Kidney transplantation is a life-saving process, and it also improves the patient's quality of life, and Turkey has become one of the best countries to perform kidney transplantationKidney TransplantAnd turning it into a global destination in the field of organ transplantation, especially kidney transplantation.
Doctors turn to Kidney transplant Mostly in the case of kidney failure or renal disease in the last stage of it, and in the process of kidney transplantation in Turkey, doctors transfer a kidney from a stranger (whether alive or recently dead) and implant it in the patient’s body.
Many patients have many inquiries about the kidney transplantation process. How long does a kidney transplant live? Is a kidney transplant dangerous? what is The best place for a kidney transplant in the world? Find out with us the answer to all these questions in this article.
Kidney transplantation to treat renal failure in Türkiye
Before getting to know the kidney transplant process in Turkey, we must understand the function of the kidney and what are the reasons for its failure to learn more about the importance of this process.
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 vital organs whose function is 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.
Where the kidneys perform several major functions to maintain the health of the body, including:
- 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 transported to the bladder through the ureters, where the bladder acts as a storage for urine.
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 continues (chronically), it results in end-stage kidney failure.
As toxic waste products accumulate in the body, either dialysis or a kidney transplant is required.
The main causes of kidney failure:
- High blood pressure
- Kidney polycystic disease
- Severe anatomical problems in the urinary tract
- Treatments used to treat Kidney failure in the final stage
Kidney failure treatment
There are not many options when the kidney reaches the stage of complete failure, and among the treatments we mention:
- Hemodialysis (hemodialysis): It is a mechanical process of cleaning waste from the blood.
- Peritoneal dialysis: where waste products are removed by passing chemical solutions through the abdominal cavity.
- 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.
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, or a spouse or close friend, may want to donate a kidney.
This person is called a "living donor," as the donor must be in good health, well-informed about transplantation, and able to give consent for a kidney donation.
Note: For a foreign patient coming from outside Turkey, the donor must be a family member up to the fourth degree, as it is not possible to obtain a kidney from a foreign person for the donor.
A deceased donor kidney comes from a brain dead person. Organ donation for transplantation is permitted 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.
Tissue match analysis for kidney transplantation
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 kidney to the recipient. This test is a Tissue Matching Analysis for Kidney Transplant and is a four step procedure.
Tissue match analysis for kidney transplantation - blood group test
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 is accepted from all other blood groups, and blood type O is the hardest to match.
Tissue analysis for kidney transplantation - a histocompatibility complex test
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, as this examination is performed as a second stage for both the donor and the donor.
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.
Tissue match analysis for kidney transplantation - cross-match test
Throughout life, the body makes substances called antibodies that work to destroy foreign matter.
Individuals 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 antibodies in the donor kidney, the body may destroy the transplanted 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, meaning there are antibodies against the donor, the recipient should not receive this particular kidney unless special pre-transplant treatment is performed to reduce antibody levels.
If the match is negative, it means that the recipient has no donor antibodies and is eligible for a kidney transplant.
Tissue match analysis for kidney transplantation - serological examination
Testing for viruses, such as HIV, hepatitis and cytomegalovirus (CMV), is also performed 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 after a kidney transplant.
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 they are not completed Chemotherapy
- Active septic infections
- Uncontrollable mental illness
- current drug abuse
- Current 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 in Turkey
Implant surgery is performed under general anesthesia, the procedure 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 (either Liver Transplants Heart transplants are in-situ transplants, in which the diseased organ is removed and the transplanted organ is placed in the same place), where the kidney is transplanted into the front part of the lower abdomen (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, where 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 anastomized to the bladder by forming a vesicoureterostomy,
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 carries blood to the kidneys and the vein that carries blood away are surgically connected to the already existing artery and vein in the recipient's pelvis, and the ureters that carry urine from the kidneys are connected 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, even if they are rare, and despite their rarity, Turkey has recently worked to significantly reduce the complications and risks of kidney transplantation in Turkey.
Complications of a kidney transplant include:
- Delayed functioning 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 complication is small if the donor is alive.
- Renal artery thrombosis (rare 1%).
- Renal vein thrombosis (6%).
- Renal artery stenosis: It usually appears several months after transplantation with high blood pressure and impaired kidney function. Diagnosed by angiography, the preferred treatment is usually vessel repair.
- Ureteral leaks occur at the site of the uretero-bladder anastomosis, resulting in decreased urine output and increased abdominal pain.
- Obstruction in the urinary tract, due to strictures in the distal ureter section as a result of external pressure from the hematoma (it is treated by means of a tube placed to lower the pressure).
