When discussing end-stage kidney failure, the most commonly mentioned treatment is dialysis, which helps remove waste from the body as a substitute for kidney function. Peritoneal dialysis must be done 3-4 times a day, while hemodialysis with a dialysis machine must be done at least 3-4 times a week, which may affect the daily life of some patients. Today, I would like to introduce another treatment method for chronic kidney failure, which is the best method and improves the quality of life for patients. That method is “kidney transplantation.”
What is kidney transplantation?
Kidney transplantation is the best treatment for end-stage chronic kidney failure. It involves transplanting a normally functioning kidney from a living donor or a deceased brain-dead donor to the recipient. After the kidney transplant, the recipient must take immunosuppressive drugs for life to prevent kidney rejection.
Where do transplanted kidneys come from?
Transplanted kidneys mainly come from two sources:
- Kidney transplantation from a living donor, called Living donor kidney transplant. The donor must comply with the Medical Council regulations, meaning they have a familial relationship such as parents, siblings, uncles, aunts, nephews, etc., or be a registered spouse or have lived together as husband and wife for at least 3 years or have children together.
- Kidney transplantation from a deceased brain-dead donor, called Deceased donor kidney transplant. This involves transplanting kidneys from donors diagnosed as brain-dead by a medical team, meaning the donor is medically declared deceased.
Currently, there is advanced kidney transplantation technology that can transplant genetically modified pig kidneys to kidney failure patients. This is still in the experimental study phase and requires long-term evaluation. In the future, pig kidneys may be transplanted to humans to reduce organ shortage problems.
How many types of kidney transplantation are there?
Currently, kidney transplant surgery is divided into 2 types:
- Open kidney transplant surgery involves placing the transplanted kidney in the recipient’s pelvis on either side. The surgical incision is generally about 15–30 cm, depending on the patient’s weight and height.
- Robot-assisted kidney transplant surgery is a new transplantation technology first introduced in 2010. It is still limited to certain countries. In Thailand, it is available only in some government hospitals. The surgical incision is generally about 7 cm, with four additional 8 mm incisions for inserting robotic arms.
What are the steps of kidney transplantation?
The kidney transplantation process is divided into 3 stages:
- Initial patient evaluation stage
This is when the patient first meets the doctor. The patient undergoes an initial assessment and receives information about kidney transplantation, including indications, contraindications, physical and psychological preparation, medical rights, and transplantation types from the medical team and transplant coordinator nurse (TC nurse). If no contraindications are found, the process moves to the next stage.
- Evaluation stage with lymphocyte testing
This stage involves blood tests, radiological examinations, and consultations with various specialists to prepare the patient for kidney transplant surgery. End-stage chronic kidney failure patients often have comorbidities and complications that must be treated before transplantation. At this stage, lymphocyte testing is done to assess the risk of kidney rejection.
If the patient is receiving a kidney from a living donor who is a relative, after completing stage 2 evaluation, the transplant surgery can be scheduled immediately. However, patients waiting for a kidney from a deceased brain-dead donor must proceed to stage 3, which is waiting for the transplant.
- Waiting stage for kidney transplantation
At this stage, the patient has completed the readiness evaluation. Patients waiting for a kidney from a deceased brain-dead donor must submit blood samples monthly to remain on the waiting list until they receive a transplant. This stage can take a long time due to the high number of patients waiting for kidney donations.
Advantages of kidney transplantation
Proven and supported by global research studies, there are 3 main advantages:
- Better quality of life means patients reduce the burden of having to travel to the hospital for 4-hour dialysis sessions 2-3 times a week for life or performing peritoneal dialysis themselves 3-4 times a day. After transplantation, patients can drink fluids like normal people, have significantly fewer dietary restrictions, and live a life close to normal.
- Lower long-term costs Research on the cost-effectiveness of kidney transplantation shows that, on average, the overall expenses for transplant patients are lower than for those on dialysis.
- Higher survival rate Patients who receive kidney transplants have statistically significantly lower mortality rates related to kidney failure. Most dialysis patients die from complications such as heart disease or stroke.
Limitations of kidney transplantation
- Must take immunosuppressive drugs for life.
- Increased risk of complications due to immunosuppressive drugs, such as higher susceptibility to infections, especially opportunistic infections, and increased risk of cancer. However, when comparing the potential risks (which occur only in some cases) with the benefits, kidney transplantation clearly offers greater benefits.
The most important thing is the quality of life of the patient.
Therefore, kidney transplantation is a good option for patients with end-stage chronic kidney failure.
