test_procedure/urology/kidney_transplantation_ procedure92,p07708/ New-England-Journal of Medicine.“Processing of kidneys”, n.d. Web. 29 May 2013. http://new-england-journal-of-medicine.process.of.kidneys.com Roberts, John P. “Professor and chief, division of transplantation surgery”.UCSF Division of Transplant Surgery Kidney Transplantation, n.d. Web. 28 Feb. 2013. http://transplant.surgery.uscf.edu/conditions--procedures/living-donor-kidney- transplantation.aspx