The donor kidney is typically placed inferior of the normal anatomical location.

Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the recipient organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Image File history File links Kidtransplant. ... Image File history File links Kidtransplant. ... An organ transplant is the moving of a whole or partial organ from one body to another (or from a donor site on the patients own body), for the purpose of replacing the recipients damaged or failing organ with a working one from the donor site. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Chronic renal failure (CRF) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which usually determined indirectly by the creatinine level in blood serum. ...

History

The first documented kidney transplant in the United States was performed June 17, 1950, on Ruth Tucker, a 44-year-old woman with polycystic kidney disease, at Little Company of Mary Hospital in Evergreen Park, Illinois, a Chicago suburb. Even without immunosuppressive therapy -- the development of effective antirejection drugs was years away -- Tucker lived another 5 years before dying of an unrelated illness. Thereafter, successful kidney transplantations were undertaken in 1954 in Boston and Paris. The Boston transplantation was done between identical twins to eliminate any problems of an immune reaction. The first kidney transplant in the United Kingdom did not occur until 1960, when Michael Woodruff performed one between identical twins in Edinburgh. Until the routine use of medications to prevent and treat acute rejection, introduced in 1964, deceased donor transplantation was not performed. The kidney was the easiest organ to transplant, tissue-typing was simple, the organ was relatively easy to remove and implant, live donors could be used without difficulty, and in the event of failure, kidney dialysis was available from the 1940s. Tissue-typing was essential to the success: early attempts in the 1950s on sufferers from Bright's disease had been very unsuccessful. In 1954, Dr. Joseph E. Murray performed the world's first successful renal transplant between genetically non-identical patients, for which he won the Nobel Prize for Medicine in 1990. The donor is still alive as of 2005; the recipient died eight years after the transplantation. Nickname: City on the Hill, Beantown, The Hub (of the Universe)1, Athens of America, The Cradle of Revolution, Puritan City, Americas Walking City Location in Massachusetts, USA Counties Suffolk County Mayor Thomas M. Menino(D) Area    - City 232. ... City flag City coat of arms Motto: Fluctuat nec mergitur (Latin: Tossed by the waves, she does not sink) The Eiffel Tower in Paris, as seen from the esplanade du Trocadéro. ... Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Sir Michael Woodruff Sir Michael Francis Addison Woodruff FRS (3 April 1911 – 10 March 2001) was a British surgeon and scientist principally remembered for his contribtions to organ transplantation. ... , Edinburgh (() pronounced ; Scottish Gaelic: ) is the capital of Scotland and its second largest city. ... This article is about clinical dialysis; for the laboratory technique, see Dialysis (biochemistry) In medicine, dialysis is a method for removing waste such as urea from the blood when the kidneys are incapable of this, i. ... Brights disease is a historical classification of kidney diseases that would be described in modern medicine as acute or chronic nephritis. ... Joseph E. Murray (born 1 April 1919), American surgeon, performed the first successful human kidney transplant from an adult to his identical twin. ... An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. ...

Indications

The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. This is defined as a drop in the glomerular filtration rate (GFR) to 20-25% of normal. Common diseases leading to ESRD include malignant hypertension, infections, diabetes mellitus and glomerulonephritis; genetic causes include polycystic kidney disease as well as a number of inborn errors of metabolism as well as autoimmune conditions including lupus and Goodpasture's syndrome. Diabetes is the most common cause of kidney transplant, accounting for approximately 25% of those in the US. The majority of renal transplant recipients are on some form of dialysis – hemodialysis, peritoneal dialysis, or the similar process of hemofiltration – at the time of transplantation. However, individuals with chronic renal failure who have a living donor available often elect to undergo transplantation before dialysis is needed. Chronic renal failure (CRF) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which usually determined indirectly by the creatinine level in blood serum. ... Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. ... An infection is the detrimental colonization of a host organism by a foreign species. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Glomerulonephritis is a primary or secondary autoimmune renal disease featuring inflammation of the glomeruli. ... Polycystic kidney disease (PKD) is a progressive, genetic disorder of the kidneys. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... It has been suggested that Artificial kidney be merged into this article or section. ... Peritoneal dialysis In medicine, peritoneal dialysis is a method for removing waste such as urea and potassium from the blood, as well as excess fluid, when the kidneys are incapable of this (i. ... In medicine, hemofiltration, also haemofiltration, is a renal replacement therapy similar to hemodialysis which is used almost exclusively in the intensive care setting. ...

