Marios Prikis MD FACP, Medical Director of Pancreas and Kidney Transplant Programs, University of Vermont Medical Center and Assistant Professor of Medicine at the Robert Larner M.D College of Medicine at the University of Vermont

Marios Prikis MD FACP, Medical Director of Pancreas and Kidney Transplant Programs, University of Vermont Medical Center and Assistant Professor of Medicine at the Robert Larner M.D College of Medicine at the University of Vermont

The Role of the kidneys

The kidneys play a critical role in the proper functioning of our body by carrying out many important tasks. These are the maintenance of body composition, removal of metabolic end products and foreign substances, production and secretion of enzymes and hormones that are involved in blood pressure control, blood production and bone metabolism.

The Kidney in disease

In end stage kidney disease, the kidneys lose their ability to function, and therefore fluid, waste products, and electrolytes begin to build up in the blood. This may be lead to symptoms that include nausea, loss of appetite, and energy, vomiting, and others. Kidney functions are essential for life and need to be replaced.

Kidney transplantation and dialysis are treatments for end-stage kidney disease in an attempt to replace these functions of the kidneys. Dialysis takes over a portion of the function of the failing kidneys whereby a machine helps get rid of toxins and waste products from the blood of the patient. Patients have to visit a dialysis center three times per week for their treatments, or carry out dialysis on their own at home every day using a home machine.

Why kidney transplant?

On the other hand, kidney transplantation provides the patient with a new functioning kidney that can completely take over the failing kidney’s tasks, obviating the need for any sort of dialysis and providing the patient with more independence. Therefore, kidney transplantation is considered the treatment of choice for many people with end stage kidney disease, due to improvements in their quality of life and survival both of which are better than in people on dialysis.

Where do organs come from?

A kidney can come from a living relative, a living unrelated person, or from a person who has died (deceased or cadaver donor); only one kidney is required to survive. In general, organs from living donors function better and for longer periods of time than those from donors who are deceased.

How safe is it to have a kidney transplant?

Sixty three years ago, on December 23, 1954, a kidney was transplanted from one healthy identical twin to his twin who was dying of kidney disease. The surgery was performed at the Peter Bent Brigham Hospital in Boston, and John Merrill, Joseph Murray, and Hartwell Harrison led the clinical team. The operation was successful, kidney function was restored in the recipient and the donor suffered no ill effects. This was the first successful transplantation. For this reason, it created enormous excitement, both in the media and among medical professionals. We have come a long way since that first transplant both in techniques of preventing rejection and prolonging the life of the transplanted kidney and improving the quality of the patients’ lives. Today, transplantation clinicians have an armamentarium of immunosuppressive agents at their disposal, all of which are used in various combinations both for induction and maintenance immunosuppression. If the process of evaluating and accepting both the donor and the recipient is followed carefully, kidney transplantation enjoys very high success rates and positively impacts the patient’s life. Loss of organs due to acute, irreversible rejection is now uncommon and one-year graft-survival rates of 80 to 90 percent are the norm.

Organ transplants performed in the United States reached a record high during 2016, for the fourth year in a row, according to preliminary data from the United Network for Organ Sharing. During 2016, there were 33,606 transplants, an 8.5% increase over 2015 and up 19.8% since 2012. This growth can be mostly attributed to an expanding number of deceased donors. About 82% (or 27,628) of the transplants involved organs from deceased donors, who often provide multiple organs. The remaining 18% (or 5,978) were performed with organs from living donors. Despite this, there continues to be a shortage of organs available for donation. Many people who are candidates for kidney transplantation are put on a transplant waiting list and require dialysis until a kidney is available.

Who is eligible for a kidney transplant?

Unfortunately though, not everyone is a good candidate for kidney transplantation. It is important that the selection is done carefully so that patients will enjoy the benefits of receiving a fully functioning kidney and not experience the negative effects. Older age and severe heart or vascular disease may mean that it is safer to be treated with dialysis rather than undergo kidney transplantation. Other conditions that might prevent a person from being eligible for kidney transplantation include active or recently treated cancer, dementia, current drug or alcohol misuse, poorly controlled mental illness, history of poor compliance with medications or dialysis treatments and extreme obesity. People with other medical conditions are evaluated on a case-by-case basis to determine if kidney transplantation is an option. Transplant centers are also looking for a robust social support system around the patient that will help him through the difficulties or complications that may arise the first few months after the transplant and ensure long survival of both the patient and the kidney.

Disadvantages

Kidney transplantation is a major surgical procedure that has risks both during and after the surgery. The risks of the surgery include infection, bleeding, and damage to the surrounding organs. Even death can occur, although this is very rare. After kidney transplantation, patients are required to take medications and have frequent monitoring to minimize the chance of organ rejection. This must continue for the patient’s entire lifetime or as long the kidney transplant is functioning. These medications may have significant side effects.

In summary, kidney transplantation is the treatment of choice for many people with end-stage kidney disease. A successful kidney transplant can improve the ill person’s quality of life and reduce the risk of dying. In addition, people who undergo kidney transplantation do not require hours of daily dialysis treatment. Ideally, patients who are eligible to get a kidney transplant do so before ever starting on dialysis. Patients will be evaluated thoroughly to ensure that kidney transplantation is the right direction for them so that they will actually enjoy the benefits of such a procedure and avoid the disadvantages.

Marios Prikis MD FACP, Medical Director of Pancreas and Kidney Transplant Programs, University of Vermont Medical Center and Assistant Professor of Medicine at the Robert Larner M.D College of Medicine at the University of Vermont

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