How is a kidney transplant performed? What should I do while I am expecting a kidney? Obtain a quota for a federal agency.

Twenty thousand Russians suffering from chronic renal failure are “chained” to the apparatus artificial kidney and several times a week are forced to undergo hemodialysis. Another five hundred of our fellow citizens are in line for a donor kidney. About who most often becomes a donor for a sick person, how much a kidney transplant operation costs and whether it is possible to sell your kidney to another person, told RIA Novosti correspondent Tatyana Vinogradova the day before world day kidneys March 11 Director of the Research Institute of Transplantology and artificial organs named after academician V.I. Shumakov Sergey Gauthier.

Sergey Vladimirovich, how many kidney transplants are performed annually in Russia? How many such surgeries are performed by the Transplant Center?

After some lull, when we had a failure in transplantation in connection with the case of the 20th hospital in 2002-2004, the number of operations has now begun to increase. And in 2009, there were 820 kidney transplants in the country. The year before, 100 fewer transplants had been done. A year before that - another 100 transplants less. That is, a certain growth, by a hundred a year, is a success for us.

Our Center performs more than a hundred kidney transplants annually. In 2009, we performed 106 kidney transplants.

How many people are in line for a kidney donation?

It's not really a queue. This is the so-called waiting list - a list of patients who need transplantation, in this case, kidneys. The waiting list across the country can be counted by several hundred people - somewhere, probably, about five hundred people in total, maybe a little more.

But that doesn't mean it's a finite list. It's just that those patients who have been diagnosed are referred to a transplant center. There they were looked at and told that they really needed a kidney transplant, and in connection with this they were put on the waiting list. In this case, the person understands that he must comply certain rules. And if he got a phone call and was told that there is a donor organ, he should immediately come to the center, and not say that, they say, I changed my mind, sorry, I was joking. A person must make this serious decision for himself.

And then, when he has undergone surgery, he must follow the recommendations of the doctors and take the appropriate medications. Otherwise, the graft function will not be able to provide him normal life.

How long does a person have to wait in line?

It's not a queue - today you, and tomorrow I will. It depends on the compatibility, on the blood type, on the coincidence of some indicators of tissue compatibility. A person is selected from the waiting list when it is the most good combination organ and person. Therefore, it is also a matter of chance.

A person can wait for his kidney from one day to several years. Sometimes people have certain immune characteristics that do not allow you to pick up the first organ that comes across. There are various laboratory tests that allow you to clarify right before the transplant itself whether this organ is suitable for this person or whether it is still better for him not to have surgery this time, because it will be difficult to avoid a rejection reaction, organ death and transplantation will be done in vain.

- How does a person's life change after a kidney transplant?

It usually changes to better side. Very many people who now live and work have transplanted organs. Some employees of our center - too.

Kidney transplant women can have children. If this childbearing age, then why not? Just do not lose touch with the observing doctors, you need to seek the advice of a doctor constantly. And we, together with obstetricians and gynecologists, bring these patients to childbearing. And normal children are born.

- Do all the kidneys take root and are there any statistics on the survival rate of the kidneys?

On the this stage development of transplantology in the world and in Russia, cases of some kind of super-acute rejection - they just transplanted a kidney, liver or heart, and it immediately swelled up and stopped working - are extremely rare. In principle, at the current level of development of the pharmacy of immunosuppressants, that is, those drugs that we use to suppress rejection, this question is practically not worth it. There is no such thing that the kidney will not take root, that the organ will be rejected directly. In the future, chronic rejection syndrome may develop, when over many months, years of work, the function of the organ is gradually lost. This may be. And then the question of retransplantation arises.

How many times can a kidney be transplanted to one person?

Infinitely, but it is desirable to do it less often. There are, for example, cases when a transplanted kidney functions for 30, 20, 15 years. And this is good. Five to ten years is average term for transplanted kidney function at correct selection immunosuppressants, with the right way life. When we talk about kidney transplantation, this is not so relevant - the kidney just stopped working. After all, you can go on dialysis, then prepare for new transplant. Of course, this is undesirable, but, nevertheless, such cases do happen. There are quite successful repeated and even third transplants.