Contraindications

Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease. Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications. Recent cancer, active substance abuse, or failure to adhere to prescribed medical regimens may make someone ineligible for a transplant.

Sources of kidneys

Since medication to prevent rejection is so effective, donors need not be genetically similar to their recipient. Most donated kidneys come from deceased donors, with some coming from living donors. However, the utilization of living donors in the United States is on the rise. In the year 2006, 47% of donated kidneys were actually from living donors (Organ Procurement and Transplantation Network, 2007). It is important to note that this varies by country: for example, only 3% of transplanted kidneys during 2006 in Spain came from living donors (Organización Nacional de Transplantes (ONT), 2007).

Living donors

Potential donors are carefully evaluated on medical and psychological grounds. This ensures that the donor is fit for surgery and has no kidney disease whilst confirming that the donor is purely altruistic. Traditionally the donor procedure has been through an incision but live donation has increasingly proceeded by laproscopic surgery. This reduces pain and accelerates return to work for the donor with minimal effect on the outcome of the kidney. Overall, recipients of kidneys from live donors do relatively well, in comparison to deceased donors Cholecystectomy as seen through a laparoscope Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0. ...

Deceased Donors

Deceased donors can be divided in two groups:

• Brain-dead (BD) donors
• Donation after Cardiac Death(DCD) donors

Although brain-dead (or "heart-beating") donors are considered dead, the donor's heart continues to pump and maintain the circulation. This makes it possible for surgeons to start operating while the organs are still being perfused. During the operation, the aorta will be cannulated, after which the donor's blood will be replaced by an ice-cold storage solution, such as UW (Viaspan), HTK, or Perfadex. [Depending on which organs are transplanted, more than one solution may be used simultaneously.] Due to the temperature of the solution (and since large amounts of cold NaCl-solution are poured over the organs for a rapid cooling of the organs), the heart will stop pumping. Brain death is defined as a complete and irreversible cessation of brain activity. ... Diagram of the human circulatory system. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ... The aorta (generally pronounced or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... A cannula (plural cannulae) is a flexible tube which when inserted into the body is used either to withdraw fluid or insert medication. ... Histidine-tryptophan-ketoglutarate (Custodiol® HTK) solution is a high-flow, low-potassium preservation solution used for organ transplantation. ... Sodium chloride, also known as common salt, table salt, or halite, is a chemical compound with formula NaCl. ...

"Donation after Cardiac Death" donors are patients who do not meet the brain-dead criteria, but have no chance of recovery whatsoever. In this procedure, the treatment is abstained (mechanical ventilation is shut off). Usually, a certain amount of minutes after death has been pronounced, the patient is rushed to the operating theatre, where the organs are procured, after which the storage solution is flushed through the organs itself. Since the blood is no longer being circulated, coagulation must be prevented with relatively large amounts of anti-coagulation agents, such as heparin. mechanical or forced ventilation is the use of powered equipment, e. ... Coagulation is a complex process by which blood forms solid clots. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ...

Kidneys from brain-dead donors are generally of a superior quality, since they have not been exposed to warm ischemia (the time between the stopping and the kidney being cooled). In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...

Compatibility

The donor and recipient generally have to be ABO blood group compatible, although some programs are experimenting with ABO-incompatible transplantation using increased immunosuppression and plasmapheresis. Also, they should ideally share as many HLA and "minor antigens" as possible. This decreases the risk of transplant rejection and the need for another transplant. The risk of rejection may be further reduced if the recipient is not already sensitized to potential donor HLA antigens, and if immunosuppressant levels are kept in an appropriate range. In the United States, up to 17% of all deceased donor kidney transplants have no HLA mismatch. However, it is important to note that HLA matching is a relatively minor predictor of transplant outcomes. In fact, living non-related donors are now almost as common as living (genetically)-related donors. In 2004 the FDA approved the Cedars-Sinai High Dose IVIG protocol which eliminates the need for the donor to be the same blood type or even a good tissue match. Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells. ... HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... This article does not cite any references or sources. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ...

Procedure

Since in most cases the barely functioning existing kidneys are not removed because this has been shown to increase the rates of surgical morbidities, the kidney is usually placed in a location different from the original kidney (often in the iliac fossa), and as a result it is often necessary to use a different blood supply: The internal surface of the ala is bounded above by the crest, below, by the arcuate line; in front and behind, by the anterior and posterior borders. ...

• The renal artery of the kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac artery in the recipient.
• The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.

