Kidney Transplantation - Benefits of Renal Transplantation - Research Paper Example

? Kidney Transplantation - Kidney Transplantation Brief History Kidney Transplantation is a process in which a non-functioning or diseased kidney is replaced with a functioning kidney. The late 1950s saw the development of modern transplantation techniques. The clinical and experimental transplantation was extensively exploited in the early 1950s and the first two decades of the 20th century. Joseph Murray and colleagues performed the first successful renal transplant in 1954 at Boston, USA. With no effective immunosuppressant therapies, Murray was aware that tissue rejection would complicate matters for the recipient; therefore in order to minimize the chances of rejection Murray performed the transplantation between monozygotic twins. Murray was awarded the Nobel Prize for Physiology or Medicine in 1990 for successful renal transplantation. Today, renal transplantation has improved drastically due to advancements in the procedures of effective immunosuppression, evolution of human leukocyte antigen (HLA) typing, cross-matching and modern techniques for organ preservation. Such medical developments have improved both patient and graft survival after renal replacement therapy. Patients with end-stage renal failure in the 21st century have the option of renal transplant as an optimum treatment. (Torpey, 2010). Benefits of Renal Transplantation Some of the tremendous advantages of renal transplantation are listed below: Eliminates the need of maintenance dialysis: In most countries, the number of patients with advanced chronic kidney disease or receiving dialysis has increased over the past few years. The number of patients receiving dialysis annually shows an increase of 5.8% in the UK alone. It is undisputable fact that dialysis is a poor substitute for normal renal function therefore; renal transplantation provides an optimum therapy for patients with advanced renal disease. Dialysis is not a substitute for normal kidney functioning in many ways including the fact that it does not replace vitamin D metabolism and erythropoietin synthesis. Advancements in biomedical technologies have guaranteed improved patient survival through the effective elimination and treatment of post-operative infections. Transplantation corrects the medical consequences of Chronic Kidney Disease. After renal transplant, the uraemic symptoms, Vitamin D and metabolism as well as anemia are cured. Renal transplant improves the quality of the patient’s life because normal kidney functions are carried out once the patient receives the transplant. Moreover, the patient is freed from the need for dialysis. Furthermore, the recipient can gain employment and return back to normal life. After renal transplant, the recipient’s exercise capacity drastically improves. The individual’s sexual functions also revert back to normal. In female recipients, the chances of conceiving increase by several folds. Transplantation is economical and cheaper than dialysis. The quality of life of the immediate family also increases. (Torpey, 2010). Survival Rate and Immunology The survival rates for patients who have received renal transplant are superior to the patients receiving dialysis. The major reason is the fact that dialysis does not compensate normal kidney functions. The survival rates in UK for transplant versus dialysis are 87% and 30% respectively. (Torpey, 2010). One of the major barriers which limit the success of renal transplantation is the body’s immune system. Tissue rejection occurs when transplanted organ is recognized as foreign and stimulates adaptive immune response. Except in syngeneic graft, the difference in genes and proteins gives rise to antibodies because they act as antigens which are specifically known as alloantigens. In the presence of alloantigens, the transplanted organ is known as allograft or allogeneic graft. The highly polymorphic major histocompatability complex (MHC) is the source of alloantigens. The differences in minor histocompatability loci are responsible for rejection that occurs in cases of complete matching of the MHC. A complex series of cellular interactions occur which enables the recognition of major and minor histocompatability complex antigens. Once the process of recognition is complete, it is followed by an amplification of the immune response against the alloantigens. (Torpey, 2010). Tissue Typing and Organ Allocation The evolution of Human Leukocyte Antigen typing has contributed tremendously to the success of modern renal transplantation. From HLA typing it is evident that the closer the match between donor-recipient HLA types the lesser the chances of acute rejection are. Therefore, the rate of graft survival is high in patients receiving kidneys from donors with similar HLA types. In live donation transplants, the long term graft survival is influenced a great deal by HLA matching. Recipients with 0-0-0 mismatch (MM) transplants have greater chances of graft survival compared to other LD transplants. Organ allocation schemes have been devised to ensure that the recipients receive kidneys without the health professionals being biased. The numbers of patients requiring a kidney are always several folds more than the number of donated organs available therefore governments around the world have developed organ allocation schemes. Through such schemes, the government is able to ensure that kidney transplants are performed with minimal risks. The schemes have not only increased the prospect of good long term function but have also ensured that priority is given to patients with urgent clinical need. Around the