Thursday, 19 Apr 2018

“Gifted kidney”. A rare operation can prolong life

16 April 2018, 17:25

American Journal The Atlantic recounts about a rare case of a kidney transplant. In 2017, Vertis Boyce received a call from her surgeon, Geoffrey Vila, who said that she had found a kidney for a transplant. This kidney was transplanted two years ago from a 17-year-old girl to a guy who was 20 with a small one. The young man died during a car accident, Vertis can become the second recipient of this body if he wants to.

Mathematics of transplants
69-Lenya Boyce wanted this, because it was not known how long she would have to wait for another organ to transplant. She did not want to become one of 13 patients , dying a day, expecting a kidney transplant in the US: in the queue for transplantation in 100 000 people, operations are conducted only 17 000 lucky ones per year.
Here it will be appropriate to provide more extensive statistics. In Russia, the need for kidney transplantation implemented by 10%, in the USA by 30%. According to the data of 2013, about 1000 transplants per year are performed in Russia. In 2016, the waiting list for kidney transplantation in the Russian Federation was 4818 potential recipients, that is, 13.8% of the total number of patients receiving hemo- and peritoneal dialysis treatment (35 000 according to the data of the Russian Dialysis Society). The mortality rate in the period of waiting for kidney transplantation in the Russian Federation in 2016 was 1.6% (77 patients). Wherein mortality of patients on dialysis – about 20% per year.

Bodies do not like to use repeatedly
Considering such unhappy and cold mathematics, the sources of organs for transplantation are one of the most important issues. At the same time, the use of organs for the second time is very rarely taken into account. “It’s just a dogma. Repeated kidney transplantation is almost like a taboo, “said Jeffrey Veale, a surgeon at the University of California, Los Angeles, Ronald Reagan UCLA Medical Center.
Of course, there is a reason for limited reuse of organs. “These organs have gone through many stressful situations. Not many of them are good enough for a transplant, “said Richard Formica, a nephrologist at Yale University. He listed the stress factors through which the kidney passes: the death of the first donor, ice, reperfusion injury after transplant, the action of immunosuppressors. And the repetition of this cycle with a repeat transplant.
The centers of transplantation do not want to take organs that are “not perfect” for a number of reasons. The risks of unsuccessful transplants, including the reputation and status of the medical institution, are too high.
Also today, there is no procedure for informing patients that they want to transplant a kidney that has already been transplanted. “Doing this during transplantation would be dishonest. People often refuse and say that it is better to wait for another kidney, a younger one, “says Formica.
In the described The Atlantic the kidney turned out to be quite good: from a young donor, with good indicators of the first recipient. Another problem of a second transplant is the formation of scar tissue on the renal artery. To successfully carry out the transplant, Vil took the donor and a fragment of the iliac artery so that the kidney could take root. Thus, Vertis Boyce received tissue from two donors at once.

Repeated transplant – hundreds of years of life for recipients
For Vila, this was the second kidney transplant operation. This is a really rare procedure: how informs American Journal of Transplantation , from 1988 to 2014 in the United States, 38 kidneys, 26 liverworms and three hearts were re-transplanted. These are too small figures to really compare the effectiveness of retransplanted organs with conventional ones, scientific data on the problem are really very modest.
Given the small number of recipients of organs compared to the total population, the number of organs that can be used a second time is quite small. But this issue is part of the important problem of expanding the pool of donor bodies.
“Between 20% and 25% of patients who live with the kidney transplanted die before the kidneys function normally. These kidneys could give other people so many years of life, “- He speaks Jeffrey Will. In his opinion, such a protocol of transplantation should become the standard.
A second transplant changed the life of Vertis Boyce. She no longer needs dialysis three times a week, she can travel and recently visited her nephew’s wedding. “I’m just fine, I feel free,” she says.

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