The human body, in connection with the interaction with the organ that was transplanted for the first time, develops a certain immunity. And it is already quite difficult to re-select the corresponding organ that would not be subject to a rejection reaction immediately after transplantation. Therefore, the waiting time for re-transplantation is often long. One kidney does not fit, the other - and then they are waiting for a new one.

- All this time a person lives on dialysis. What is the availability of dialysis centers in Russia? Are they enough?

If you immediately say so in the forehead, then, of course, it is not enough. But now this problem is solved. We now have about 20,000 people on dialysis. Every year, the need for dialysis increases by about six thousand people. A year ago, there were about 17,000 people on dialysis. That is, the progress in providing dialysis places is on the face.

Of course, much depends on how local doctors identify those people who are indicated for dialysis. You need to come to the doctor, the doctor must look and say that a person has kidney failure, take tests, see to what extent this kidney failure is pronounced, and say that you, my friend, need to do dialysis and send him to a dialysis center. But many people do not reach the doctor: medical education not enough, or maybe the doctor will point you in the wrong direction. It happens.

- Who is the most common donor for a person with chronic renal failure today?

Most of the dead are not relatives. There is no sale and purchase of organs in Russia. The donor will not receive any compensation. If a person dies, he donates his organs for nothing. You don't even need parental permission. And it is right.

There are two positions in world law on this matter. There is a presumption of consent, when if there is no refusal, then it is possible. And the presumption of awareness when you need to ask permission from relatives or the patient himself. Or, let's say, a person died, they found him, and he has a letter in his pocket stating that he is ready to become a donor. It's taken abroad and on enough good level supported. In Russia, as well as in Spain and France and in many other European countries, there is a presumption of consent, when it is not necessary to specifically ask for permission. If relatives are against it, then it's another matter, no one will take anything from anyone. But if there is no refusal, then it is generally accepted that this deceased person is a donor.

A living person can also become a donor, but he also cannot make money on a kidney or other organ. It's against the law.

- How much does a kidney transplant cost? Who pays for postoperative medication?

The amount that the state provides is 808 thousand rubles for any type of transplantation. Now the standards are being revised and, apparently, there will be some increase in the cost, because everything is becoming more expensive: both consumables and medicines. Then a person receives immunosuppressants for life and free of charge.

If we talk about what a person should do to keep the heart healthy, everything is simple. Do not smoke, do not eat fatty, do not drink, do not be nervous. From the point of view of preserving the health of the kidney, it is more difficult here, because the kidney is an organ that suffers from various other diseases of the body, in particular infectious diseases. For example, you can have an untreated tooth and get nephritis with kidney damage with a further transition to chronic renal failure. Therefore, there should be a common culture here, and overall health should be monitored.

- Is it necessary to somehow change the "donor" legislation?

The law is sufficiently civilized and based on foreign analogues and doesn't contradict anything. There is no need to change the legislation, it is necessary to change the attitude of the population and the medical community to the need for development posthumous donation organs. To do this, a person during his lifetime must know and understand that in the event of death he can bring some relief or recovery to at least five people, prolong their life, prolong the normal life of their families. But you need to carry this in your subconscious, not be tuned in such a way that “I died - and burn everything with fire!”. This should not be.

Abroad, there is a tradition: if someone close died, then this person after death became a donor for someone. People know that his heart was transplanted to another person, a neighbor or a nonresident. And between these families friendly relations are fastened. Because the heart of a loved one continues to live in this person. This is a very subtle understanding, but it should be. We need to come to this, it must be at the level of national self-consciousness.

- Can a foreigner in Russia sign up for a "waiting list" and transplant an organ?

A conference will soon be held in Madrid to discuss the issue of donation in terms of self-sufficiency of the country's population to provide itself with donor organs.

After all, you can go to the USA, pay a lot of money, and they will transplant an organ to you, which means that this organ will not go to someone in the USA. Question: what is the point of the United States to transplant organs to people from other countries? Purely commercial. In our country, this is impossible, because there is a shortage of organs in Russia, and the arrival of a foreigner to us to have an organ transplanted is logically impossible. Because we have huge transplant waiting lists that need to be filled. And, accordingly, we have no right to make such operations to foreigners, even if they pay a lot of money. Because we are depriving our own member of society of the opportunity to receive this organ. This is called transplant tourism, against which all normal civilized transplant societies are fighting in the world.

