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Regarding kidney transplant

Regarding kidney transplant


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One of the options is correct

Kidney can be taken from a dying person who has the

a) cessation of neurological function only

b) cessation of cardiac function only

c) cessation of respiratory function only

d) cessation of kidney function only

I think that answer should be b. as if heart stops working then the person is definitely dead. but m not sure if on the cessation of neurological/respiratory function, one still has chance of revivial. Moreover answer is given as A. I don't know how. Could it be that on cessation of cardiac/respiratory function, kidney gets damaged while not so in case of neurological dysfunction?


There are actually very few situations where organs can be harvested from donors. For all deceased donor transplants, the donor must be confirmed as being brain dead (both brain stem and higher cortical functions). However, in order for the organs to remain viable they must not become ischaemic - which is obviously a huge problem when the patients heart has stopped beating. For this reason most patients who die and go on to become organ donors were already on a ventilator in intensive care in order to keep their blood oxygenated and circulating to perfuse their organs.

Kidneys are listed by NHSBT as a special case where a ventillator may not be required in advance to maintain viability - offhand I'm not sure why this would be - however to answer your question:

A. Neurological death - correct answer - the patient must be deceased without chance of recovery (hence brainstem and cortical death)

B. Cardiac function - were this to stop unilaterally then the patient may still be recoverable whilst the organs may be damaged due to lack of perfusion and thus not be viable for transplant

C. Respiratory function - almost identical to the cessation of cardiac function (and indeed will lead onto it very quickly)

D. Renal function - there's no point transplanting useless kidneys!

Have a look through the NHS Blood and Transplant Organ Donation site linked above, it's a great and trustworthy resource.


Transplant Immunology: The Science Behind Organ Transplantation

Patients receiving treatment at the renowned organ transplant programs at NewYork-Presbyterian/Columbia University Medical Center may be unaware that just beyond their treatment rooms, a one-of-a-kind research powerhouse is quietly at work conducting some of the most vital studies underway in transplant immunology today. The multidisciplinary Columbia Center for Translational Immunology (CCTI), established in 2010 under the leadership of Megan Sykes, MD, Director, is performing a host of cuttingedge studies. The work aims to increase understanding of immunologic diseases and directly translate that knowledge to the development of new or improved clinical therapies for transplant patients at NYP/Columbia and beyond.

Of these areas of study, one area holds particular importance for patients undergoing organ transplantation: hematopoietic cell transplantation (HCT). Hematopoietic cells are cells (including bone marrow cells) that develop into blood cells transplantation of these cells from a healthy donor, the most widely used form of cellular therapy today, is the only known cure for certain blood cancers (leukemia, lymphoma, myeloma) and is performed in approximately 60,000 patients each year for that purpose. But HCT also has the potential to reverse the autoimmune process responsible f or diseases such as type 1 diabetes–and to induce tolerance in patients who receive organ transplants.

What is "Tolerance"?

When a patient receives a heart, lung, liver, kidney, or pancreas from an organ donor (living or deceased), the patient's immune system will recognize the foreign tissue and mobilize to reject the organ unless he or she takes medications that suppress the immune system's natural processes. These medications, known as immunosuppressants, are a lifelong requirement after organ transplantation. While these drugs allow people to tolerate the presence of foreign organs, they also increase patients' risk of contracting infections, and infections and are associated with other undesirable side effects. The ability to induce tolerance to a transplanted organ, allowing it to thrive in the body without requiring these life-long immunosuppresssants, would signify a dramatic improvement in quality of life for patients undergoing organ transplantation. For many in the field, induction is considered the "holy grail."

During the last decade, Dr. Sykes' research in HCT (begun while she was Associate Director of the Transplantation Biology Research Center at Massachusetts General Hospital) has produced notable results toward that goal. In one protocol, out of ten patients studied, seven have achieved long term tolerance, so far lasting three to ten years. Although several other U.S. hospitals have subsequently attempted similar protocols, this has been the most successful and longlasting tolerance demonstrated to date.

