What is a kidney transplant?

A kidney transplant is a surgery done to replace a diseased or injured kidney with a healthy kidney from a donor. 肾脏可以来自已故的器官捐赠者，也可以来自活体捐赠者. Family members or others who are a good match may be able to donate one of their kidneys. 这种类型的移植被称为活体移植. 捐赠肾脏的人可以用一个健康的肾脏过上健康的生活.

接受移植的人通常只能得到一个肾脏. 在极少数情况下，他们可能会从已故捐赠者那里得到两个肾脏. 患病的肾脏通常留在原位. The transplanted kidney is placed in the lower belly on the front side of the body.

为什么我可能需要肾脏移植?

如果你患有终末期肾病(ESRD)，你可能需要肾脏移植。. 这是一种永久性的肾衰竭. It often needs dialysis. 这是一种用于清除血液中的废物和其他物质的过程.

The kidneys:

• 将尿素和液体废物以尿液的形式从血液中排出. 尿素是由含有蛋白质的食物产生的, such as meat, poultry, and certain vegetables, are broken down in the body. 尿素在血液中被运送到肾脏.

• Balance salts, electrolytes, such as potassium and sodium, and other substances in the blood

• 制造促红细胞生成素，一种帮助红细胞形成的激素

• Regulate blood pressure

• 调节体内液体和酸碱平衡，保持中性. 这是人体许多过程正常运作所必需的.

可能导致ESRD的肾脏疾病包括:

• Repeated urinary infections

• Kidney failure caused by diabetes or high blood pressure

• Polycystic kidney disease or other inherited disorders

• 肾小球肾炎，这是肾脏滤过单位的炎症

• 溶血性尿毒症，一种罕见的疾病，会导致肾衰竭

• Lupus 以及其他免疫系统疾病

• Obstructions

Other conditions, 比如肾脏的先天性缺陷, 是否需要进行肾脏移植.

There may be other reasons for your healthcare provider to recommend a kidney transplant.

肾移植有哪些风险?

与任何手术一样，并发症也会发生. 一些并发症可能包括:

• Bleeding

• Infection

• 通往新肾的血管阻塞

• 输尿管尿漏或尿在输尿管阻塞

• 刚开始的时候，新肾脏功能不足

新的肾脏可能会被排斥. 排斥反应是身体对外来物体或组织的正常反应. 当一个新的肾脏被移植到接受者体内时, the immune system reacts to what it thinks is a threat and attacks the new organ. 移植器官才能存活, medicines must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object.

用于预防或治疗排斥反应的药物都有副作用. 确切的副作用取决于所服用的具体药物.

不是每个人都适合肾脏移植. 如果你有以下情况，你可能不符合资格:

• 不能有效治疗的当前或反复发生的感染

• 癌症已经从原来的部位扩散到身体的其他部位

• 严重的心脏或其他健康问题使得手术不安全

• Serious conditions other than kidney disease that would not get better after the transplant

• 不遵守治疗计划

根据您的具体医疗状况，可能会有其他风险. Be sure to discuss any concerns with your transplant team before the procedure.

我该如何为肾脏移植做准备?

从已经死亡的器官捐献者(尸体)那里获得肾脏, you must be placed on a waiting list of the United Network for Organ Sharing (UNOS). Extensive testing must be done before you can be placed on the transplant list.

移植团队负责对肾脏进行评估. 该团队包括一名移植外科医生, a transplant nephrologist (healthcare provider specializing in the treatment of the kidneys), 一名或多名移植护士, a social worker, 精神科医生或心理学家. 其他团队成员可能包括一名营养师, a chaplain, your primary care provider, 麻醉师或护士麻醉师.

The evaluation includes:

• Mental health evaluation. 涉及器官移植的心理和社会问题, such as stress, financial issues, 并评估家庭和重要他人的支持. 这些问题会极大地影响移植的结果. 对活体供体进行同样的评估.

• Blood tests. 验血是为了找到合适的供体, 检查你在捐献名单上的优先级, 也可以增加供体器官不被排斥的几率.

• Diagnostic tests. Diagnostic tests may be done to check your kidneys as well as your overall health status. These tests may include X-rays, CT scan, ultrasound, kidney biopsy, and dental exams. 女性可以做巴氏涂片检查、妇科检查和乳房x光检查.

移植团队会权衡采访中的所有事实, your medical history, physical exam, 还有确定你是否有资格接受肾脏移植的测试.

Once you have been accepted as a transplant candidate, you will be placed on the UNOS list. 当供体器官可用时, 我们会通知你，让你马上到医院来.

If you are to get a kidney from a living family member (living-related transplant), 移植可以在计划的时间进行. 献血者必须血型相容且身体健康. A mental health check will be done to be sure the donor is comfortable with the decision.

这些步骤将在移植前进行:

• Your transplant team will explain the procedure to you, and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the surgery. 仔细阅读表格，如果有不清楚的地方问问题.

• 如果你在手术前做过常规透析, 手术前你会做透析.

• 计划活体移植, 手术前你应该禁食8小时, generally after midnight. 在尸体器官移植的案例中, 一旦你被告知有肾可用，你就应该开始禁食.

• 在手术前，你可能会服用镇静剂来帮助你放松.

• Based on your medical condition, your transplant team may ask for other specific preparations.

肾脏移植会发生什么?