Human kidneys viewed from behind with spine removed The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood. ... AORTA can also mean always-on real-time access, referring to WAN computer networks. ... The external iliac arteries are large arteries that connect the femoral arteries to the common iliac arteries. ... The renal veins are veins that drain the kidney. ... This article may be too technical for most readers to understand. ... Veins of the abdomen and lower limb - inferior vena cava, common iliac vein, external iliac vein, internal iliac vein, femoral vein and their tributaries. ...

Kidney-pancreas transplant

See also: Pancreas transplantation

Occasionally, the kidney is transplanted together with the pancreas. This is done in patients with diabetes mellitus type I, in whom the diabetes is due to destruction of the beta cells of the pancreas and in whom the diabetes has caused renal failure (diabetic nephropathy). This is almost always a deceased donor transplant. Only a few living donor (partial) pancreas transplants have been done. For individuals with diabetes and renal failure, the advantages of earlier transplant from a living donor are approximately equal to the risks of continued dialysis until a combined kidney and pancreas are available from a deceased donor. The pancreas is a gland organ in the digestive and endocrine systems of vertebrates[2]. It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Beta cells are a type of cell in the pancreas in areas called the islets of Langerhans. ... Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. ...

These procedures are commonly abbreviated as follows:

• "SKP transplant", for "simultaneous kidney-pancreas transplant"
• "PAK transplant", for "pancreas after kidney transplant"

(By contrast, "PTA" refers to "Pancreas transplant alone".)

The pancreas can come from a deceased donor as well as a living one. A patient can either receive a living kidney followed by a donor pancreas at a later date (PAK, or pancreas-after-kidney) or a combined kidney-pancreas from a donor (SKP, simultaneous kidney-pancreas.) The pancreas is a gland organ in the digestive and endocrine systems of vertebrates[2]. It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ...

Transplanting just the islet cells from the pancreas is still in the experimental stage, but shows promise. This involves taking a deceased donor pancreas, breaking it down, and extracting the islet cells that make insulin. The cells are then injected through a catheter into the recipient and they generally lodge in the liver. The recipient still needs to take immunosuppressants to avoid rejection, but no surgery is required. Most people need two or three such injections, and many are not completely insulin-free. Microscopic image of an islet of Langerhans (lighter area) surrounded by exocrine pancreas tissue (darker staining) Islet transplantation is the transplantation of islets from a donor pancreas and into another person. ... A porcine islet of Langerhans. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is an anabolic polypeptide hormone that regulates carbohydrate metabolism. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ...

Post operation

The transplant surgery lasts about three hours. The donor kidney will be placed in the lower abdomen and its blood vessels connected to arteries and veins in the recipient's body. When this is complete, blood will be allowed to flow through the kidney again, so the ischemia time is minimized. In most cases, the kidney will soon start producing urine. Since urine is sterile, this has no effect on the operation. The final step is connecting the ureter from the donor kidney to the bladder.

Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3-5 days to reach normal functioning levels, while cadaveric donations strech that interval to 7-15 days. Hospital stay is typically for four to seven days. If complications arise, additional medicines may be administered to help the kidney produce urine.

Medicines are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the patient's life. The most common medication regimen today is : tacrolimus, mycophenolate, and prednisone. Some patients may instead take cyclosporine, rapamycin, or azathioprine. Cyclosporine, considered a breakthrough immunosuppressive when first discovered in the 1980's, ironically causes nephrotoxicity and can result in iatrogenic damage to the newly transplanted kidney. Blood levels must be monitored closely and if the patient seems to have a declining renal function, a biopsy may be necessary to determine if this is due to rejection or cyclosporine intoxication. Tacrolimus (also FK-506 or Fujimycin) is a 23-membered macrolide lactone discovered in 1984 from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis. ... Mycophenolic acid (INN) (IPA: ) or mycophenolate is an immunosuppressant drug used to prevent rejection in organ transplantation. ... This article or section does not adequately cite its references or sources. ... Cyclosporine (IPA: ), ciclosporin (INN), or cyclosporin (former BAN), is an immunosuppressant drug. ... Sirolimus is a relatively new immunosuppressant drug used to prevent rejection in organ transplantation, and is especially useful in kidney transplants. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ...

Acute rejection occurs in 10% to 25% of people after transplant during the first sixty days. Rejection does not necessarily mean loss of the organ, but may require additional treatment. [1]

Complications

Problems after a transplant may include:

• Transplant rejection (hyperacute, acute or chronic)
• Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection
• Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants)
• Imbalances in electrolytes including calcium and phosphate which can lead to bone problems amongst other things
• Other side effects of medications including gastrointestinal inflammation and ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a male-pattern distribution), hair loss, obesity, acne, diabetes mellitus (type 2), hypercholesterolemia, and others.
• The average lifetime for a donor kidney is ten to fifteen years. When a transplant fails a patient may opt for a second transplant, and may have to return to dialysis for some intermediary time.