To achieve these results, Dr. Sykes' team first administered drugs known as a "conditioning regimen" to reduce both the immune function and the numbers of the patients' own bone marrow cells. Next, they performed bone marrow and kidney transplants from living unrelated donors. A short course of immunosuppressant medications was administered immediately after transplantation, and then tapered down and stopped altogether.

According to Dr. Sykes, it was remarkable that tolerance was successful even when the donor's most potent transplantation antigens were mismatched to the recipient's. Most bone marrow transplants normally require a match between the donor's and recipient's human leukocyte antigen (HLA) system, part of the immune system which encodes the most potent antigens. Performing bone marrow transplants across the HLA barrier usually results in serious, systemic rejection known as graft versus host disease (GVHD). Using the protocol mentioned above, however, they achieved significant success without GVHD even across HLA barriers. "These are exciting results showing that we can achieve robust tolerance," says Dr. Sykes.

Dr. Sykes' team continues to test multiple protocols in an effort to strengthen tolerance even further, first in animal models to evaluate safety and efficacy. These protocols aim to achieve the following goals in stages:

  • inducing tolerance with HLA-identical patients with kidney failure due to malignant disease (such as multiple myeloma)
  • reliably performing transplants without GVHD in HLAmismatched patients
  • using a large animal model to achieve more durable bone marrow engraftment and hence more reliable tolerance
  • achieving tolerance of pancreatic islet cells–to be studied in animal models and eventually in patients with combined islet and bone marrow transplants
  • achieving tolerance of liver transplants by combining liver and bone marrow transplantation
  • eventually, expanding tolerance studies to lung and heart transplantation.

Markus Mapara, MD, PhD, Director of the Blood and Marrow Transplantation (BMT) Program at Columbia University Medical Center, will collaborate with CCTI to develop novel hematopoietic cell transplant protocols beginning in 2013. According to Dr. Sykes, "The establishment of the BMT program is a key step in allowing NYP/Columbia to take a leadership role in these promising new applications of hematopoietic cell transplantation." CCTI and the BMT program will further collaborate with leaders of the NYP/Columbia kidney and liver transplant programs, including Drs. Lloyd Ratner, David Cohen, Waichi Wong, Jean Emond and Tomoaki Kato.


What is the process for getting a kidney transplant?

If you want a kidney transplant, the process includes these steps:

  • Tell your doctor or nurse you want to have a kidney transplant.
  • Your doctor will refer you to a transplant center for tests to see if you’re healthy enough to receive a transplant. Living donors need to be tested to make sure they’re healthy enough to donate a kidney.
  • If you don’t have a living donor, you’ll be placed on a waiting list to receive a kidney. You’ll have monthly blood tests while you wait for a kidney.
  • You must go to the hospital to have your transplant as soon as you learn a kidney is available. If you have a living donor, you can schedule the transplant in advance.

Talk with your doctor

The first step is to talk with your doctor to find out whether you’re a candidate for a transplant. If you’re on dialysis, your dialysis team will also be part of the process. If you and your doctor think a kidney transplant is right for you, your doctor will refer you to a transplant center.

Talk with your doctor to find out whether you’re a candidate for a kidney transplant.

Get tested at a transplant center

At the transplant center, you’ll meet members of your transplant team. You’ll have tests to make sure you’re a good candidate for transplant.

Tests will include blood tests and tests to check your heart and other organs—to make sure you’re healthy enough for surgery. Some conditions or illnesses could make a transplant less likely to succeed, such as cancer that is not in remission, or current substance abuse.

You’ll also have tests to check your mental and emotional health. The transplant team must be sure you’re prepared to care for a transplanted kidney. You’ll need to be able to understand and follow a schedule for taking the medicines you need after surgery.

In a process called cross-matching, the transplant team tests the donor’s blood against your blood to help predict whether your body’s immune system will accept or reject the new kidney.

If a family member or friend wants to donate a kidney and is a good match, that person will need a health exam to make sure he or she is healthy enough to be a donor. If you have a living donor, you don’t need to be on a waiting list for a kidney and can schedule the surgery when it’s best for you, your donor, and your surgeon.

Testing and evaluation at the transplant center may take several visits over weeks to months.

