An introductory article about the kidney transplantation process in Turkey in detail, as Turkey has become one of the best countries for kidney transplantation, turning it into a global destination in the field of kidney transplantation. organ transplant
What is the main function of the kidney and who are the patients who need a kidney transplant in Turkey?
Chronic kidney failure is a major health concern that affects a large number of people.
When kidney function drops to a certain level, end-stage renal failure patient needs either dialysis or a transplant to sustain their lives.
Normal kidney function
The kidneys are organs whose function is essential to sustain life.
Most people are born with two kidneys located on either side of the spine, behind the abdominal organs and below the rib cage.
The kidneys perform many major functions to keep the body healthy.
- Blood purification to remove waste products from metabolism in the body's normal cells, which involves removing waste from the body in the form of urine, and returning water and chemicals to the body when necessary.
- Regulating blood pressure by secreting several hormones.
- Stimulating the production of red blood cells by secreting the hormone erythropoietin.
The normal anatomy of the kidneys includes two bean-shaped organs that produce urine.
The urine is then transferred to the bladder via the ureters.
The bladder acts as a urine storage.
When the body feels the bladder is full, urine is excreted from the bladder through the urethra.
What is kidney failure?
When the kidneys stop working, kidney failure occurs.
If this kidney failure persists (chronically), end-stage renal failure results.
As toxic waste products accumulate in the body, either dialysis or a kidney transplant is required.
The main causes of kidney failure:
- diabetes mellitus
- Polycystic kidney disease.
- Severe anatomical problems in the urinary tract.
- Treatments used to treat end stage renal failure.
Kidney failure treatment
Treatments for kidney failure are either through (dialysis) hemodialysis: a mechanical process of cleaning the blood of waste.
or peritoneal dialysis: Where waste is removed by passing chemical solutions through the abdominal cavity
Or a kidney transplant.
However, while none of these treatments cure a patient with end-stage kidney failure, a transplant offers the closest result to a normal life because a transplanted kidney can replace a failing kidney.
However, to maintain the health of the new kidney, certain medications must be used for life.
Some of these medicines may have serious side effects.
Kidney Transplant in Turkey
The kidneys to be transplanted come from two different sources: either a living donor or a deceased donor.
Sometimes family members, including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, a spouse or a close friend may want to donate a kidney.
This person is called a "living donor". The donor must be in good health, well acquainted with the transplant, and able to give consent for the kidney donation.
A healthy person can donate a kidney safely.
note: For a foreign patient coming from outside Turkey, the donor must be a family member up to the fourth degree. Where it is not possible to obtain a kidney from a foreign person for the donor.
A deceased donor's kidney comes from a brain-dead person. It allows organ donation for transplantation at the time of death and families are allowed to provide such permission.
After permission to donate is granted, the kidney is removed and stored until the recipient patient is selected.
This type is not available for a foreign citizen because Turkish laws prohibit donation from a deceased Turkish citizen to a foreign national.
How is the evaluation process for kidney transplantation and what is the tissue match analysis for kidney transplantation in Turkey?
Regardless of the type of living donor or deceased donor, special blood tests are required to find out what type of blood and tissues are present.
These test results help match the donor's kidney to the recipient.
The first stage in a tissue match analysis for a kidney transplant is blood type.
The first test determines the blood group.
There are four types of blood: A, B, AB, and O. Everyone belongs to one of these groups. The recipient and the donor must have the same blood type or two compatible blood types as shown in the list.
If the acceptor has type A, the donor must have either type A or O.
If the acceptor is type B, the donor must have either a B or O type.
If the acceptor is O, then the donor must be O.
If the acceptor is AB, the donor must have either A, O, AB, or B type.
AB is the easiest because it accepts all other factions
Blood type O is the hardest to match.
Although people with type O blood can donate to all types, they can only receive kidneys from type O blood donors. For example, if a patient with type O blood receives a kidney from a donor with type A blood, the body will recognize on the donor's kidney as foreign and destroys it.
The second test is tissue analysis for kidney transplantation.
The second test, a blood test for human leukocyte antigen (HLA), called the histocompatibility complex, characterizes each individual's tissues.
These signs are inherited from the parents. Where this examination is performed as a second stage for both the donor and the giver.
The more compatible the histocompatibility rate, the better the transplant results, as the best results are obtained from the twin sibling.
Although the operation can be performed whether the HLA-compatible complex is fully, partially or absent.
