During end-stage renal failure, when renal filtration drops below approximately 10 ml/min, we offer kidney transplantation and dialysis methods to patients as treatment options. All functions of the kidney return only after a successful kidney transplant, so kidney transplant is the most ideal renal replacement treatment option. Kidney transplantation not only improves the quality of life, but also causes a significant extension of life expectancy.
CURRENT KIDNEY TRANSPLANTATION FIGURES IN TURKEY
End-stage renal disease in Turkey. The number of patients diagnosed with the disease is increasing. According to the Turkish Nephrology Association Kidney Registration System report, as of the end of 2017, there are a total of 77,311 patients in Turkey who received renal replacement therapy, of which 58,635 were hemodialysis, 3,346 were peritoneal dialysis and 15,330 were kidney transplantation.
Especially T.R. With the intense efforts of the Ministry of Health, there has been a significant increase in the number of kidney transplants in Turkey after 2010. The number of annual kidney transplants has increased to over 3,000 in the last three years. A total of 3,342 kidney transplants were performed on 3,330 patients in 2017. Considering the period after 2002, Turkey is the country with the highest increase in the number of kidney transplants in the world. This is a pleasing development. However, in our country, the majority of kidney transplants, 80%, are performed from living donors, while kidney transplantation from cadavers is around 20%. However, in most European countries, these rates are exactly the opposite. There is a need to increase the number of kidney transplants from cadavers in our country.
DONOR CRITERIA
Organ transplantation from living organs; It can be made from the recipient's spouse, with whom he/she has actually lived for at least two years, and blood and in-law relatives up to the fourth degree (including the fourth degree). If the person has a non-relative donor, the ethics commission to be established in the province where the transplant will be performed must confirm that there is no issue against the legislation between the donor and the recipient and that organ donation is ethically appropriate. Patients who do not have a living donor are registered to the National Kidney Waiting List after preparations for cadaver transplantation are completed in organ transplantation centers.
HOW ARE PATIENTS PREPARED…
Before kidney transplantation, the patient undergoes a detailed evaluation. Necessary precautions are taken for all complications and diseases that may occur during or after transplantation. For example, existing urinary system anatomical problems are corrected, active infection foci are found and treated, vaccinations are administered, and if necessary, the heart and circulatory system are evaluated with angiography. This ensures that the patient undergoes kidney transplantation in the best physical condition.
LIVE DONOR OR CADAVER KIDNEY?
The advantages of living donor kidney transplantation are that there is no waiting period, so the patient It is a transplant without being exposed to the wear and tear that occurs on your body during the dialysis treatment process. During the preliminary preparation phase, necessary precautions are taken for possible complications such as immunological sensitivity and infection development that may occur in the recipient. Since it is a planned operation, the kidney is removed and placed in the recipient under the best conditions, and therefore the life of the transplanted kidney is longer. In cadaveric kidney transplantation, there are unpredictable parameters such as the medical conditions of the donor, the time spent during the removal and transplantation of the kidney, and the lack of preliminary preparation since it is an urgent procedure. All developed countries that can effectively use their organ coordination networks prefer cadaver transplantation today. Currently, transplants can be made between countries and even intercontinental organ transfers.
NOTES ABOUT FOLLOW-UP AFTER TRANSPLANTATION
Immunosuppressive drugs, which we call immunosuppressive, are used to prevent kidney rejection after kidney transplantation. Drug doses are adjusted taking into account the patient's immune system. Since a new tissue is introduced, the risk of rejection is higher, especially in the first year, and therefore drug doses are kept higher in the first year. The first year, especially the first three months, is the period when the patient's risk of infection is high. It should be known that you will be under regular drug treatment under the supervision of a physician after transplantation, and that insufficient use of drugs may lead to rejection, and high dose use may lead to organ damage. As a result, patients experience increased appetite and weight gain. At this stage, it is important to follow general health recommendations, such as avoiding unnecessary excess weight gain, eating a balanced diet, and consuming less salt. Long-term use of immunosuppressive drugs increases the risk of various cancers. It is recommended that patients avoid long-term direct sunlight and use sunscreen in order to avoid increasing the risk of skin cancer.
The recipient's age, the activity of the immune system, the disease that caused kidney failure, the immunosuppressive drugs used, the patient's compliance with the treatment, Many factors, especially other existing diseases and smoking, can affect success. In the long-term success after transplantation, the patient's regular check-ups, keeping treatment compliance at maximum, early recognition of possible diseases or complications and taking precautions play an important role.
CAN KIDNEY TRANSPLANTATION BE REPEATED?
Kidney transplantation. It is a repeatable treatment method. A kidney transplant can be performed from a living or cadaveric person by going through similar testing stages to a person who loses a transplanted kidney for any reason. Third or fourth kidney transplantation is not uncommon, especially in countries where the cadaver system is actively used.
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