For patients with uremia (or impending uremia) whose kidney function is irreversible and reaching end-stage disease, kidney transplantation is the best treatment option. Current controlled studies have confirmed that kidney transplant patients have a longer life expectancy and better quality of life than ordinary maintenance hemodialysis and peritoneal dialysis.
In fact, kidney transplantation treatment can bring so many benefits, not entirely due to the surgery, but also to the management related to the surgery.
1. When to prepare for kidney transplantation?
When most people consider kidney transplantation, they are already undergoing regular hemodialysis and peritoneal dialysis. The remaining kidney function at this time is often less than 10% of that of young and healthy people. Internationally, it is recommended that kidney transplantation should be evaluated when the kidney function is lower than 30%; kidney transplantation can be performed when the kidney function is lower than 20%.
It is generally believed that if a person who is already undergoing regular hemodialysis or peritoneal dialysis undergoes a kidney transplant, the long-term outcome will not be as good as that of an earlier kidney transplant.
Studies have shown that the longer the “dialysis duration” before kidney transplantation, the higher the risk of death after kidney transplantation. And this relationship is “time dependent”. For example, those who have been on dialysis for more than 6 months before kidney transplantation have a higher risk of death than those who do not undergo dialysis.
This higher risk of death may stem from cardiovascular problems. People on long-term dialysis are more likely to have calcium and phosphorus deposition leading to arteriosclerosis.
In addition, long-term dialysis patients are more susceptible to cancer, which also increases the risk of death.
2. What does kidney transplant matching mean?
We know that blood transfusions need to take blood type into consideration. In fact, this refers to the typing of red blood cells. There are multiple classifications based on the characteristics of the antigens on red blood cells.
But kidney transplantation should not only consider red blood cells, but also consider the type of white blood cells. The consensus in the kidney transplant community is that when the human leukocyte antigen (HLA) is matched, the survival rate of the transplanted kidney is higher.
Currently, HLA-A, -B, -C, -Bw4, -Bw6, -DR, DR51/52/53, and -DQB antigens are mainly considered. Especially HLA-A, -B and -DR antigens. Because the mismatch between these three groups of antigens is significantly detrimental to the prognosis of kidney transplantation. Secondly, HLA-DQ antigen also has a greater impact.
3. After kidney transplantation, how many times do I need to meet with the doctor?
Different kidney transplant centers will have different requirements. After kidney transplantation, strict monitoring of rejection, infection risks, etc. is required. Therefore, generally speaking, the frequency of follow-up visits to the hospital is high at the beginning. Over time, the frequency of follow-up visits to the hospital will decrease.
The requirements for some centers are as follows:
1. First month: 2 times a week
2. Second to April: once a week
3. In the first year thereafter: once every two weeks;
4. Once every 1 to 6 months thereafter; lifelong
The above is just a general approach. In fact, different kidney transplant centers will have different requirements. Kidney transplant patients should actively cooperate with the doctor’s follow-up consultation requirements to better harvest their second kidney.
4. What does the doctor’s review include?
The purpose of the re-examination is to monitor the recovery of renal function, immune suppression status, etc. Some must be checked every time, some need to be reviewed at a certain period, and some need to be reviewed depending on the situation.
1. Must check: blood routine, urine routine, creatinine, blood sugar, bicarbonate, electrolytes, urine protein/creatinine ratio, immunosuppressant drug trough concentration
2. Monitoring at different time points:
After kidney transplantation, glycated hemoglobin and blood lipids should be reviewed every 3 months;
Measure parathyroid hormone and vitamin D3 every 6-12 months;
Screen for BK virus every month for the first 6 months and then recheck every 3-6 months.
Those who do not receive cytomegalovirus preventive treatment need to be reviewed for cytomegalovirus nucleic acid testing once a week in the first 3 months after transplantation.
Dietary requirements:
1. Do not eat food that is not cooked thoroughly, do not eat leftover food from every other meal, do not eat fruits that have rotten scars, and do not eat fruits that have been cut and left for several hours.
2. Eat easily digestible foods that are high in protein, low in fat, low in sugar, and rich in multiple vitamins.
3. Avoid taking ginseng and bee jelly immune enhancers.
Functions and adverse effects of food:
1. Milk can cause bloating
2. Animal offal, fat, animal fat, river eel, etc. can increase blood lipids.
3. Ice cream and chocolate can increase blood sugar and blood lipids.
4． Eating too much carbohydrates increases blood lipids.
5. Yogurt can regulate intestinal flora and eliminate bloating.
6. Fresh vegetables are good for supplementing a variety of vitamins and are beneficial for bowel movement.
7． Watermelon is a diuretic and relieves heat.
8. Suitable for high-protein foods, lean meat, river fish, eggs, silky chicken, duck, etc.
More we explain an important life guideline after kidney transplantation
(1) Daily life
1. Measure and record body weight regularly every day
2. Measure body temperature and blood pressure twice a day, morning and evening
3. Record urine and water intake daily
4． Keep detailed records of your general condition, blood pressure, body temperature, weight, etc.
5. Avoid entering public places for six months after surgery. Wear a mask when you must go to prevent infection.
6. A single room is disinfected with household ultraviolet light for 30 minutes regularly every day.
7． Pay attention to personal hygiene and develop the habit of rinsing your mouth after drinking and brushing your teeth before going to bed.
8. Clothing should be loose-fitting to avoid compression of the transplanted kidney by tight clothing.
9. To prevent colds, add clothes in time.
(2) Taking medication
You must abide by the doctor’s instructions every day and do not stop or increase the dosage on your own to avoid inducing rejection or poisoning.
(3) Spiritual aspect
You need to be emotionally stable, optimistic, and cheerful to maintain family harmony. You can do whatever you can, but pay attention to the balance between work and rest. Improve self-cultivation and psychological quality, treat diseases correctly, and do not worry or feel sad when encountering setbacks.
(4) Work
Six months or one year after the kidney transplant, the patient is in good condition and can continue to participate in the work arranged by the unit to the best of his or her ability.
(5) Marriage and love
1. After kidney transplantation, most patients have normal fertility and can get married and have children. Generally, they can start sexual life after six months when they feel comfortable. However, they must not indulge. They must exercise appropriate restraint and pay attention to the location of the transplanted kidney to prevent oppression.
2. Fertility issues: Women who have menstrual resumption a few months after surgery, and who still ovulate even if it is irregular, should use contraception. Long-term use of immunosuppressants may affect the next generation. Even if they must have a next generation, they must wait until at least 2 years. years later.
Indicators that should be observed after renal transplantation
1. The body weight was measured every day and the weight gain was abnormal. The weight increased by 1 kilogram in one day or more than 2 kilograms in 2 days.
2. Record urine output and water intake every day. Normal urine output is 2000-5000ml/24hr, and normal nocturnal urine output is greater than 750ml/12hr.
3. Take your temperature every morning and afternoon
4． Measure blood pressure once a day in the morning and evening
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