Get on the waiting list

If your tests show you can have a transplant, your transplant center will add your name to the waiting list. Wait times can range from a few months to years. Most transplant centers give preference to people who‘ve been on the waiting list the longest. Other factors, such as your age, where you live, and your blood type, may make your wait longer or shorter.

A transplant center can place you on the waiting list for a donor kidney if your kidney function is 20 or less—even if you aren’t on dialysis. While you wait for a kidney transplant, you may need to start dialysis.

Have monthly blood tests

While you wait for a kidney, you’ll need monthly blood tests. The center must have a recent sample of your blood to match with any kidney that becomes available.

Have your kidney transplant

During kidney transplant surgery, a surgeon places a healthy kidney into your body. You’ll receive general anesthesia before the surgery. The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.

If you’re on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.

If a family member or friend is donating the kidney, you’ll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.

Your surgeon connects the transplanted kidney to your blood vessels and your bladder. Your blood flows through an artery into the transplanted kidney, and a vein takes filtered blood out. Your urine flows through a transplanted ureter to your bladder.


Infection

Why is infection a concern after kidney transplant?

The anti-rejection medicines that help keep your body from rejecting your transplanted kidney also lower your immune system. Because your immune system is lowered, viral and other infections can be a problem.

What is the best way to stay healthy?

Finding and treating infections as early as possible is the best way to keep you and your transplanted kidney healthy. Exposure to diseases such as the flu or pneumonia can make you very sick. Receiving vaccines as determined by your transplant team can help you stay healthy. It is also important to frequently wash your hands or use an antimicrobial gel during cold and flu season.

What problems should I report to my doctor?

You should report any of the following problems to your doctor as soon as possible:

  • Sores, wounds, or injuries especially those that don’t heal
  • Urinary tract infection symptoms such as frequent urge to urinate, pain or burning feeling when urinating, cloudy or reddish urine, or bad smelling urine
  • Respiratory infection symptoms such as cough, nasal congestion, runny nose, sore or scratchy throat, or fever

How can I avoid getting infections?

To avoid getting infections you should:

  • Wash your hands regularly
  • Maintain good hygiene habits especially around pets
  • Avoid close contact with people who have contagious illnesses
  • Avoid close contact with children recently vaccinated with live vaccines (see section on Vaccines). Also, no one in the household should get the nasal influenza vaccine
  • Practice safe food handling. For more information on safe food handling go to USDA: Basics for Handling Food Safely
  • Inform your doctor well in advance of any travel plans

Kidney transplant

History

The first successful human kidney transplant occurred between identical twins at the Peter Bent Brigham Hospital in Boston in December of 1954. Kidney transplantation is now routinely performed as the treatment of choice to improve quality of life and survival for patients with end-stage renal disease (ESRD). Etiologies of ESRD include but are not limited to diabetic nephropathy, longstanding hypertension, and various types of nephrotic and nephritic diseases. Kidney transplantation has shown to improve survival as compared to patients on dialysis (33).

Deceased donor kidney transplants (DDKT) vs. living related donor kidney transplants (LRDKT) and graft survival outcomes

Currently, 30% of donors are LRDKT and 70% are DDKT (18). LRDKT organ donors are usually family members or close friends to the patient, although altruistic non-directed kidney donations exist as well. The impact for living donors is not insignificant (34). Living kidney donation is associated with an increased risk of gestational hypertension, pre-eclampsia, and rarely ESRD (π.5% increase in incidence at 15 years) (35). However, living donors in the U.S. have a similar life expectancy and quality of life as the average healthy patient who does not donate a kidney (35).

Living transplants are associated with better graft and recipient patient survival (36). The most recent national data from the U.S. Department of Health and Human Services shows that 1-, 3-, and 5-year survival rates are 97.5%, 92.6%, and 85.6%, respectively, for LRDKT and 93.2%, 85.1%, and 74.4%, respectively, for DDKT (17). Interestingly, the number of LRDKTs decreased dramatically over the past decade (37). For instance, the rate of pediatric LRDKTs comprised 47.2% of pediatric kidney transplants in 2005 and only 34.2% in 2016 (37). While 2015 to 2017 saw an increase in the number of kidney transplants performed altogether, the increase was mostly attributable to an increase in DDKT (37). Research has been done to investigate the reason for the decline in LRDKT, citing financial disincentives, declining health status of the general population (increased prevalence of obesity, diabetes, and hypertension), shorter wait times and increase number of donations of DDKT kidneys (38).