And Russia signed the Istanbul Declaration, which says that this kind of tourism is a harmful phenomenon and unacceptable for civilized countries.

- Can any organ be transplanted to a person or are there any restrictions?

No, not any, because you need to know why to transplant and what will happen next. Transplantation is an event that is associated with subsequent artificial suppression of immunity. That is, to some extent, we create an immunodeficiency in order for the organ in the body to hold on, take root, and function. Creating an immunodeficiency is a certain risk for a person, therefore, in order to give an indication for transplantation, you need to understand that without transplantation, a person will definitely die or he will develop complications from which he will die a little later. We take risks precisely for the sake of saving lives through transplantation. To do this, there are commissions for the selection for transplantation. It's not just like that: a person came and wants a kidney transplant. It is transplanted not because a person will die tomorrow if a kidney is not transplanted to him, but because he becomes very dependent on circumstances. He is on dialysis. Whether he will receive dialysis or not also depends on the circumstances: how he will tolerate this dialysis, how socially limited he will be in this regard. After receiving a donor kidney, a person becomes normal member society.

In order for the patient to have a full life after a kidney transplant, it is required to follow all the recommendations of the doctor in the process. postoperative rehabilitation. In this case, the first time the patient is shown to remain in a hospital under strict supervision. The doctor daily monitors the patient's health status, monitors how the kidney takes root, how fully it functions and copes with tasks. During the recovery process, what dietary rules should be followed, what strength is allowed, and what are the chances of living a full life after an organ transplant?

Life after a kidney transplant will be different from usual, and following the doctor's recommendations is a condition for the length of the patient's years.

After it passes critical period, in which the development of complications after a kidney transplant is possible, the patient will need to strictly monitor their health. Compliance therapeutic diet counts important point which will provide the patient with a healthy and full life. Principles of a therapeutic diet in postoperative period based on rules healthy lifestyle life and nutrition. The patient should limit their use simple carbohydrates, which do not bring any benefit to the body, at the same time increase the level of cholesterol and glucose in the blood. These products include:

• bakery products from higher grades flour;
• sweet desserts, milk chocolate;
• fatty meat, smoked meats;
• some types of cereals (semolina, wheat, millet).

If blood tests show an increase in cholesterol, you need to limit the consumption of foods that contain a lot of fat. These are dairy products fatty varieties meat and fish, butter and vegetable oil, lard. It is advisable to refrain from out-of-season vegetables and fruits, as they contain a lot of nitrates, and this can cause kidney complications. In the postoperative period, you need to adhere to the drinking regimen. You need to drink at least 1.5-2 liters of liquid per day, mostly clean drinking water. With caution, drink store-bought juices, fruit drinks. Under strict prohibition are alcoholic drinks, beer, sweet soda, and you need to give up cigarettes.

Physical exercise

After a kidney transplant, a person needs to limit heavy lifting, especially in the first six months. It is permissible to lift a load weighing no more than 6-7 kg. Classes are welcome physical therapy preferably under the supervision of a specialist who is aware of the diagnosis. In this case, he will select a set of exercises aimed at keeping the body in shape, while the load will not negative impact on the internal organ after transplantation.

Immunosuppressive Therapy

After kidney transplant surgery, it is important to carry out immunosuppressive therapy, in which the doctor prescribes the use of drugs - Neoral, Prednisolone and Mifortic. When taking Neoral, the doctor sets the dose depending on how the drug is concentrated in the blood. The medicine should be taken at the time determined by the doctor, while the twelve-hour interval must be strictly observed. The medicine can be drunk before or after meals, washed down with juice (except grapefruit) or compote.

"Prednisolone" is shown to drink in the morning, before that, be sure to have breakfast. "Mifortic" is also taken after a meal; when distributing the dosage, it is important to adhere to the twelve-hour interval. The above drugs have side effects, so you need to strictly agree on the dosage with your doctor and stick to it. In the first six months or a year, there is a high probability of developing inflammatory processes in the organ after transplantation, so you should always have antibiotics, uroseptics, and sulfanidamides in your first aid kit.

Diseases infectious diseases after kidney transplant requires immediate therapy to prevent possible complications.

What to do if you get ARD?