world, different countries have used different ways in the development of allocation schemes. Due to the fact that the transport of organs over large distances is impractical therefore, Health authorities have divided USA into different zones. On the other hand, the consortium of seven European countries has evolved an allocation system consisting of a centrally managed waiting list. Such an allocation system enhances and maximizes the chances of HLA matching. (Torpey, 2010). The Transplant Operation and Immunosuppressant therapy The principles of renal transplantation have not changed since the 1950s and it is a straightforward procedure. The operation lasts for about 2-3 hours under general anesthesia. The first step involves the removal of the kidney from the donor. The recipient is given general anesthesia and below the navel a diagonal incision is made into the abdomen either on the right or left. Just above the groin, the transplant kidney is placed into the lower abdomen. The transplant kidney has an artery, vein, and ureter. The artery is connected to the recipient’s iliac artery that is supplying the blood to the leg. The transplant kidney’s vein is connected to the iliac vein carrying the blood away from the leg. The ureter is attached to the bladder and to ensure that the ureter does not block after the operation a double J stent is inserted. The abdomen is then sutured. (Stein, Higgins, & Wild, 2008). Tissue rejection is a common problem which limits the success of renal transplantation. Therefore, to prevent tissue rejection, anti rejection or immunosuppressant therapy is given to the recipient. The anti-rejection medications are used alone or combined therapies are given. The most commonly used drugs are cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, prednisone, OKT3, antithymocyte Ig, and sirolimus. The process for the development of more effective immunosuppressant drugs is ongoing and currently, the anti-rejection therapies are tailored in order to meet patient specific demands. (anonymous, Kidney Transplantation Procedure). Conclusion Kidney Transplant, despite being a successful optimum treatment for patients of Chronic Kidney Disease has its limitations. The major obstacle health professionals face nowadays is the wide gap between the donor recipient ratios. The gap seems to be broadening with each passing year as hospitals become crowded with patients in need of transplant kidneys. In such circumstances, the economists and general public are rethinking about the strictness of the 1984 National Organ Transplant Act. The gap has given rise to free market sales of transplantable kidneys. The proponents of free market sales of kidneys argue that such sales could prevent the lives of millions of patients in clinical need. Moreover, they argue that if humans adopt a healthy lifestyle then it is possible to lead a normal life on one kidney so there must not be any government prohibition on free-market sales of transplantable organs. ( Shelton & Mckenzie, 2012). Over the years, the renal replacement therapy has gained tremendous popularity around the world due to advancements in biomedical techniques and procedures. Longevity, improved lifestyle, and savings in health care costs are some of the clear benefits of kidney transplantation. One of the most recently developed biomedical procedures is the desensitization treatment which has increased the rate of graft survival in patients with HLA mismatching. The technique has increased the popularity of organ transplantation by reducing the chances of tissue rejection. The technique involves plasmapheresis and the use of cytomegalovirus immune globin. Recent research has revealed the effectiveness of desensitization which shows that patient survival rate increases drastically upon receiving the therapy. With the advent of modern immunosuppressant therapies, the success of kidney transplantation has increased and such therapies have the added advantage of being tailored according to patient specific needs. Research on improving transplant techniques and procedures is on going therefore in the future it is inevitable that chances of tissue rejection will be completely removed. (Montgomery, 2011). The increasing number of patients with CKD now has the option of optimum therapy in the form of renal replacement treatment which not only improves the recipient’s quality of life but also provides an economical way to deal with renal insufficiency. References: Torpey, N. (2010). Renal transplantation. Oxford: Oxford University Press. Shelton, k., McKenzie, B. "How Free-Market Kidney Sales Can Save Lives—And Lower the Total Cost of Kidney Transplants." March 5, 2012. Library of Economics and Liberty. Retrieved August 3, 2012 from the World Wide Web: http://www.econlib.org/library/Columns/y2012/SheltonMcKenziekidney.html Anonymous. Kidney Transplantation Procedure. The Johns Hopkins University, The Johns Hopkins University, and Johns Hopkins Health System. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/kidney_transplantation_procedure_92,P07708/ Stein, D. A., Higgins, D. R., & Wild, J. (2008). Kidney transplants explained: Everything you need to know. London: Class Pub. (London) Ltd. Montgomery, R. A., Lonze, B. E., King, K. E., Kraus, E. S., Kucirka, L. M., Locke, J. E., Warren, D. S., ... Segev, D. L. (January 01, 2011). Desensitization in HLA-incompatible kidney recipients and survival. The New England Journal of Medicine, 365, 4, 318-26. Image showing scars formed as a result of Nephrectomy and Kidney transplant. (Photo courtesy of PUVs.org) Image showing a Kidney after Tissue Rejection (Photo courtesy of http://pathmicro.med.sc.edu) Read More