Allocation of kidneys

Guidelines from the National Kidney Foundation provide useful information on which patients qualify for kidney transplant based on various factors such as stage of kidney disease, cardiovascular status, and presence or absence of chronic infection (39,40). In general, any patient approaching stage 4 chronic kidney disease or end-stage renal disease should be evaluated for inclusion on the kidney transplant listing, even if the patients are not yet on hemodialysis. Kidneys are then allocated to those on the transplant waiting list via the Kidney Allocation System (KAS), which was started in 2014. KAS matches donor kidneys with the longest potential graft survival to the patient that has the longest life expectancy. Donor kidneys are given a kidney donor profile index (KDPI) score. This score summarizes the likelihood of graft survival after DDKT (41). Lower KDPI scores are associated with longer graft survival and higher scores are associated with shorter duration of kidney graft function (41). Once offered, the patient can then decide if they will accept the kidney based on their health status, quality of life, and transplant center logistics. This becomes especially relevant for high risk donor organs such as donors with a history of incarceration, intravenous drug use, risky sexual behavior, or even hepatitis or HIV status if the recipient has a positive history as well. The KAS system has been successful at providing equitable distribution of kidney transplants, which has improved the number of transplants in patients with a lower socioeconomic status since its inception in 2014 (37).

Alternatively, some kidney transplant patients who are not yet on dialysis and ranked non-urgently on the transplant list may consider pre-emptive transplantation (42). Pre-emptive transplantation typically occurs in the setting of ESRD and occurs in the context of a LRDKT and is associated with superior allograft survival and patient survival (42).

The concept of “matched pair donation” was developed by Segev et al. to increase transplant opportunities for living donor and recipient pairs who are blood-type or cross-match incompatible (43). The concept of matched pair donation refers to a process where a living donor who fails to match to their intended recipient can donate an incompatible organ within a national system and the recipient can therefore match with another incompatible living donor-recipient mismatch pair (43,44). As a result, both people in need of a transplant will receive a compatible organ. This system is organized under the National Kidney Paired Donation (KPD) program (43). Pooled living donor donation has improved wait times in most situations, although O blood type recipients still experience longer wait times than their AB counterparts (43).

Surgical strategy

Living related donor kidney allografts are usually retrieved laparoscopically or laparoscopic-assisted. Laparoscopy has made living donation less morbid by reducing incision size, reducing postoperative pain, decreasing narcotic requirements, and decreasing the length of hospital stay (45).

The most common surgical approach for transplanting the donor kidney into the recipient patient is to implant the kidney extraperitoneally in the pelvis. Three anastomoses are typically performed which include the arterial anastomosis usually between the donor kidney renal artery and the recipient’s right external iliac artery, the venous anastomosis between the donor kidney renal vein and the recipient’s right external iliac vein, and lastly, the donor ureter is anastomosed to the recipient bladder (44). A stent is commonly placed across the ureterovesical anastomosis and removed 8� weeks post-transplant (44). Typically, a LRDKT allograft is expected to function immediately following allograft reperfusion or following the operation (18,36). However, up to 40% of DDKT allografts do not function immediately (18). This phenomenon is called delayed graft function (DGF) and has been reported to occur in 21.3% of cases (46). DGF is the development of acute kidney injury (AKI), requiring dialysis within 7 days of the transplant (46). Once technical issues have been addressed and graft rejection ruled out, the patient is managed with hemodialysis until the AKI resolves (18). Allograft dysfunction of the DDKT may occur up to 1𠄲 months after transplant (18). DGF can have a clinically significant impact on early graft survival. The 1-year graft survival of DDKT with DGF is significantly lower (76.3%) compared to DDKT with no DGF (92.3%) (47). Interestingly, both groups share a similar graft half-life of roughly 20 years. However, DGF is often confounded by acute rejection which can then severely diminish graft 1-year survival (67.9%) resulting in a half-life of 10.5 years (47). Therefore, while DGF can complicate early post-transplant management, the long-term outcomes of DDKT with DGF are negligible unless the etiology of DGF results in subsequent acute rejection.


