Kidney transplantation

Sometimes a person's kidneys do not work.

A new kidney can help them. This is called a transplant.

A kidney can come from a living person. It can also come from someone who has died.

Doctors put the new kidney in the belly.

Doctors must check the person first. They want to make sure the person is healthy. This helps the surgery go well.

The body might try to fight the new kidney. The person takes medicine to stop this. This helps the kidney stay in the body.

People with a new kidney can live longer. They can also feel much better. It is a big help to their life.

Sometimes a person's kidneys stop working well. This is called end-stage kidney disease.

A kidney transplant can help them. This is when a doctor puts a new kidney into a patient.

Kidneys can come from different sources. Some come from living donors. These can be family members or other people. Other kidneys come from deceased donors. These are people who have died.

In 1954, doctors made the first successful transplant. They used identical twins for the surgery. This helped prevent the body from fighting the new organ.

Before surgery, doctors do a medical evaluation. They study the patient to ensure they are healthy. The new kidney usually goes in the lower belly. Doctors often leave the old kidneys in place.

After surgery, the patient must take medicine. These are called immunosuppressants. They help stop the immune system from attacking the new kidney. This is called rejection. These medicines help the person live longer. However, they can also make it easier to get sick.

A kidney transplant is a special surgery for people with end-stage kidney disease. This means their kidneys can no longer do their job well.

A transplant gives a patient a new, healthy kidney. This can help them live a longer and better life. Many people use a machine called dialysis before they get a transplant. A transplant is often better than using that machine every day.

There are two main ways to get a new kidney. Some come from living donors who are still alive. These donors might be family members or people who are not related. Other kidneys come from deceased donors who have died.

During the surgery, doctors usually place the new kidney in the lower abdomen. This area is often called the belly. Doctors usually do not remove the patient's old kidneys during this process. They only take them out if there is a medical reason.

Doctors have been working on this for a long time. In 1907, a researcher named Simon Flexner said organ transplants might be possible in the future. In 1933, a surgeon named Yuriy Vorony tried a transplant in Ukraine. That attempt was not successful because the body rejected the organ. The first truly successful transplant happened on December 23, 1954.

A team in Boston led by Joseph Murray performed it. They used identical twins named Ronald and Richard Herrick for the surgery.

Many important numbers tell the story of transplants. Joseph Murray won a Nobel Prize in 1990 for his work. In 2018, about 95,479 kidney transplants were done around the world. Of those, 36% came from living donors. In the United States, the average wait for a deceased donor kidney is three to five years. One very young person in Oman received a transplant in 1994. This newborn survived for 22 years after the surgery.

After the surgery, the body might try to fight the new kidney. This is called rejection. To stop this, patients take medicines called immunosuppressants. These drugs help suppress the immune system so it stays calm.

Because the immune system is quieter, patients might get sick from infections more easily. Doctors must check the new kidney every three months. They use blood tests to make sure everything is working just right.

A kidney transplant, or renal transplant, is a surgical procedure used to treat end-stage kidney disease (ESRD). ESRD occurs when the kidneys can no longer perform their vital functions, such as filtering waste from the blood. This condition is defined by a glomerular filtration rate of less than 15 ml/min/1.73 m2.

Replacing a failing kidney with a healthy one can offer a patient a better quality of life. Most patients with ESRD live longer after a transplant than those who rely on dialysis. Dialysis is a process used to clean the blood when the kidneys fail, but a transplant is often a more effective long-term solution.

The mechanism of a transplant involves placing a new kidney into the recipient's body. During the surgery, the new organ is usually positioned in the lower abdomen. Interestingly, surgeons do not typically remove the patient's original, diseased kidneys. They only remove the native kidneys if a specific medical reason requires it.

Once implanted, the new kidney must begin filtering blood immediately to support the patient's health.

There are different types of donors that provide these organs. Transplants are classified as either deceased-donor or living-donor transplants. Deceased-donor transplants come from individuals who have died. Living-donor transplants come from people who are still alive. Living donors can be genetically related to the recipient or non-related.

In the United States, the use of living donors is currently rising.

History shows that scientists have long dreamed of organ substitution. In 1907, researcher Simon Flexner suggested that replacing diseased organs with healthy ones might one day be possible. In 1933, surgeon Yuriy Vorony attempted a human kidney transplant in Ukraine. This attempt failed because the kidney was incompatible with the recipient's blood group. The first truly successful kidney transplant occurred on December 23, 1954, at Brigham Hospital in Boston.

A team led by Joseph Murray performed the surgery on identical twins, Ronald and Richard Herrick. Because they were identical twins, the body was less likely to react against the new organ. Joseph Murray later received a Nobel Prize in 1990 for this groundbreaking work.

The most significant challenge in transplantation is the recipient's immune system. The immune system often views a transplanted kidney as "non-self" and attempts to attack it. This process is known as rejection. Rejection can be classified as cellular rejection or antibody-mediated rejection.

Antibody-mediated rejection can be hyperacute, acute, or chronic, depending on how long after the surgery it occurs. To prevent this, patients must take immunosuppressants, which are medications that suppress the immune system. While these drugs protect the kidney, they also increase the risk of infections and cancer, such as lymphoma.

Doctors use several medications to manage the immune response. Prednisolone is a common corticosteroid used in these regimens. However, long-term use of high-dose prednisolone can cause side effects like diabetes, weight gain, and osteoporosis. To reduce these risks, doctors often use non-steroid agents such as azathioprine, mycophenolate, ciclosporin, or tacrolimus. These allow for lower doses of prednisolone to be used.

To ensure the kidney stays healthy, doctors monitor the patient at least every three months. They measure serum creatinine and may use donor-derived cell-free DNA (dd-cfDNA) blood testing to detect early signs of rejection.

Transplantation is a massive global medical effort. In 2018, an estimated 95,479 kidney transplants were performed worldwide. Of these, 36% came from living donors. In the United States, patients waiting for a deceased donor kidney face an average wait time of three to five years. Many people face various causes for kidney failure, with diabetes being the most common known cause, accounting for about 25% of transplants in the U.S. Because kidney transplantation was relatively simple compared to other organs, it served as the foundation for moving toward heart and liver transplants.