An infection is the detrimental colonization of a host organism by a foreign species. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Immunosuppression is the medical suppression of the immune system. ... Post-transplant lymphoproliferative disorder (PTLD) is the name given to a group of B cell lymphomas occurring in immunosuppressed patients following organ transplant. ... This article is about lymphoma in humans. ... Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. ... Baldness (formally alopecia) is the state of lacking hair where it usually would grow, especially on the head. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ...

Prognosis

Recent studies have indicated that kidney transplantation is a life-extending procedure. The typical patient will live ten to fifteen years longer with a kidney transplant than if kept on dialysis. The years of life gained is greater for younger patients, but even 75 year-old recipients (the oldest group for which there is data) gain an average four more years' life. People generally have more energy, a less restricted diet, and fewer complications with a kidney transplant than if they stay on dialysis.

Some studies seem to suggest that the longer a patient is on dialysis before the transplant, the less time the kidney will last. It is not clear why this occurs, but it underscores the need for rapid referral to a transplant program. Ideally, a kidney transplant should be pre-emptive, i.e. take place before the patient starts on dialysis.

At least three professional athletes have made a comeback to their sport after receiving a transplant: NBA players Sean Elliott and Alonzo Mourning; and New Zealand rugby legend Jonah Lomu. “NBA” redirects here. ... Sean Michael Elliott (born February 2, 1968 in Tucson, Arizona) is a former NBA basketball player. ... Alonzo Harding Mourning, Jr. ... A rugby union scrum. ... Jonah Tali Lomu, MNZM (born May 12, 1975) is a New Zealand rugby union footballer who has played 73 times (63 caps) as an All Black after debuting in 1994. ...

Kidney transplant requirements

Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age (e.g. the person must be less than 69 years old when put on the waiting list) and require that one must be in good health (aside from the kidney disease).

Significant cardiovascular disease, incurable terminal infectious diseases and cancer often are transplant exclusion criteria. In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant. People with mental illness and/or significant on-going substance abuse issues may be excluded. Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Substance abuse refers to the overindulgence in and dependence on a psychoactive leading to effects that are detrimental to the individuals physical health or mental health, or the welfare of others. ...

HIV was at one point considered to be a complete contraindication to transplantation. There was fear that immunosuppressing someone without a depleted immune system would result in the progression of the disease. However, current rasearch does not bear out this fear; in fact there are findings that immunosuppressive drugs and antiretrovirals may work synergistically to help both HIV viral loads/CD4 cell counts and prevent active rejection.

Kidney transplant statistics

• Australian Aboriginal activist Charles Perkins, is the longest surviving receiver of a kidney transplant, living twenty-eight years on his donor organ.^{[citation needed]}
• Denice Lombard of Washington, D.C., received her father's kidney on August 30, 1967 aged 13 and is still alive and healthy thirty-nine years later.
• The Sindh Institute of Urology and Transplantation (siut.org SIUT) is the only hospital in the world giving free-of-cost transplantation treatment.^{[citation needed]}

The Sindh Institute of Urology and Transplantation (SIUT) is the largest public sector health organization in Pakistan which provides free, comprehensive and modern medical care in kidney diseases and transplantation to all. ... is the 242nd day of the year (243rd in leap years) in the Gregorian calendar. ... Year 1967 (MCMLXVII) was a common year starting on Sunday (link will display full calendar) of the 1967 Gregorian calendar. ... The Sindh Institute of Urology and Transplantation (SIUT) is the largest public sector health organization in Pakistan which provides free, comprehensive and modern medical care in kidney diseases and transplantation to all. ...

References

• Brook NR, Nicholson ML (2003). "Kidney transplantation from non heart-beating donors". Surgeon 1 (6): 311-322. PMID 15570790. 
• {{cit Science Daily http://www.sciencedaily.com/releases/2004/12/041208234532.htm

Notes

Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 94th day of the year (95th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 6th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 6th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 6th day of the year in the Gregorian calendar. ...

External links

• MedlinePlus Overview kidneytransplantation
• med/3604 at eMedicine
• International Kidney Donors and Transplantations
• Living Donors Online
• Patient-oriented summary at emedicinehealth.com
• International Kidney Transplantation Association
• The Kidney Patient Guide
• 1/3/421