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.
Post-kidney transplant period
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 a 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 it can occur at any time, even years later. Prompt treatment can reverse rejection in most cases.
Anti-rejection kidney transplant medications
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.
Prednisone (a type of corticosteroid) taken orally or intravenously, is given in low doses to reduce side effects as much as possible.
- Change in body shape, such as a round face and accumulation of fat around the abdomen
- Slowing down the speed of wound healing
- High blood sugar
- mood changes
- Muscle weakness and joint pain
- form cataractwhich sometimes leads to cataracts
- Gastric ulcer
Anti-proliferative kidney transplant drugs
- Kidney transplant medication azathioprine
- Kidney transplant medicine Mycophenolate mofetil
- Mycophenolate sodium
Cytokinin-inhibiting drugs for kidney transplantation
- Lymphocyte-inhibiting globulin
- Muromonab-CD 3
- Interleukin-2 receptor antibodies (Zenapax® or Simulect®)
The risks of using medications after a kidney transplant are:
- Weight gain after a kidney transplant in Turkey, which is due to the use of corticosteroids, as described above
- Thinning of the bones
- Increased hair growth
- young love
- Increased risk of some types of infection skin cancers orNon-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 enlarges slightly because it takes on the function 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.
Possible barriers to live donation
- Age is less than 18 years old
- Uncontrollable high blood pressure
- History of recurrent pulmonary emboli or thromboembolism
- Problems with the time of blood clotting
- Uncontrollable mental illness
- Morbid obesity
- Uncontrollable cardiovascular disease
- Chronic lung disease with poor oxygenation or ventilation
- History of skin cancer
- Presence of cancer with vectors
- Bilateral or recurrent nephrolithiasis (Kidney stones)
- Chronic kidney disease (CKD) stage 3 or less
- Proteinuria >300 mg/day except for 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.
Robotic kidney transplant in Turkey
most used Organ Transplant Centers A laparoscopic surgical technique to remove the kidney and in some centers a robot.
This type of surgery, which is performed under general anesthesia, uses very small incisions, a thin scope 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 kidney is resected along with the renal artery with a graft of the aorta, the renal vein with a graft of the vena cava, and the ureter.
For living donor kidney transplantation, nephrectomy is commonly performed via laparoscopic technique and robotic kidney transplantation is now possible, the left kidney is preferred due to the length of the renal vein, but no graft from the aorta or inferior vena cava can be taken 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 operation takes 2-3 hours and recovery time in the hospital is usually 1-3 days. Donors are often able to return to work within 2-3 weeks after the operation.
Sometimes the kidney needs to be removed with a large surgical incision.
Although laparoscopy is increasingly being used in place of open surgery, from time to time the surgeon may 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 kidneys taken using either method are good. Regardless of the technique, all donors will need lifelong monitoring of their general health, blood pressure and kidney function.
Special programs for kidney transplantation from living donors
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 obtain a kidney from a living donor who has an incompatible blood type. To be able to receive such a kidney, a patient must undergo several treatments before and after transplantation 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 antibody-producing cells.
Positive match and sensitive renal transplantation
This program makes possible kidney transplants for patients who have developed antibodies against kidney donors - a condition known as "positive match".
This process is similar to a kidney transplant that occurs when the blood type is not compatible. Patients receive medications to reduce their antibody level 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 allergen positive/allergenic 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, obtaining a kidney from a deceased follower for a foreign citizen is not possible because Turkish law prohibits a donation from a deceased Turkish person to a foreign patient.
My experience with a kidney transplant
Twenty years after her kidney transplant, Eileen Krynicki says:
“I did not expect this success and activity after my kidney transplant. I had the operation twenty years ago, and I am now in the best condition of my life.
But I followed the doctor’s instructions to the letter, and took all the medications he told me to take, and this is what I recommend to all those who will have a kidney transplant.”
Her journey was not easy to find a living donor to give her a kidney, but her sister gave up a part of her body to relieve her younger sister from the torment dialysis.
How long does a kidney transplant live?
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.
A table showing the age of the transplanted kidney and the age of the patient after donation:
|donor type||1 year||3 years||5 years||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 in Turkey starts from 20 thousand US dollars, and the price may vary according to the degree and quality of the hospital.
You can also read on our site about The best liver transplant centers in Turkey.
In the end, we find that kidney transplantation is a safe process and doctors can perform it on almost all patients due to the rapid medical development in Turkey, and that kidney transplantation has become the perfect solution for kidney failure, and it has given patients great hope in life after losing their kidneys.