Chronic kidney disease (CKD) is caused by progressive deterioration of kidney function due to loss of functional units in the kidneys. Once a large proportion of the functional units have been lost, the patient reaches end-stage renal disease (ESRD). The only option for treating ESRD patients is dialysis, a procedure performed while the patient is waiting for a new kidney from a matching donor. The availability of donor kidneys from living or deceased donors is scarce, and patients often wait for years before a matching donor is found.
How many people need a kidney transplant?
In Europe, there are several transplant waiting lists such as Eurotransplant, ScanTx and others. In 2016, there were 10.901 patients on the waiting list at Eurotransplant and 2.027 patients at ScanTx. The scarce number of available donor kidneys results in long waiting lines, and about half of patients are on the waiting list for 2to 4 years, while a third of patients are on the waiting list for 5 or more years. Based on 2019 data, 71.320 kidney transplants were performed in the regions: Americas, Europe, Africa, Eastern Mediterranean, and Western Pacific.
How are recipients and donors matched?
Potential recipients of a donor kidney are identified based on general criteria such as blood type, length of time on the waiting list, whether the recipient is a child, whether the height of the donor and recipient are a good match, and the severity of the patient's health condition. Other factors used for kidney allocation include a negative lymphocytotoxic crossmatch, the number of HLA antigens shared by the donor and recipient based on tissue typing, and the patient not having a current infection. When matching organs from deceased donors to patients on the waiting list, many of the factors considered are the same for all organs.
How are patients who receive a kidney transplant treated?
Patients receiving a kidney transplant are treated with immunosuppressive treatments (anti-rejection medications). Immunosuppressive treatment of transplant recipients always carries the risk of over-immunosuppression, which has been shown to increase the risk of infections and malignancies, and thus patient mortality.
Medications for rejection after kidney transplantation include:
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