The third test, tissue match analysis for kidney transplantation, is cross-match
Throughout life, the body makes substances called antibodies that work to destroy foreign matter.
People may make antibodies every time they have an infection, during pregnancy, when they have a blood transfusion, or when they undergo a kidney transplant.
If there are antibody producing antibodies in the donor's kidney, the body may destroy the kidney.
For this reason, when a donor kidney is available, a test called cross-matching is performed to ensure that the recipient does not have preformed antibodies against the donor's tissue.
Matching is done by mixing the recipient's blood with cells from the donor.
If the match is positive, then there are antibodies against the donor. Recipients of this particular kidney should not receive unless special treatment is performed prior to transplantation to reduce antibody levels.
If the match is negative, it means that the recipient does not have donor antibodies and is eligible for this kidney.
Cross-matches are performed multiple times during preparation for a living donor transplant, and a final match is performed within 48 hours before a kidney transplant in Turkey.
The fourth test for tissue match analysis for kidney transplantation is serology.
Testing for viruses, such as human immunodeficiency virus (HIV), hepatitis and CMV is also done to select appropriate preventive medications after transplantation.
These viruses are screened in any potential donor to help prevent the disease from spreading to the recipient.
Steps and stages of the kidney transplantation process in Turkey
The period before a kidney transplant
This period refers to the time before the evaluation of a potential living donor is completed.
The recipient undergoes testing to ensure that they are prepared for the procedure and are able to tolerate the necessary anti-rejection medications after transplantation.
The type of tests vary depending on age, gender, cause of kidney disease, and other associated medical conditions.
It may include, but is not limited to:
General examinationsGeneral metabolic laboratory tests, coagulation studies, complete blood count, colonoscopy, Pap smear, mammography (women) and prostate (men).
Kidney transplantation for heart patients is done after cardiovascular evaluation: electrocardiogram, stress test, echocardiogram, cardiac catheterization.
Pulmonary assessmentChest x-ray, spirometry.
Kidney transplant conditions
Possible reasons for excluding a transplant in a recipient:
- Uncorrectable cardiovascular disease.
- A history of cancer when carriers are present or when chemotherapy has not been completed.
- Active infection.
- Uncontrollable mental illness.
- Current drug use.
- Present neurological impairment with significant cognitive impairment and inability to make a decision.
The patient's age is no longer an obstacle, as one study showed that age does not affect unless there are accompanying diseases.
Explanation of how to perform a kidney transplant
The implant surgery is performed under general anaesthesia.
The process usually takes 2-4 hours.
This type of operation is a heterogeneous transplant, meaning that the kidney is placed in a different location than the existing kidney.
(Liver and heart transplants are in-place transplants, in which the affected organ is removed and the transplanted organ is placed in the same place).
The kidney is transplanted into the front (anterior) part of the lower abdomen, in the pelvis.
First The new kidney is examined, the renal artery and vein are identified, and then they are washed with a preventive solution (to check that there are no leaks), and if there are leaks, they are repaired, while preserving the entire length of the ureter and removing any surrounding fat.
The kidney is placed extraperitoneally in the iliac fossa, often on the right side.
The iliac vessels are examined and all identified lymphatic vessels are ligated.
An anastomosis is performed between the donor's renal vein and the external iliac vein of the recipient, and between the donor's renal artery and the external or internal iliac artery.
The ureter is anastomosed to the bladder by forming a ureterovesical stoma.
The anastomosis is performed on a stent placed in the ureter that can be removed about six weeks after implantation.
The original kidney is usually not removed unless it is causing serious problems such as uncontrollable high blood pressure, frequent kidney infections, or if it is significantly enlarged.
The artery that brings blood to the kidneys and the vein that carries blood away are surgically connected to the artery and vein already in the recipient's pelvis.
The ureters that carry urine from the kidneys are delivered directly to the bladder.
The recovery period in the hospital is usually 3 to 7 days.
Complications of a kidney transplant
Complications of kidney transplantation that may occur although they do not occur often, but they can occur,
Delayed work of the transplanted kidney
Where the kidney must be washed (blood washing) in the first week after transplantation.
This matter changes from one center to another, and this multiplication is few if the donor is alive.
Complications of a vascular kidney transplant
Early complications include renal artery thrombosis (rare, 1%) and renal vein thrombosis (6%).
It must be identified immediately using a Doppler ultrasound and if it forms, it will require a return to the operating room.
Aspirin and/or heparin are often started after surgery to reduce this risk.