NEW LAW – Kidney Transplant Patients Act Passed for Lifetime Immunosuppressive Drug Coverage

The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act that passed in the United States Congress in 2020 extends Medicare coverage for anti-rejection drugs from 36 months to the life of the transplant.

Troy Zimmerman, Special Projects Director at the National Kidney Foundation, worked closely with U.S. Congress members to bring this bill to fruition. He explains the details of the bill, when it goes into effect, and who will benefit from the new law.

You can also listen to and download the podcast with these apps:

Apple Podcasts Google Podcasts iHeart Radio

Hosted By Lori Hartwell

Lori Hartwell is the Founder & President of Renal Support Network (RSN) and the host of KidneyTalk®, a radio podcast show. Lori was diagnosed with kidney disease at the age of two. In 1993 she founded RSN to instill “health, happiness and hope” into the lives of those affected by chronic kidney disease. Lori is also the author of the inspirational book Chronically Happy: Joyful Living in Spite of Chronic Illness and is a four-time kidney transplant recipient.


Transplants and grafts

Transplants of animal tissue have figured prominently in mythology since the legend of the creation of Eve from one of Adam’s ribs. Historical accounts of surgical tissue grafting as part of the cure of patients date back to the early Hindu surgeons who, about the beginning of the 6th century bce , developed techniques for reconstructing noses from skin flaps taken from the patient’s arm. This method was introduced into Western medicine by Italian surgeon Gaspare Tagliacozzi in the 16th century. The flap was left attached to the arm for two to three weeks until new blood vessels had grown into it from the nose remnant. The flap was then severed and the arm freed from the reconstructed nose.

It was found that extremely thin pieces of skin could be cut free and would obtain enough nourishment from the serum in the graft bed to stay alive while new blood vessels were being formed. This free grafting of skin, together with the flap techniques already mentioned, constituted the main therapeutic devices of the plastic surgeon in the correction of various types of defects. Skilled manipulations of such grafts produced surprising improvements in the appearance of those born with malformed faces and in the disfigurements resulting from severe burns. Cornea, which structurally is a modified form of transparent skin, can also be free grafted, and corneal grafts have restored sight to countless blind eyes.

Blood transfusion can be regarded as a form of tissue graft. The blood-forming tissues—bone marrow cells—can also be transplanted. If these cells are injected into the bloodstream, they home to the marrow cavities and can become established as a vital lifesaving graft in patients suffering from defective marrow.

The chief distinguishing feature of organ and limb grafts is that the tissues of the organ or limb can survive only if blood vessels are rapidly joined (anastomosed) to blood vessels of the recipient. This provides the graft with a blood supply before it dies from lack of oxygen and nourishment and from the accumulation of poisonous waste products.

As can be seen from the examples cited, living-tissue grafts may be performed for a variety of reasons. Skin grafts can save life in severe burns, can improve function by correcting deformity, or can improve appearances in a cosmetic sense, with valuable psychological benefits. Organ grafts can supply a missing function and save life in cases of fatal disease of vital organs, such as the kidney.

A tissue removed from one part of the body and transplanted to another site in the same individual is called an autograft. Autografts cannot be rejected. Similarly, grafts between identical twins or highly inbred animals— isografts—are accepted by the recipients indefinitely. Grafts from a donor to a recipient of the same species—allografts or homografts—are usually rejected unless special efforts are made to prevent this. Grafts between individuals of different species—xenografts or heterografts—are usually destroyed very quickly by the recipient. (The methods used to prevent rejection are discussed in full below.)

Tissue or organ grafts may be transplanted to their normal situation in the recipient and are then known as orthotopic—for example, skin to the surface of the body. Alternatively, they may be transplanted to an abnormal situation and are then called heterotopic—for example, kidneys are usually grafted into the lower part of the abdomen instead of into the loin (the back between the ribs and the pelvis), as this is more convenient. If an extra organ is grafted, it is called auxiliary or accessory—for example, a heterotopic liver graft may be inserted without removal of the recipient’s own liver.

