Kidney Transplant

　　Various chronic kidney diseases, if they develop into uremia, are unresponsive to medication, and only dialysis treatment or kidney transplantation surgery can save the patient's life. Dialysis can only remove part of the toxins produced in the body, and long-term dialysis can lead to a series of complications, and the patient cannot leave the hospital for a long time, resulting in a significantly lower quality of life compared to the general population. Kidney transplantation involves implanting a healthy kidney into the patient, which can completely correct the systemic complications of uremia and end-stage renal disease after surgery, allowing the patient to return to society and enjoy a quality of life similar to that of the general population. This is what every uremic patient aspires to, and the long-term cost is lower than dialysis.

　　Some patients may develop irreversible chronic allograft rejection, other late complications include drug toxicity, potential recurrence of renal disease, side effects of prednisone, and infection. Moreover, the incidence of malignant tumors in patients with allogeneic renal transplantation is increased, the risk of squamous cell carcinoma is 10 to 15 times higher than that of normal people, the risk of lymphoma is about 30 times, the treatment of tumors is the same as that of non-immunosuppressive cancer patients, the treatment of squamous cell carcinoma generally does not require reduction or discontinuation of immunosuppressants, but the treatment of rapidly progressing tumors and lymphomas advocates for the suspension of immunosuppressants. In recent years, EB virus-related B cell lymphoma is very common in recipients of grafts, although it has been assumed that various tumors are related to the use of cyclosporine and ALG or OKT3, it is more consistent with the use of more effective immunosuppressants to over-suppress immunity.

　　Acute rejection reaction

　　The diagnosis of acute rejection reaction is sometimes very difficult, and it is difficult to differentiate from other conditions, especially when infection is present. The treatment principle is completely different, and it must be identified in a timely manner.

　　Acute, anuria or oliguria occurs early after renal tubular necrosis surgery, which is often related to renal ischemia, such as prolonged warm ischemia time of the donor kidney, improper perfusion, or prolonged preservation time; or caused by urinary tract or vascular angiography, often requiring renal biopsy to differentiate, and is manifested as interstitial edema, localized ischemia, and extensive tubular变性 and necrosis.

　　Chronic rejection reaction

　　It occurs 6 months to 1 year after surgery, and is the consequence of persistent humoral immunity and cellular immunity. It can have characteristics of both immunological types, often dominated by the former. It is often caused by incomplete treatment of early postoperative rejection reactions or recurrent acute rejection reactions, and is often latent.

　　Clinical manifestations include slowly progressive hypertension, proteinuria, progressive shrinkage of the transplanted kidney, decreased function, hematuria, oliguria, increased blood creatinine, urea nitrogen, decreased intrinsic creatinine clearance rate, and decreased hemoglobin.

　　It is a common preventive measure to pay more attention to diet, supplement nutrition, and ensure sufficient nutrition to improve immunity. The diagnosis of acute rejection reaction is sometimes very difficult, and it is difficult to differentiate from other conditions, especially when infection is present. The treatment principle is completely different, and it must be identified in a timely manner.

　　Due to the antigenic differences between the renal donor and the recipient of renal transplantation, which is the basis for the occurrence of rejection reactions after renal transplantation, the occurrence of rejection reactions directly affects the survival of the transplanted kidney. In humans, the main ones related to transplantation are the ABO blood group antigen system and the human leukocyte antigen system (abbreviated as HLA). In order to avoid or reduce the possibility of rejection reactions after renal transplantation, achieve the success of renal transplantation, and ensure the long-term survival of the transplanted kidney, it is necessary to perform various matching tests before renal transplantation, including blood type, lymphocyte toxicity test, human leukocyte antigen (HLA) system, and selective group reaction antibody (PRA) test.

　　Inquire about medical history and comprehensive physical examination

　　Matching experiment

　　Blood type;

　　Human antibody response test (PRA);

　　HLA typing;

　　Cross-matching test (lymphotropic test).

　　Laboratory examination

　　Blood routine, coagulation time, prothrombin time/partial thromboplastin time;

　　Blood biochemistry routine examination, liver and kidney function, blood sugar, blood lipids;

　　Hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), human immunodeficiency virus (HIV), plasma rapid reagin test (syphilis);

　　Urine routine, urine culture;

　　Stool routine, occult blood test.

　　Imaging examination

　　Chest X-ray, abdominal ultrasound, gastrointestinal barium meal examination (endoscopy if necessary).