Late complications include renal artery stenosis, which usually appears several months after transplantation with high blood pressure and poor kidney function.
It is also diagnosed by angiography, and the treatment of choice is usually vessel repair.
Complications of kidney transplantation for ureter
Ureteral leaks occur at the site of the uretero-bladder anastomosis, resulting in decreased urine output and increased abdominal pain.
Often requires repeated surgical intervention.
Urinary tract obstruction can also occur, due to strictures in the distal ureteral section due to external pressure from the hematoma (treated with a tube placed to reduce pressure).
Long-term complications of kidney transplantation
The most common cause of death after surgery in the first year is cardiovascular disease.
Most other long-term complications are often associated with the use of immunosuppressive agents, such as recurrent infection, diabetes mellitus or malignancy.
The period after kidney transplantation
The post-transplant period requires careful monitoring of renal function, monitoring for early signs of rejection, and adjustment of various medications, which alert for an increased incidence of immunosuppressive effects such as infection and cancer.
Just as the body fights bacteria and viruses (germs) that cause disease, it can also fight a transplanted organ because it is a “foreign body.”
When the body fights the transplanted kidney, rejection occurs.
Rejection is an expected side effect of the transplant and up to 30% of people who undergo a kidney transplant will experience some degree of rejection.
Most rejections occur within six months after transplantation, but they can occur at any time, even years later.
Prompt treatment can reverse rejection in most cases.
Anti-rejection kidney transplant drugs
Immunosuppressive or anti-rejection kidney transplant drugs prevent rejection, as these drugs will have to be used for life and if they are stopped the transplanted kidney may fail.
This is a list of the medications used, which the doctor will adopt in the appropriate selection, according to the patient's condition.
First: Anti-inflammatory drugs:
Prednisone (a type of corticosteroid) taken orally or intravenously, is given in low doses to reduce side effects as much as possible.
- Change in the shape of the body such as a round face and the accumulation of fat around the abdomen.
- A slowdown in the speed of wound healing.
- high blood sugar;
- mood changes
- Muscle weakness and joint pain.
- form cataractSometimes it leads to cataracts in the eye.
- Gastric ulcer.
Second: Anti-proliferative kidney transplant drugs:
- Kidney transplant medication azathioprine
It is taken intravenously or orally.
The main side effects are:
- Decreased white blood cell count.
- Liver problems.
- hair loss;
- Kidney transplant medicine Mycophenolate mofetil
Mycophenolate mofetil is taken by mouth.
The most common side effects are:
- Low white blood cells.
- Low erythrocytes.
- Abdominal pain and diarrhea.
- Sodium mycophenolate
Mycophenolate sodium is taken orally. It has the same effect as the previous drug.
It is given orally.
The most common side effects of treatment are:
- Decreased platelet count, white and red blood cells.
- It can also lead to high cholesterol and fat.
Third: Kidney transplantation drugs that inhibit cytokinin:
- Cyclosporine Cyclosporine is given orally.
The most common side effects are:
- Kidney failure.
- liver problems;
- Feel in the skin.
- Swelling or bleeding gums.
- High potassium in the blood.
- Increased blood sugar level.
The treatment is given orally. Some of the side effects include:
- Kidney failure.
- high blood pressure.
- High potassium in the blood.
- Increased blood sugar level.
- anxiety before bed
Fourth, anti-lymphocyte drugs:
- Lymphocyte-inhibiting globulin
Lymphocyte-suppressing globulin is taken intravenously.
The most common side effects of treatment are:
- A decrease in the number of platelets and white blood cells.
Muromonab-CD 3 is given intravenously and the most common side effects of treatment are:
- shortness of breath.
- Interleukin-2 receptor antibodies (Zenapax® or Simulect®)
These medicines are given intravenously. It rarely has side effects
And more of these effects are:
- Exessive sensitivity.
- Decreased leukocytes.
- shortness of breath.
The risks are due to the use of medications after kidney transplantation
- Weight gain after a kidney transplant in Turkey, which is due to the use of cortisone as described above.
- Thinning of the bones.
- Increased hair growth.
- young love.
- Increased risk of some types of skin cancer and non-Hodgkin's lymphoma.
Kidney transplant in Turkey from a living donor
Living donor kidney transplants are the best option for many patients for several reasons.
Better results in the long run.
There is no need to wait in the transplant waiting list to get a kidney from a deceased donor.
The surgery can be planned in time for both the donor and the recipient.