Grafts are usually performed for long-term effects. Occasionally, the limited acceptance of a skin allograft may be lifesaving by preventing loss of fluid and protein from extensive burned surface in severely ill patients. The graft also provides a bacteria-proof covering so that infection cannot occur. When the allograft is removed or rejected, the patient may be sufficiently recovered to receive permanent autografts.

Certain tissues, including bone, cartilage, tendons, fascia, arteries, and heart valves, can be implanted even if their cells are dead at the time of implantation or will be rejected shortly thereafter. These are structural implants rather than true grafts or transplants. They are more akin to the stick to which a rose is attached for support—although their support is essential, their function does not depend on biological processes. In fact, xenografts or inert manufactured devices may often be equally suitable substitutes.


Background

Thanks to the improvement of surgical techniques and immunosuppressant treatments, organ transplantation is nowadays considered as a routine strategy for patients suffering a series of pathological states of a number of organs such as the heart, kidney, or liver. Transplant of these organs in patients with end-stage diseases has been demonstrated to significantly improve survival and/or quality of life. However, a refinement of therapeutic strategies, including immunosuppressant treatments, as well of the comprehension of the pathogenetic mechanisms leading to successful or ineffective transplantation outcome appears mandatory. Several lines of evidence suggested that successful organ transplantation could depend upon a plethora of factors. Among these are race, size, age, weight, and even sex/gender [1]. Gender-related factors, i.e., sociocultural matters, or sex-related factors, i.e., biological determinants, appeared in fact as a pivotal matter in this scenario, being capable of influencing transplant outcome. In this Commentary, we would like to briefly underscore some of these critical points in order to stimulate a reappraisal of the gender/sex issue in transplantation studies and practice. We underline the strict intertwining between sociocultural and biological questions as pivotal issues in this field.

Impact of gender on organ transplantation

The gender of donors and recipients is involved in the entire process, including organ donation and transplant surgery. In general, women seem to have more self-sacrifice and sense of responsibility than men [2]. As a consequence, it has been observed that women are more predisposed to donate their organs. In fact, in cost-free living donation, two thirds of all organs were donated by women [3]. In contrast, women are less disposed than males to accept transplant surgery [2]. Despite comprising 35 % of transplants, the number of female transplant recipients continued to decline. Several factors have been suggested to explain these differences [1]. Nowadays, women and men present different social, economic, and cultural roles, and a disparity of knowledge may exist. In fact, women were considered to have less information about transplantation diagnosis and therapy. However, besides these psychosocial aspects, another important factor should be considered to explain the above reported gender bias: men have a higher incidence of end-stage diseases that necessitate a transplant and are more inclined to hypertension or ischemic heart disease, leading to their inappropriateness as donors.

Regarding graft outcome, male recipients have been observed to have a worse prognosis than females and this could be partially explained by the observation that women have better immunosuppressant compliance than men they undergo follow-up visits and habit change and show more concern with regard to protecting graft function [4].

Impact of sex on organ transplantation

Several clinical studies have connected the use of female donor organs as a risk factor for death and rejection [5]. In renal transplantation, female donor kidneys have a worse 5-year survival [6, 7] and this observation could be explained by the lower number of nephrons in the female kidney in comparison to men [8]. In addition, animal experiments suggested that kidneys of females express more HLA antigens and are more antigenic [5]. Moreover, male grafts are less susceptible to nephrotoxic effects of some immunosuppressants than female grafts [7]. Long-term retrospective studies in renal transplants revealed that male recipients undergo a worse survival in comparison to females [9]. It can be hypothesized that protection afforded by hormones in women could result in their better long-term prognosis. Estradiol can in fact improve graft function, preserve graft architecture, and diminish cellular infiltration, including mononuclear cell infiltration [10].

