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The kidneys have five roles in the body:
When the kidneys fail, they can't do their job as described above, resulting in a number of symptoms. Uremic toxins accumulate due to the inability to break down nutrients, and the inability to maintain water and electrolyte equilibrium and osmotic pressure in the body leads to high blood pressure, arrhythmias, pulmonary edema, nausea, vomiting, and coma. In addition, cardiac arrhythmias and heart attacks can occur due to the failure to maintain acid-base equilibrium, and anemia and fractures can occur due to the inability to synthesize hematopoietic hormones and active vitamin D.
*Glomerular filtration rate: Indicates how much filtrate is produced from the glomeruli in unit time, in ml/min/1.73m2.
The treatment of kidney failure is also called renal replacement therapy. This means that it is a treatment that replaces the kidneys. Methods include hemodialysis, peritoneal dialysis, and kidney transplantation. Among them, kidney transplantation has the advantage of having a higher transplant survival rate than the other two treatments.
The lifespan of transplanted kidneys is 19.2 years according to a 2021 American Journal of Transplantation survey, and 11.7 years for brain-dead transplants. Brain-dead patients generally have comorbidities, and the kidney life expectancy is a little shorter in the case of brain-dead transplantation because the kidney damage inevitably progresses when brain dead.
Even if a kidney transplant proceeds, loss may occur. The main causes are rejection in the body, death of the patient, and recurrence of the original disease.
First, rejection
Since it is not essentially an organ belonging to a recipient*, rejection by the body's immune system occurs. In order to prevent such rejection, it is necessary to take immunosuppressive drugs thoroughly and to monitor drug concentrations regularly. This is because immunosuppressants are so delicate that if you miss them, the concentration will drop significantly, and if you stop taking them and start taking them again, the concentration in your body can go up excessively. It is also recommended to perform regular HLA antibody assessments and surveillance biopsies.
You usually take three different types of immunosuppressive medications a day. Group 1 immunosuppressants are calcineurin inhibitors. Calcineurin inhibitors should be taken twice a day, 12 hours apart, on an empty stomach. In the case of extended-release drugs, it is taken once a day, every 24 hours, on an empty stomach. The reason why it should be taken on an empty stomach is that it must be taken with an empty stomach so that it is fully absorbed. Side effects of calcineurin inhibitors include the risk of infection when acting at excessive concentrations, headaches, hand tremors, numbness of hands and feet, elevated blood sugar, increased blood pressure, hair loss, and kidney failure.
As a second-line immunosuppressive drug, steroids are taken 1 time a day immediately after breakfast. Steroid drugs can cause metabolic side effects such as increased appetite, increased blood sugar and blood pressure, edema, gastrointestinal upset, thinning of the skin, and osteoporosis, so there are cases where the drug is stopped after gradually decreasing.
Group 3 immunosuppressants require metabolic blockers to be taken 1 or 2 times a day.
Second, the death of the patient
The main reasons for the death of patients are infection, cardiovascular disease, and malignant tumors.
In order to prevent post-transplant infection, it is necessary to practice good personal hygiene, and to perform pre-transplant vaccinations, such as the herpes zoster vaccine, and post-transplant vaccinations. In the case of post-transplant vaccinations, live vaccines are not allowed, so live vaccines must be given. Protein antigen vaccines such as flu/herpes zoster protein antigen vaccine and pneumococcal vaccine, as well as gene and transcription vaccines such as corona vaccines, are available. In addition, it can be fatal after transplantation, so you need to be careful to prevent food poisoning.
In addition, a low-salt diet and regular exercise are necessary to minimize the risk of cardiovascular disease, and regular cancer screening, thorough tumor evaluation before transplantation, and thorough use of immunosuppressive drugs are necessary to manage malignant tumors.
Third, recurrence of the original disease
Recurrence of a condition you had before the kidney transplant can also cause kidney loss after transplantation. In order to prevent this, it is necessary to adjust the timing of transplantation according to the activity of the disease, select the donor, and take immunosuppressive drugs thoroughly to reduce the risk of recurrence.
In conclusion, here's how to minimize the side effects of a kidney transplant:
There are medications and foods that you should be careful about taking because of the risk of drug interactions after a kidney transplant. Medications include antibiotics, antifungals, tuberculosis drugs, and the COVID drug Paxlovid. Among antibiotics, macrolide antibiotics should be treated with great care because they can affect even in small amounts. In addition, nonsteroidal antibiotics (NSAIDs) can cause kidney damage. Acetaminophen, such as Tylenol, is okay to take.
Foods to watch out for include grapefruit, which inhibits immunosuppressant metabolism, St. John's wort, which promotes immunosuppressant metabolism with schisandra, and fatty foods, which inhibit the absorption of immunosuppressants
It can vary depending on the body surface area, body mass, and the size of the kidney. One kidney from a well-built person may have better filtration than two kidneys from a shorter person.
Primates such as chimpanzees are so similar to humans that pigs are being studied as an ethical issue. Since pig organs are larger than human organs and have different immune systems, we are conducting research on transplanting organs from pigs that have been genetically modified so that heterogeneous antigens can evade the innate immune system. In Korea, formal clinical trials have not yet been conducted.
In the case of donors, it is necessary to take thorough care to prevent diabetes from occurring, and if high blood pressure occurs, hypertension management should be carried out.
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