Reduce the risk of complications or rejection and improve the early function of the transplanted kidney.
Any healthy person can donate a kidney.
When a living person donates a kidney, the remaining kidney swells slightly because it takes over the functioning of two kidneys.
Donors do not need medications or special diets, once they recover from surgery they return to their normal lives.
As with any major surgery, there is a chance of complications, but kidney donors have the same life expectancy as normal people, their general health is not affected, and kidney function is the same as most other people.
Kidney loss also does not interfere with a woman's ability to have children.
Possible Barriers to Live Donation:
- Age is less than 18 years.
- Uncontrollable high blood pressure.
- History of recurrent pulmonary emboli or thrombus formation.
- Problems with blood clotting time.
- Uncontrollable mental illness.
- Morbid obesity.
- Uncontrollable cardiovascular disease.
- Chronic lung disease with poor oxygenation or ventilation.
- Skin cancer history.
- The presence of cancer with the presence of vectors.
- Bilateral or recurrent nephrolithiasis (Kidney stones).
- Chronic kidney disease (CKD) stage 3 or less.
- Proteinuria >300 mg/day excluding postural proteinuria.
- HIV infection.
If a person successfully completes a medical, surgical, and psychological and social evaluation, they will undergo the removal of one kidney.
most used Organ Transplant Centers A laparoscopic surgical technique to remove the kidney and in some centers a robot.
This type of surgery, performed under general anesthesia, uses very small incisions, a thin endoscope with a camera to see inside the body, and special tools to remove the kidney.
Compared to the large incision procedure used in the past, laparoscopic surgery has greatly improved the donor's recovery process in several ways:
- Decreased need for strong pain relievers.
- Shorter recovery time in hospital.
- Faster return to normal activities.
- The complication rate is very low.
It has finally evolved Kidney transplantation by robot Which had better aspects on both the donor and the taker.
Explanation of the method of kidney transplantation in Turkey for the donor
The abdomen is fully examined and the intestines are moved to reach the retroperitoneal (kidney) space.
The donor is given heparin, and then the vessels and ureters are identified and isolated.
The kidney is then excised with the renal artery with a patch of the aorta, the renal vein with the patch of the vena cava, and the ureter
. The organs are then taken to the back table for further examination.
For a living donor kidney transplant, nephrectomy is commonly performed via laparoscopic technique and it is now possible to perform Robotic kidney transplantation. The left kidney is preferred because of the length of the renal vein, but a graft cannot be taken from the aorta or inferior vena cava in these cases.
Once the kidneys are removed, they should be washed with preservation fluid as soon as possible.
The mortality rate for donor nephrectomy is low, estimated at 1 in 3,000 for all surgical methods.
The process takes 2-3 hours.
Recovery time in the hospital is usually one to three days.
Donors are often able to return to work within 2-3 weeks after the procedure.
Sometimes the kidney needs to be removed with a large surgical incision.
She used the open operation before the discovery of the laparoscopic technique, this surgery was the standard operation to remove the donated kidney.
It is done through a 12-18 cm incision in the waist, where the muscles were cut and the tip of the twelfth rib was removed.
The operation usually takes 3 hours and the hospital recovery rate ranges from 4 to 5 days with 6 to 8 weeks of downtime.
Although laparoscopy is increasingly used in open surgery, the surgeon may from time to time choose to perform an open procedure when individual anatomical differences in the donor indicate that this would be a better surgical approach.
The quality and function of the kidneys taken using either method works well.
Regardless of the technique, all donors will need lifelong monitoring of their general health, blood pressure and kidney function.
Special programs for living donor transplants
Many patients have relatives or non-relatives who would like to donate their kidneys but are unable to do so because their blood type or tissue type does not match.
In such cases, the donor and recipient are said to be "incompatible".
Blood type incompatible kidney transplant
This program allows patients to receive a kidney from a living donor who has an incompatible blood type. To be able to receive such a kidney, patients must undergo several pre- and post-transplant treatments to remove harmful antibodies that can lead to rejection of the transplanted kidney.
A special process called plasmapheresis, which is similar to dialysis, is used to remove these harmful antibodies from the patient's blood.
Patients require multiple treatments with plasmapheresis prior to transplantation, and may require several other treatments after transplantation to keep their antibody levels low.
Some patients may also need to have their spleen removed at the time of transplant surgery to reduce the number of cells that produce antibodies.
The spleen (a spongy organ about the size of a fist) produces blood cells.