The impact of sex mismatch on transplant outcome still remains a matter of debate. Several studies reported that female donor to male recipient grafts seems to have a worst prognosis in particular for liver [11–13] and heart transplantation [14]. In particular, in a recent single-center retrospective study, Schoening et al. [15], evaluating the effect of sex differences on long-term graft survival after liver transplant, found that female donor-male recipient combination showed the worst graft survival. They suggested that this event could be caused by the reduced female donor “quality” (female donors were significantly older, died significantly more frequently from cerebrovascular causes and less frequent by trauma) and by unfavorable characteristics of male recipients (higher incidence of hepatocellular carcinoma in the male recipient group). Interestingly, in studies carried out in animal models, livers from female rats have been demonstrated to present an increased acidosis during transplant-associated ischemia in comparison with livers from male rats this sex difference in the liver’s metabolic response to ischemia appeared estrogen-mediated and could have a significant influence on the outcome of transplantation [16, 17]. Since a similar sex-dependent metabolic response has been found also in myocardial function [18], the possibility that this sexual disparity could influence cardiac transplants cannot be ruled out. In contrast with these studies, other studies on renal transplantation observed that male donor to female recipient combination is an independent risk factor for poor graft survival [19, 20] and the significantly higher percentage of H-Y antibody production in the male donor-female recipient population could play a role in this phenomenon [21]. Regarding heart transplant patients, the observation that donor-recipient sex mismatch could result in a lower survival suggested that sex mismatch can be undesirable in female, as well as male, recipients [22].

Discussion

An important point to be considered in the evaluation of the possible sex/gender disparity in transplantation policy is the limited availability of data worldwide. Legislation differs in fact significantly among western countries, some of which lack specific rules. In Italy, organ donation and transplantation activities are coordinated by law by the National Transplant Centre (CNT) which, in collaboration with 90 transplantation centers operating in Italy, should ensure the quality and traceability of the entire process all over the national territory. To this purpose, all donations, patients, and transplants performed in Italy are recorded on the Transplant Information System (SIT). Transplant activity data registered in SIT since 2002 (the last 13 years) are reported in Table 1 in which the gender of donors and recipients in transplants from living and cadaveric donors are shown. In line with those reported above, i.e., a better capacity to donate of the female gender in comparison with the male gender, we observed that 66 % of living donors were women (in Italy, all living donors are unpaid), whereas 65 % of total transplants were performed in males. The main diseases leading to transplantation in our patients were the following: (i) for kidney transplants, chronic glomerulonephritis, and Berger disease (67 and 80 % in males, respectively) (ii) for liver transplants, hepatitis C virus cirrhosis, alcoholic cirrhosis, and hepatocellular carcinoma (77, 86, and 85 % in males, respectively) and (iii) for heart transplants, idiopathic dilated cardiomyopathy (78 % in males). Interestingly, these percentages were comparable with the gender differences in the distribution of the same diseases in the general population. Therefore, in our opinion, the gender bias in access to transplantation, i.e., the fact that recipients of organs are mainly males, could reflect the gender bias in the incidence of transplant-related pathologies.

Evaluating the graft survival by Kaplan-Meier analyses (Fig. 1), we observed that the donor female (F)–recipient male (M) mismatch presented (i) a significant decrease of graft survival after heart transplantation (Fig. 1a, P = .0002), (ii) a significant decrease of graft survival in the long run after kidney transplantation (Fig. 1b, P = .002), and (iii) a not significant trend of decrease of graft survival after liver transplantation (Fig. 1c, P = .442). On the other hand, the donor M–recipient F mismatch showed the best long-term survival, in particular for heart transplantation. However, the number of variables to be considered before identifying proper gender differences appears to be quite complex and a lot of data regarding, among others, the severity of the disease in recipients and the quality of transplanted organs should be taken into account. Furthermore, the mean age (± standard deviation) of donors appears higher for females than that for males (F: 53 ± 18.1 M: 46 ± 19.6), whereas the mean age of recipients is higher in males than that in females (F: 47 ± 16 M: 50 ± 14.1) so that we can hypothesize that the age of both the donor and the recipient can represent a critical risk factor exerting a significant influence on the graft survival.

ac Graft survival in Italy. Kaplan-Meier estimates of graft survival of all the transplants performed in the period 2006–2013, excluding re-transplants, combined transplants, and transplants with more than one risk factor (according to risk assessment protocols adopted in Italy since the year 2006). The log-rank test is used to test the null hypothesis. Latest update of graft follow-up: year 2016

A multivariate analysis could represent in our mind, the unique and proper statistical approach capable of providing valuable information about possible gender disparity in organ transplantation allowing to understand the strict intertwining between biological and sociocultural determinants.


