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Renal failure is a serious and even killer disease some tenths of years ago. Nowadays there are two possibilities for the patient.  The first one, luckily immediately available, is the dialysis – artificial kidney. The second one, in terms of patient, much better, is a renal transplantation. All over the world and also in our country a continuously increasing number of kidneys have been successfully transplanted already for several tenths of years. The first renal transplantation in Slovakia took place in the year 1972.
The kidney is an organ, which copes very well with changes after the transplantation and yearly survival of a new kidney is 85 – 90 percent. The donor organ may come from a deceased or living donor.

What is the renal transplantation?
It is an option method of the chronic renal failure treatment. A functional kidney from an alive or deceased donor is inserted into the recipient body during the operation. A non-functional kidney remains in its original place unless there is a substantial reason for its removal. In case of a not complicated course the patient remains hospitalized for about two weeks. The patient must – after the transplantation - take an immunosuppressant treatment, which prevents from a rejection of the transplanted organ, till the end of his or her life.

What are the advantages of the renal transplantation compared to the dialysis treatment?
• the transplantation provides the patient with an incomparably higher quality of life and more freedom
• dietary measures after the transplantation are less demanding as they are during the dialysis
• treatment by transplantation is expensive, but, in outcome, it is substantially cheaper than the dialysis treatment!

Places of a new hopefulness
Kidneys from the living and deceased donors are transplanted in Slovakia in four transplantation centers: in the cities of Bratislava, Banská Bystrica, Martin, and Košice.

Who may become a person on the kidney waiting list?
Patient suffering from the chronic renal failure, who agrees with the transplantation and by whom the transplantation is medically possible, becomes a person on the kidney waiting list. The state of health which allows that the patient will get the transplantation and post-transplantation period under control is the condition for it. It is necessary to eliminate a more serious cardiac and pulmonary disability, serious infection or tumor disease in progress, diabetic foot syndrome in case of diabetic patients and psychiatric disease, which would threaten observation of the drug regimen.

Waiting list
If transplantation is possible, the patient is included into the waiting list. The enlistment is indicated by the attending physician of the patient in the dialysis centre. The patient waiting list does not represent a simple rank list. A waiting person is selected for each procured kidney according to the precisely set criteria, which are suggested and approved by the Slovak Society of Cardiology. The main criteria include blood group matching, HLA antigen matching (see the transplantation antigens below), patient sensibilization – antibodies against lymphocytes and period of waiting for kidney. A specific selection of the donor – recipient pairs is done by computer, which disposes of an algorithm according to the set criteria. The aim is to choose the patient with the best probability of a long-term survival of the transplanted organ. It may happen this way that one patient has been waiting for a kidney for several weeks and another one – for several years. The preference in the order is given to the so called urgent patients who are in an immediate threat to life. Small children also represent a special group.

Kidney donor
Numbers of transplantation depend on the numbers of donors and it is still true that “There are no transplantations without donors“. In case of the renal transplantations there are two possibilities: deceased or living donor.

Deceased donor
The deceased donor is the one, by which a brain death was determined and the kidneys are not damaged in contrast to the brain. Any person who suffered from a malignant or serious infection disease may not become a donor. The rules for the organ donation are set by legislation.

Living donor. Who may become a donor?
In the conditions of our country a living donor may be a close relative, husband, wife, as well as emotionally close non-relative person. Such person must meet certain health criteria; he/she must be informed on any risks of the specific intervention and must give his/her consent with the kidney procurement (which is always unpaid). A written consent of both donor and recipient with the procurement and transplantation is required. Any kidney procurement from minor and non sui juris individuals is prohibited. The second kidney of the donor must be healthy and fully functional; the blood groups of the donor and recipient must be compatible to each other. The sale of kidney to any unknown person is not possible in our country (and nor in all developed countries).

Indirect donation
This type of donation is not common in majority of the European countries. In such case the donor is a completely unknown person who donates his/her kidney to someone included in the transplantation waiting list.

Criteria for the donor
• healthy adult blood relative, partner or friend, capable of a general anaesthesia,
• existence of two healthy kidneys,
• matching in blood group and negative cross-match,
• non existence of any disease, which could cause the recipient kidney failure,
• consent with the donation. The donor must be informed and his/her donation must be voluntary.

Advantages of the living donor compared to the deceased one  
• possibility to schedule the operation, even before the dialysis treatment beginning,
• better initial function of the kidney,
• better survival of the transplanted kidney.

Slovak Centre for Organ Transplantation (SCOT)
The SCOT is a national coordinator of transplantation in the Slovak Republic and its tasks include as follows:
1. management and administration of the National Transplantation Registry, it includes the patient waiting list and organ donor and recipient register,
2. administration of the register of persons who refused to donor their organs after their death (so called Non-donor Register),
3. central immunogenetics (HLA) laboratory, which performs: immunological and immunogenetics examinations (HLA typing, antibodies determination, cross-matches and like that) of the patients including in the waiting list, of the organ donors and other patients. It carries out a reference activity in the field of HLA and allele determination.

Laboratory examinations
The renal transplantations are associated with a number of laboratory examinations the results of which often determine whether the transplantation will be realized or not and direct the clinical employees to the adjustment of an optimal treatment.

Determination of the HLA (Human Leukocyte Antigens)
Determination of the HLA is an examination, which determines the transplantation antigens. The HLA are special structures on the surface of the cells, responsible for the transplant rejection. An HLA typing of the donor is carried out before each of the renal transplantations and the data are entered into the computer, which, on the basis of match will choose suitable recipients from the waiting list. Serological methods and the DNA analysis methods are used for the transplantation antigen determination.

Antibodies against the lymphocytes
The human organism creates the antibodies as a response to the extraneous albumins, which it does not recognize. The antibodies are created during the infection encompassment, during the pregnancy, after the transfusion administration and after transplantation. Their task is to protect the organism against any damage. The person, the organism of whom created the antibodies against the lymphocytes (a part of white blood corpuscles), is so called sensibilised patient. He/She often has a positive cross-match and is automatically removed from the selection of suitable recipients because of risk of a hyperacute rejection (very quick rejection of the kidney), regardless of the HLA similarity. There is also a bigger risk of a humoral rejection – graft rejection caused by the antibodies. Such patients usually wait for kidney for the longest time.

The cross-match is a laboratory method, which is carried out before transplantation from the living or deceased donor in order to find out the risk of rejection (transplant rejection). This is a “tube transplantation“, when the recipient serum (non-cell part of the blood, which contains the antibodies) is mixed with the donor lymphocytes with antigens – signs, against which the antibodies may be formed. Patients with a positive cross-match – specific antibodies against the donor cells – may not undergo the transplantation because they most likely would quickly reject the kidney.

Source: Slovak Centre for Organ Transplantation,