The spleen is located in the upper left part of the abdomen under the rib cage, and the spleen can be removed laparoscopically.
Positive match and sensitive kidney transplantation
This program makes it possible for kidney transplants to be performed on patients who have developed antibodies against kidney donors - a condition known as a "positive match".
This process is similar to a kidney transplant that occurs when blood types are incompatible.
Patients receive medications to reduce their level of antibodies or they may undergo plasma treatments to remove harmful antibodies from their blood.
If the donors' antibody levels are successfully reduced, they can then proceed with transplants.
Blood type-incompatible kidney transplants and positive/allergen-positive kidney transplants have been very successful in Turkey and internationally.
Success rates are close to the success rates of transplants from compatible living donors and are better than the success rates of transplants from deceased donors.
Kidney transplant from a deceased donor
When an individual does not have a living donor but is an acceptable candidate for transplant, they will be placed on a waiting list.
Unfortunately, for a foreign national, it is not possible to obtain a kidney from a deceased follower.
Because Turkish law prohibits donation from a Turkish deceased to a foreign patient.
Compared to dialysis patients who have a 4-7 times greater chance of dying than transplant recipients.
Kidney transplant problems
Organ transplantation from a deceased person is not possible for a foreign patient, as sometimes the patient does not have any relative or friend to donate the kidney.
Xenotransplantation (cross-species transplantation) was therefore developed.
Even with innovative ways to tap into more living and deceased donors, another source of kidneys is likely to be necessary.
Xenotransplantation has already occurred from non-human donors such as chimpanzees, monkeys, and baboons.
However, these animals are an endangered species, and differences in size and blood type as well as concern over transmission of infectious diseases have led to the banning of these transplants by the US Food and Drug Administration.
Currently, most research in this area is focused on the pig as the potential xenograft donor.
Pigs have desirable characteristics: multiple offspring, rapid maturation to adulthood, but the high incidence of bacterial infection may rise significantly with this method of transmission.
Several barriers to successful organ transplantation are across the species under study and ongoing developments may lead to solving the organ shortage crisis.
don't hesitate baContact us If there is any problem after the operation.
Immunity due to medication after kidney transplant
Lifelong immunosuppression is a huge burden for patients. The body's ability to "accept" the organ without daily immunosuppressive anti-rejection medication is medically considered the "holy grail" of a transplant.
Most successful models include extensive medication at the time of transplantation with bone marrow injections from the donor who supplied the organ.
The recipient fuses the bone marrow cells, becomes "chimeric" and the new bone marrow cells re-educate the recipient to accept the organ.
There are many issues to be improved in human organ transplantation, but scientists and clinicians are working together to eliminate the need for lifelong immunosuppression.
Clinical trials of kidney transplantation
Continuous advances in our understanding of the mechanisms involved in accepting kidney transplantation have led to exciting new drugs.
After testing new drugs in animal models, these drugs move to human clinical trials.
The great success of transplantation occurred as a result of many basic scientific research, rigorous testing of drug innovations, and patients' willingness to participate in controlled studies of new drugs.
Even immunosuppressive protocols will require the administration of new, short-term immunosuppressive drugs.
Patient collaboration and participation in clinical trials is essential to maintaining the advancement of the field of kidney transplantation.
What is the success rate of kidney transplantation? How long does a kidney transplant live?
The success rate of a kidney transplant varies depending on whether the donated organ is from a living donor or a deceased donor as well as the recipient's medical conditions.
Kidneys from living donors generally last longer.
Most cases of kidney loss are due to rejection, but bacterial infection, circulatory problems, cancer and recurrence of original kidney disease can all lead to kidney loss.
Kidney transplant success rate
Donor type 1 year 3 years 5 years 10 years
A table showing the age of the transplanted kidney and the patient's age after donation
|donor type||1 year||3 Years||5Years||10 years|
|living donor||Probable age of the transplanted kidney||95%||88%||80%||57%|
|Probable age of the patient||98%||95%||90%||64%|
|deceased donor||Probable age of the transplanted kidney||90%||79%||67%||41%|
|Probable age of the patient||95%||88%||81%||61%|
Source: SRTR - Scientific Registry of Transplant Recipients
Kidney transplant cost in Turkey
The cost of a kidney transplant ranges between 15 thousand and 20 thousand US dollars, as the price varies according to the degree and quality of the hospital.
You can also read on our site about The best organ transplant centers in Turkey.