First of all, you need to drink plenty of fluids, take the antiviral "Gerpevir" or "Acyclovir" as prescribed by the doctor. If the body temperature is elevated, it is indicated to take paracetamol. When the fever does not subside within 3 days, it is possible to develop inflammatory process, so you can’t delay a visit to the doctor, because with untimely treatment arises severe complication, which is fraught with pathologies of the kidney after transplantation and can cost the patient his life.

Kidney rejection

If a person has kidney rejection after a transplant, it is important to identify the pathology in time and start adequate treatment. In this case, the process can be stopped and the organ can be saved normal condition. In the process of rejection, the transplanted kidney ceases to function normally, but the doctor will immediately see the changes and prescribe a therapy regimen. Modern medical methods preparation of the patient for kidney transplantation in most cases prevent the development of complications and rejection, however, if this happened, then timely medical care will help to improve the condition of the organ after transplantation.

Is it possible to give birth with a transplanted kidney?

It turns out that after a kidney transplant, a woman can endure and give birth completely healthy child However, during pregnancy you need to be under strict medical supervision. If a woman, according to indications, underwent a kidney transplant operation, then she can become pregnant after at least 3 years. During this period, the kidney completely takes root, and the threat of complications passes. Doctors do not recommend planning a child later than 7 years after surgery, since a longer period may develop nephropathy in the donor kidney.

The course of pregnancy

During the course of pregnancy, a woman should always be under the supervision of a doctor, since during this period the likelihood of complications is high. In most cases, during pregnancy with a transplanted kidney, bouts of anemia, kidney failure, and inflammatory processes develop. Pyelonephritis is due to insufficient blood supply kidneys and formations in it stagnant processes. Especially the danger develops in the last stages of pregnancy, when the growing uterus and the baby put pressure on the organs abdominal cavity. With pyelonephritis, blood tests show an increase in leukocyte and erythrocyte counts in the blood, and general analysis urine shows the presence of leukocytes, erythrocytes, pus and mucus in it.

Often people have kidney failure. In order to fully recover and get the body working normally, a kidney transplant is often required.

• wrong way of life;
• disturbed metabolism;
• trauma;
• urological diseases;
• consequences of diabetes and other serious illnesses.

The decision to transplant a kidney is made in the event that a person has a condition that is not treated with medication, and dialysis is powerless.

Transfer line

When the question arises as to whether a kidney transplant is needed, the patient is transferred to dialysis - the temporary maintenance of the kidney in working condition, and is included in the list for organ transplantation. The list of people in need of a transplant is usually long, but this does not mean that a patient will be the last to receive their kidney if they are at the bottom of the list. There are a number of indicators that donor kidney may be suitable for one patient and completely unsuitable for another. Thus, the wait can take both a few days and several years. The best option for seriously ill people is a kidney transplant from a close relative, if he agrees to become a donor. The reason for this is the presence of some identical proteins in the blood, a similar Rh factor and the same antibodies. In relatives, they are the most suitable for each other. If the relative agrees to become a kidney donor for the patient, the operation is performed in urgently, and the patient leaves the list of organ donor candidates.

To get on the waiting list for a kidney transplant, you must undergo a typing procedure, in other words, take a blood test for the presence of antigens. They are compared with other antigens in the donor organs in the database and thus they find the donor organ that is as close as possible in terms of blood composition, which will definitely take root in the body and will not cause rejection. immune system. However, the body cannot fully accept a new internal organ, so those who have already had a kidney transplant take immunosuppressive drugs to avoid the process of organ rejection.

Both relatives and strangers can become donors, but most often the donors are recently deceased people who were brought to the hospital. Victims of accidents, traffic accidents, electric shocks often receive injuries incompatible with life, but nevertheless their organs remain intact. If these people during their lifetime ever signed a consent to use their organs after death, or if their relatives agree to transplant their organs to people in need, then the organs are carefully cut out, placed in a special solution and “pickled” until required, after checking the indicators. From the moment of death of a person from which an organ can be removed, no more than 1 hour should pass.

Preparing for a transplant

Human immunity is designed in such a way that when foreign substances are detected in the body, antibodies immediately begin to be produced in order to protect the system and prevent foreign cells from creating "chaos" in it.

