In 2012, the average age of the grafted rose from 45 to 50.1 years, while that of living or deceased donors is about 54 years. But age is not always a barrier to kidney transplantation. Indeed, kidney transplants are performed in people over 65 years. Currently, kidney transplantation is also possible in every severe renal impairment provided that the operative risk is not excessive, particularly cardiovascular risk and there are no cons-indication to immunosuppressive therapy. As with other transplants men predominate, accounting for 61.2% of the beneficiaries. Finally, 86.2%, it was re-transplantation. This means that a transplanted kidney has a limited life, but also that people who have had a kidney transplant have a good life expectancy.
Deceased donor or living donor
Transplantation or renal transplantation can be performed from a donor brain death or a related living donor. Indeed, one kidney is sufficient to ensure the formation of urine. Currently living donor transplantation can be done between close relatives (parents, children, siblings, uncle, aunt, cousin), but also from the brothers-in. The risk of these interventions is low, for the donor but not zero (immediate surgical risk: 0.05%; subsequent accident risk on the remaining kidney: 0.07%). The donor must be over eighteen, applicant and voluntary. The gift may also come from the spouse, or a person providing evidence of a life or a stable emotional relationship with the recipient for at least two years after approval of a judge. It is now possible to make a donation crossed when two people close are not compatible, two couples recipient / donor having cross-matching may proceed to an exchange of organs.
Regarding the transplant from a dead donor status, renal sampling criteria were broadened due to the aging population, the decreasing number of injury deaths and the increase in older donors 50 to 64, and even over 65 years. These die more often from cardiovascular diseases. In order to have these plugins, an ambitious program was set up to develop the use of renal perfusion. With this technique, the function of kidneys from deceased elderly vascular causes (called extended criteria donors) can be optimized for better efficiency and graft survival.
Moreover, whether living or deceased donors, according to the Biomedicine Agency, ideally, renal transplantation should be possible in advanced renal failure situation, even before the patient has need to be dialyzed.
The benefits of transplantation from living donor
In 2013, the Biomedicine Agency launches among others, a campaign to promote living donation. It recalls as well as for kidney transplant, living donation has advantages including the survival of transplanted kidney: one year and 5 years, it has 90.9% and 79.1% for transplant respectively from a deceased donor. It increases to 98.1% and 89.7% respectively when the transplant from a living donor. Several factors explain this difference as a better kidney gave his life (from a healthy person with good kidney function), a transplant performed soon after extraction of the donated kidney, which reduces oxygen deficiency in the kidney grafted, or the absence of inflammatory lesions in the kidney from a deceased donor. The Agency also recalls the low operative risk to the donor and the availability of funding for hospital care for renal sampling in the living donor (see our article Increase awareness kidney transplant from a living donor ) .dropoff window
The course of the transplant
To reduce the risk of releases, we try to graft most compatible possible kidneys. The donor must be of the same blood type and, if possible, the same in the HLA (identical twins) or semi-identical. The results of these transplants with living donors are better because the intervention is planned in advance (recipient and donor are operated simultaneously by two different teams in two adjacent rooms transaction), there is a better compatibility, so less risk of rejection, and especially the kidney is better because it is grafted immediately after collection. But in 2012, only 12% of kidney transplants were performed in France from living donors (against 6% in 2003). Although transplants from living donors are rising, they remain limited in our country. Indeed, the proportion is much higher in the United States (about 45%) and in some European countries, including Germany, the UK and especially in Norway where 60% of transplants are from living donors .dropoff window To fight against the shortage of organs, the National Academy of Medicine had expressed the wish that the conditions of living donor grafts are relaxed and extended to aunts and uncles, cousins, brothers-and possibly partner or companion of the recipient. A revision of the bioethics laws has subsequently been passed to this effect in July 2011, expanding the circle of potential living donors (see above). It should be noted that prior to the donation, the donor must be interviewed by a committee to authorize the taking. This interview is not required when the donor is the father or mother of the recipient, unless the magistrate in charge with the consent deems necessary. After the procedure performed, the donor can resume his professional activities after 3-4 weeks of work stoppage.
The kidney can be stored for 48 hours at a temperature of 4 ° C after collection. When a kidney taken from a brain-dead state is available, the team of transplant center has one hour to accept it. After this time, it is proposed to another team. Patients on waiting lists must be joined at any time and stand ready to respond to a transplant proposal. Today, in practice, the process between the identification of a potential donor and implantation in the recipient lasts about 24 hours.
Before transplantation, lymphocyte crossmatch is performed in the laboratory, to verify that the patient has no antibodies developed during a first transplant, transfusion or pregnancy. These antibodies are able to react against the graft and cause hyperacute rejection.
The surgery usually lasts about three hours. The diseased kidneys are left in place unless there is a risk of infection or high blood pressure.
The new kidney is introduced into the lower part of the abdomen and connected to the bladder. The vessels are then sutured. Blood may then again be filtered by the kidney, which ensures its purification function. Sometimes, a few weeks are needed before the kidney gets back to work and dialysis should be maintained during this time.
Half of transplant patients are within 15 months. However, the average waiting time is growing despite an increase in transplant activity: in 2012, it was 22.4 months for kidney transplant. Some people are a priority, including people in emergency situations, for which it is more difficult to find a suitable kidney because they have developed antibodies or are a rare group, and children.
In practice, since 2007, in the absence of priority patients, a score allocation is given to kidney transplants waiting list patients in France. This system allows each patient to have comparable chances of receiving an organ according to various well-established criteria.
Note finally the relatively frequent opposition to the removal from people in a state of brain death (38.8% on average at the national level in 2012 and to 60% in some areas). Some people have to wait several years before they are offered a compatible kidney. Fortunately, deaths are relatively rare in the waiting list.
After the transplant
Hospitalization for at least a week (sometimes more) is required after the procedure. The very demanding regime (without salt or potassium) required when hemodialysis may be abandoned, but a healthy diet is essential, in particular avoiding salty foods. After the first time, the grafted person feels in much better shape after transplantation.
The risk of death is 2-3% during the first year. But then it is less important in cases of hemodialysis. In 2012, the survival of the transplanted kidney to one year and at 5 years was 90.9% and 79.1% respectively in case of transplant from a deceased donor. It increases to 98.1% and 89.7% respectively when the transplant from a living donor. Considerable progress has been made in 10 years. Compared to patients transplanted between 1985 and 1987, a functioning graft survival rate was only 83.3% at one year and 65.2% at 5 years.