Pros and Cons of Kidney Transplant

Kidney transplant is a surgical procedure or treatment choice aimed for patients suffering from kidney diseases. A donated kidney will be placed inside the abdomen of the patients and will do the works of the failed kidneys. The kidneys of the patient will not be removed during transplant operation not unless there’s a condition that requires it. Facing a kidney transplant is a very serious matter it is an issue of life and death. Thus, people should be aware about the different factors when it comes to kidney transplant especially in terms of its advantages and disadvantages.

The Top 5 Pros Of A Kidney Transplant

1. Transplanted kidneys work just like normal kidneys.

2. The patient will be able to feel much healthier and even more normal.

3. The patient will have fewer restrictions on diets, so he/she has the chance of improving quality of life.

4. The patient who undergone a kidney transplant won’t be needing dialysis anymore.

5. A patient who successfully went through a selection process will have higher chance to live a much longer life.

The Top 8 Cons Of A Kidney Transplant

1. A kidney transplant requires major surgery, which can cause further health problems if not done successfully. Also, this process is usually expensive.

2. Donated kidneys are not always available. Some patients will need to wait for potential donors.

3. One of the most unfortunate things about kidney transplant is that, the body of the patient who needs a new kidney might reject the new kidney. Thus, one kidney transplant may or may not last for a lifetime.

4. In undergoing kidney transplant, the patient will need to use or take immunosuppressant, which can actually cause some complications.

5. Kidney transplantation is not recommended for those who have severe obesity, heath disease, mental disorders, and chronic illness.

6. Should take anti rejection medicines the rest of patient’s life or the kidney’s life.

7. Higher risks for infections from anti rejection medicines.

8. Frequent labs and tests to be drawn as well as doctor’s visits.

Though kidney transplantation serves as an excellent treatment for kidney diseases, it is still important to consider other important factors before undergoing to such a procedure. There are also other significant things to think about like choosing the kidney transplant center as well as the surgeon, the program longevity, comprising rate of survival, and most importantly the disadvantages. Though it may offer lots of health benefits and other advantages to the patient, kidney transplantation also offers risks and disadvantages that are well worth taking into account. Over the years, kidney transplantation is becoming more and more popular and it shows no sign of slowing. More and more patients are requiring this treatment. Therefore, it is essential for people to know and be aware of the different pros and cons of kidney transplant.


BIOLOGY | Kidney transplant & Dialysis

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Colour coded study resource covering kidney transplants and dyalisis from the AQA Biology specification.
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You know what's sucky about traditional teaching resources? They're outdated. From terrible puns and illustrations, to messy collages and colours which look almost condescending to students. What is educational is that? We'll answer that: NOTHING. You know what does help students break that grade 6/7 wall of doom? Real practical resources catered to the specification and exam. Stuck on a question? Take a look at our graded top-tier exemplars. Lost in revision? Look through our to-the-point.


Dialysis vs Kidney Transplant

When chronic kidney disease (CKD) progresses to kidney failure, the work of your kidneys must be done in other ways. The main options for treating kidney failure are:

  • Dialysis – regular treatments to remove waste and extra fluid from your blood.
  • Kidney transplant – an operation that places a healthy kidney from another person into your body. The kidney may come from someone who has died (called a deceased kidney donor) or from a healthy relative, spouse, friend, or anonymous donor (called a living kidney donor).

It is important to understand that dialysis and kidney transplant are not cures. Both involve a lifelong commitment to treating kidney failure.

Comparing dialysis and kidney transplant to determine which is best for you

While both treatments have advantages and disadvantages, studies show that patients who have a successful kidney transplant live longer than patients treated with dialysis.* Also, many patients who have a transplant report having better quality of life compared to being on dialysis. Kidney transplant patients enjoy being able to return to work, travel more freely, and live without diet and fluid restrictions.


Watch the video: μεταμοσχευση νεφρου (July 2022).


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