Therefore, for those who are waiting for a kidney transplant, it is important to observe the following rules:

• do not do a blood transfusion;
• avoid contact with foreign proteins in your body;
• maintain good health;
• observe hygiene;
• prepare in advance for your stay at the transplant center;
• always stay in touch with your doctor.

A donor organ can be found at any moment, and by that time the patient should be healthy and feel good. Main enemy Kidney transplants are an infection that suddenly manifests itself in the body, so hygiene is important, especially the oral cavity - bacteria multiply there, which can subsequently adversely affect the survival of the kidney in the body.

Long-term departure and change of residence while waiting for a kidney is also not best options, but if nevertheless there was a need to leave the city, the doctor should be warned about this. Abrupt change climate has a bad effect on the well-being of a patient with kidney failure, and unfamiliar bacteria in environment pose a danger.

Operation

The found donor organ for the patient must meet certain parameters, namely:

• compatibility of blood cells with the patient;
• kidney size;
• kidney age (the difference between the donor and the patient should not exceed 15 years);

If the organ meets all requirements, the patient is informed about the operation. Certain documents should be prepared for it: take an extract from the hospital about the latest tests and injections, and sign the consent to the operation directly in the center itself.

A day or at least a few hours before the operation, the patient should not eat and drink in order for the transplant to be successful. Before the operation itself, there is one more control examination of the patient to identify possible problems with health. Everything is measured: height, weight, arterial pressure. The blood is checked for the presence of electrolyte disorders, the level of hemoglobin and hematocrit in the blood should be normal. Since the operation will primarily affect the blood, if abnormalities are found in it, hemodialysis will be performed, which will bring the indicators back to normal.

Another thing to consider before the operation is anesthesia. As a rule, clinics offer several types of anesthesia - gentle or deep. Anesthesiologists often advise a more gentle one, as it has less consequences, but if the patient high sensitivity to pain, the only option is deep anesthesia. After all necessary activities, including sanitary, kidney transplant operation begins.

Contraindications

For many patients, a kidney transplant would be a real salvation from pain, but alas, not everyone can be saved. Available multiple contraindications for this operation. Kidney transplant is only possible healthy body, without spreading diseases and infections on late stage: for example, tuberculosis or HIV infection and a kidney transplant are incompatible, because it makes no sense to introduce into an infected organism healthy organ, to do such a complex and expensive operation as a kidney transplant, if over time the disease hits her.

If the patient has not undergone immunosuppressive therapy incorrectly, in other words, the use of drugs to create favorable conditions for acceptance internal organ organism, kidney transplantation may not be performed, in which case all the blame falls on the patient.

Patients who have neoplasms in the body or who have recently had their malignant tumors, also cannot be applicants for a transplant. Observation of them takes from 2 to 5 years, during this time it is forbidden to do any operations, since the risk is high. residual effects in the body.

Patients with an open stomach ulcer or with heart failure may simply not undergo surgery.

Effects

Do not expect immediate improvement immediately after a kidney transplant. It takes several days for the new kidney to start functioning and the body to get used to it. kidney failure disappears completely after a few weeks. correct reception recommended drugs. Life after a kidney transplant involves taking a lot of pills, but it's worth enduring it all for the sake of the result.

Immunosuppressive drugs are needed so that the body accepts the new organ as “its own”, and does not reject it. This happens because in the new organ there are other proteins that are dissimilar in DNA, which fall under the attack of lymphocytes - the "defenders" of the body.

Suppression of the body's defense system is fraught with instability to various kinds infections, so the operated patient is transferred to a sterile ward. It is better to visit the patient 1 or 2 weeks after the operation, since by this time the result of the operation will be visible and the patient will recover.

The worst fear for many is organ rejection, but this rarely happens if the course of steroids is taken correctly. Rejection occurs gradually, and therefore experienced doctors able to detect it even on the most early stages and start appropriate treatment.

When rejected, the transplanted kidney stops working properly, and if you do not react in time, it will die.

In general, a kidney transplant helps to extend the patient's life by an average of 5-10 years, during which he will be able to fully function. In case of a negative outcome of kidney transplantation, you can try again. If the patient meets all the criteria, he again stands in line. You can transplant kidneys to a person an unlimited number of times, but preferably at large intervals.