肾脏移植需要住院治疗. Procedures may vary depending on your condition and your healthcare provider's practices.

一般来说，肾移植的过程如下:

1. 你要脱下衣服换上病号服.

2. 将在您的手臂或手上开始静脉注射. More catheters may be put in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for catheters include under the collarbone area and the groin blood vessels.

3. 如果手术部位的毛发太多，可以剃掉.

4. 一根导尿管将插入你的膀胱.

5. 你将被安置在手术台上，仰卧.

6. Kidney transplant surgery will be done while you are asleep under general anesthesia. 一根管子将从你的嘴插入你的肺部. The tube will be attached to a ventilator that will breathe for you during the procedure.

7. 麻醉师或麻醉师护士会密切观察你的心率, blood pressure, breathing, 以及手术期间的血氧水平.

8. 手术部位的皮肤要用消毒液清洗.

9. 外科医生会在一侧的下腹做一个长切口. 在移植肾脏之前，外科医生会目视检查供体肾脏.

10. 捐赠的肾脏将被植入腹部. A left donor kidney will be implanted on your right side; a right donor kidney will be implanted on your left side. 这使得输尿管很容易连接到膀胱.

11. The renal artery and vein of the donor kidney will be sewn to the external iliac artery and vein.

12. 在动脉和静脉连接之后, the blood flow through these vessels will be checked for bleeding at the suture lines.

13. The donor ureter (the tube that drains urine from the kidney) will be connected to your bladder.

14. 切口将用缝线或手术订书钉缝合.

15. 可在切口处放置引流管以减少肿胀.

16. 将使用无菌绷带或敷料.

Talk with your healthcare provider about what you will go through during your kidney transplant.

肾移植后会发生什么?

In the hospital

• 手术后，你将被带到恢复室. Once your blood pressure, pulse, 呼吸稳定，你也很清醒, 你可能会被送往重症监护病房(ICU)进行密切监测. In time, you will be moved out of the ICU to a regular nursing unit as you recover and you are closer to going home. 肾移植通常需要在医院住几天.

• 活体捐赠者的肾脏可能马上就开始分泌尿液. 尸体肾脏的尿液生成可能需要更长的时间. 你可能需要继续透析直到尿量正常.

• 你的膀胱里会有一个导尿管来排出你的尿液. 将测量尿液量以检查新肾脏的工作情况.

• 你需要静脉输液，直到你能自己吃饱喝足为止.

• Your team will closely watch how your antirejection medicines are working to make sure you are getting the best dose and the best combination of medicines.

• 血液样本将经常被用来检查新肾脏的状态, 以及其他身体功能, such as the liver, lungs, and blood system.

• 你会慢慢地从液体食物转向更多的固体食物. 在新肾脏完全正常工作之前你的饮水可能会受限.

• 通常，在手术后的第二天，你可以开始走动了. 你应该起床，一天活动几次.

• 根据医疗保健提供者的建议，服用止痛药缓解疼痛. Don't take aspirin or certain other pain medicines that may increase the chance of bleeding. 一定要只服用推荐的药物.

• Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital, 包括对切口的护理.

• 生命体征稳定后就可以回家了, the new kidney is working, 而且你也不需要长期住院治疗.

At home

• 一旦你回到家，保持手术区域的清洁和干燥是很重要的. 你的医疗保健提供者会给你具体的洗澡指导. Generally, 在皮肤愈合之前，不要将切口浸入水中, 因为这会增加感染的风险. The stitches or surgical staples will be removed during a follow-up office visit.

• 在你的医生告诉你没事之前，你不应该开车. Plan to have someone drive you home from the hospital and to your follow-up appointments.

• Avoid any activity or position that causes pressure to be placed on the new kidney. 可能会有其他活动限制.

• 每天在家检查血压和体重. 这些增加可能意味着你的肾脏不能正确过滤液体. 你需要马上去看你的移植小组.

如果您有以下情况，请告知您的医疗保健提供者:

• 发烧，这可能是排斥反应或感染的征兆

• 切口部位出现红肿、出血或其他渗出物

• Increase in pain around the incision site, which may be a sign of rejection or infection

Fever and tenderness over the kidney are some of the most common symptoms of rejection. A rise in your blood creatinine level (blood test to measure kidney function) or blood pressure may also suggest rejection. 排异反应的症状可能看起来像其他疾病或问题. 和你的移植团队谈谈你的顾虑. 经常拜访并与移植团队联系是至关重要的.

远离你可能接触到任何可能生病的人的地方. This is because your immune system will be suppressed to protect you from rejecting the new kidney. 这将是终生的预防措施.

您的医疗团队可能会在手术后给您其他指示, depending on your situation.

如何防止被拒

让移植的肾脏在你体内存活, 在你的余生中，你将被给予药物来对抗排斥. 每个人对药物的反应可能不同.

新的抗排斥药物不断被开发和批准. 您的医疗团队将根据您的需求量身定制药物治疗方案.

通常一开始要服用几种抗排斥药物. 根据你的反应，这些药物的剂量可能会经常改变. Because antirejection medicines affect the immune system, you will be at higher risk for infections. A balance must be maintained between preventing rejection and making you very susceptible to infection.

Some of the infections you will be especially at risk for include oral yeast infection (thrush), herpes, and respiratory viruses. Stay away from crowds and anyone who has an infection for the first few months after your surgery.