Organ Transplant – Episode 1 – Kidney Transplant

Introduction:

Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the person’s own body, to replace the recipient’s damaged or absent organ.

There have been a great achievement in R&D in the mid 1990s and now we are fully aware of new methods of surgeries like robotic surgery, micro vascular surgery, laser surgery etc.  Now the technology has been more advanced and very fast in this field of organ transplant. Those days has gone when the patient had to wait for years together with an ailing sickness or illness of any major organ say the hair, eye, liver, kidney, lung, pancreas, heart etc.The major organ failure today in India is the kidney failure and today lots of lives have been saved in this field by doing renal transplant. So let’s go back to peep in the past and talk about the first kidney transplant and then we will come back as to the advancement in technology of this life saving achievement.

Kidney Transplant:

The first kidney transplant was done in December 1954 when R&D in organ transplant was miles away.  This first kidney transplant was done between identical twins Ronald and Richard Herrick. This was done at the Brigham Hospital (BWH) Boston, Massachusetts.  The three doctors involved in this kidney transplant were i) the donor transplant surgeon Dr. John Hartwell Harrison, who had served in the US Army Medical Corps and now had made Boston, Massachusetts his home, ii) Dr. Joseph E. Murray the recipient transplant surgeon, and iii) Dr. John P. Merrill.  This was the basic foundation stone laid down some 61 years back on which basis the present techniques of transplantation surgery have been renovated and revised for the betterment of human lives.

 

Chronic Kidney Disease (CKD):

What is CKD?  What are its causes?  Chronic Kidney Disease also known as chronic renal disease is a progressive loss in renal function over a period of months or years.  Our kidneys function is to filter wastes and excess fluids from our body. When the kidney stops working, and then the waste accumulates in the form of blood urea nitrogen and creatinine which results in complications like high blood pressure, anemia, weak bones, poor nutritional health and nerve damage etc. Now let us look at the causes of CKD.  CKD can be hereditary or non-hereditary.  Looking at the hereditary aspect the polycystic kidneys is a major hereditary disease and is gene carrier.   For non-hereditary or the chronic kidney disease, there are two main causes of  diabetes and high blood pressure which are responsible for up to two third of the cases. Diabetes happens when your blood sugar is too high, causing damages to many organs in the body, including Kidneys and heart, as well blood vessels and nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease or other disorders. Early detection and treatment can often keep chronic kidney disease from genetic worse. When kidney disease progresses, it may eventually lead to kidney failure, which in turn requires either dialysis or a kidney transplant to maintain a normal healthy life.

Let me take break here the discussions on the organ transplant &  make you aware of my interest in writing this topic now; one of my friends, a medical technologist, who had worked for two decades in the field of medicine as a paramedics, worked in routine clinical labs, hospital biochemical labs, and blood banks.  When he heard the news that his wife is a chronic renal failure patient when she had some ultrasound tests, he immediately resigned and came back home. At that time, she was at the initial stage of deterioration and that will be well monitored.  After ten years, she was put on renal dialysis and in November 2009 she received her kidney and is doing well for the last six years.  Here I think it will be worthwhile to mention here that renal transplant survival rate will be high based on the lifestyle the patient undergoes.

Let us go back to the main discussion, CKD.  Now I will brief you point wise facts about CKD.

1)       About 26 million American adults have CKD & millions of others are at increased risk.

2)       Heart disease is the major cause of death for all people with CKD.

3)       Early detection can help prevent the progression of kidney disease to kidney failure.

4)       Glomerular filtration rate (GFR) is the best estimate of kidney function.

5)       Hypertension causes CKD & CKD causes hypertension.

6)       Persistent proteinuria (protein in the urine) means CKD is present.

7)       High risk groups include those with diabetes, hypertension & family history of kidney failure.

8)       Two simple tests can detect CKD: Blood pressure, urine albumin & serum creatinine.

 

There are series of tests to be performed on the list of transplant donor.  The first being GFR (glomerular filtration rate), it determines how well the kidneys are working.  The second test is removal of fat tissue from belly (tummy) just close to the umbilicus. Renal transplantation using donor adipose tissue derived esenchymal Stem Cells and Hematopoietic Stem Cells are implanted in the recipient (i.e. the patient) so as to establish a firm transplant.

Table 1. Action Plan according to CKD Stage
Stage	Action Plan
1	Diagnosis and treatment of comorbid conditions, slow progression, CVD risk reduction
2	Estimate progression
3	Evaluate and treat complications
4	Prepare for renal replacement therapy (Av fistula creation)
5	Renal replacement

Blood Groups:

Now let us discuss the blood group aspect to become the donor fit for transplant.  To become the donor there is need for you to be of the same group as that of the patient.  If you are blood related say a brother, sister, father, or mother of the patient, and having the same blood group, you can close your eyes and donate.  Now let us discuss the different types of blood groups.

There are four types of blood groups A, B, O, and AB and along with that Rh factor (the antigen of the Rh blood group system). So in all, total eight different categories of blood group separately put aside for the classification as we put the Rh factor in to two classes, the Rh factor positive one and the Rh factor negative.  Now let us see there are A+ and A-, B+ and B-, AB+ and AB-, and finally O+, and O-.  For the donor transplant list always there is heading the blood group along with Rh factor and that it is vitally important in that the donor should match the recipient blood group and the Rh factor.

The second is the age factor for the doctor.  Generally, doctors do not take donors above 60s, and in rare cases where the donor is still healthy at 60 and has insisted to be considered and that this aged person still has a good GFR.

Further if the patient does not get a donor in his/her circle then the patient goes in to the cadaver (corpse) list.  There are a lot of accident cases coming in the hospital and the patient is breathing his last and if he/she agrees or says the parents agrees to donate the organ of this patient breathing his/her last breathe, then the doctors will operate him and remove the vital organs for the transplant.  There are say about thousands of patient waiting for their turn to come on the cadaver list and I have personally met a few who have received kidney from a cadaver and are doing well.

Summary

Kidney transplantation is generally known as Life Extending procedure. Because a patient will live 10 to 15 years longer with kidney transplant than if kept on dialysis. From the statistical data it has also been concluded that this increase in longevity is greater for younger patients, but even 75 years old patients with kidney transplant gain an average of four to six more years of life. People generally have more energy, a less restricted diet and fewer complications with a kidney transplant than if they stay on conventional dialysis. Some studies also reveals that longer a patient is on dialysis before the transplant, the less time the kidney will last. The exact reason for this is still not known, but it underscores for rapid referral to a transplant program. From the statistics by country, year & donor type, it has been found that Mr. Robert Perry remains the longest- surviving American kidney recipient from an unrelated donor, having received his kidney in 1974 at the age of 23; he survived over 41 years, dying May 31, 2015.

In addition to nationality, transplantation rates differ based on race, sex and income, but statistical data shows that the expenses undergoing transplant are the least in India than any other country in the word.

Further more I wish to add that a lot of awareness is necessary as there are still many patients waiting for a transplant.

References:

https://en.wikipedia.org/wiki/J._Hartwell_Harrison

http://biomedfrontiers.org/stem-cells-2015-5-12/

http://www.indmedica.com/journals.php?journalid=6&issueid=25&articleid=237&action=article

http://www.legacy.com/obituaries/chicoer/obituary.aspx?n=Robert-Allen-Perry&pid=174998823. 

Alexander, G. C.; Sehgal, A. R. (1998). "Barriers to Cadaveric Renal Transplantation among Blacks, Women, and the Poor". Journal of the American Medical Association 280 (13): 1148–1152. doi:10.1001/jama.280.13.1148. PMID 977781