　　Electrocardiogram.

　　Special renal examination.

　　Abdominal X-ray + intravenous pyelography, radionuclide renal scan, spiral CT renal angiography.

　　Dietary health care for renal transplantation:

　　1. Dietary during the early postoperative and recovery period (within one month after surgery):At this time, it is necessary to consume sufficient protein and calories to maintain a positive nitrogen balance, promote wound healing, and reduce the risk of infection. After the intestinal peristalsis recovers, semi-liquid foods such as congee, lotus root powder, and egg flower soup can be consumed. However, do not drink milk too early to avoid bloating. Subsequently, semi-liquid foods such as soup noodles, egg custard, and black fish soup can be consumed, and gradually transition to regular food.

　　2. Dietary during the family rehabilitation period:At this time, leaving the close supervision of medical staff, coupled with a significant increase in appetite and rapid weight gain, it is necessary to set long-term dietary management goals.

　　1) Water: The daily water intake should be more than 2000ml.

　　2) Salt: In the early postoperative period, a low-salt diet should be followed, with an average daily salt intake of 3 to 4 grams. After six months, the daily intake should be less than 6 grams.

　　3) Carbohydrates: Include rice and noodles. The daily intake should be about 300 grams.

　　4) Proteins: For an adult weighing 60 kilograms, the daily intake should be 100 to 150 grams, mainly from milk, eggs, lean meat, black fish, crucian carp, crucian carp, etc.

　　5) Fats: Avoid fried foods and limit the intake of high-cholesterol foods such as animal internal organs, egg yolks, crab roe, fish eggs, pork feet, skin, and chicken skin. It is recommended to consume vegetable oils, chicken oil, fish, etc.

　　6) Calcium: Intermittently consume milk, pork ribs, etc. rich in calcium. Adding a little vinegar when making bone soup can increase the solubility and absorption of calcium.

　　3. Avoid consuming food and health products that enhance immune function:Such as white fungus, black fungus, mushrooms, jujube, royal jelly, ginseng, astragalus, codonopsis, Panax notoginseng, American ginseng, pig苓 polysaccharide, Ganoderma lucidum, etc.

　　4. Pay attention to dietary hygieneDue to weakened immune function, it is essential to choose fresh and high-quality food, and avoid consuming spoiled or deteriorated food.

　　New and highly effective immunosuppressants for anti-rejection treatment after kidney transplantation continue to emerge, and the adjuvant drugs used in anti-rejection treatment have also attracted more and more attention. Rational use of adjuvant drugs can help patients reduce economic burden, alleviate the toxic and side effects of immunosuppressants, and protect and improve renal function. The anti-rejection treatment for kidney transplantation is immunosuppressive therapy. It is suitable for any kidney transplant patient except for identical twins; common drugs include:
　　Azathioprine is the most widely used drug for inhibiting organ transplant rejection reactions. The dosage is: 200mg orally the night before surgery, followed by 100mg in the morning of the operation day, fasting for 1-2 days after surgery, so azathioprine is not used. Starting from the third day after surgery, 50mg is taken orally daily until cyclosporine A is discontinued, then gradually reduced to 2mg per kilogram of body weight per day. Dosage should be reduced when liver or renal function is impaired, with the minimum maintenance dose of 0.5-1.0mg per kilogram of body weight per day.
　　Adrenal cortical hormones commonly used are prednisone. It is generally advocated to start medication on the day of transplantation. It is usually administered in a larger dose, about 1-2mg per kilogram of body weight per day, and then gradually reduced to a maintenance dose of 10-20mg per day. Fosphenylprednisolone pulse therapy can be used when necessary.
　　Cyclophosphamide can be used to treat acute rejection reactions by using cyclophosphamide pulse therapy, 200-400mg intravenous infusion daily for 2-3 days. At low doses, it can prevent chronic rejection reactions, with an oral dose of 50-75mg per day.
　　In the early years of cyclosporine, the advent of cyclosporine A brought about a revolutionary progress in the survival rate of kidney transplantation. Due to the strong immunosuppressive effect of cyclosporine A and fewer side effects than prednisone and azathioprine, it has become the first choice for anti-rejection drugs after kidney transplantation.
　　Other drugs for anti-rejection reactions include antilymphocyte globulin, monoclonal anti-T cell antibody, FK506, etc. They are expensive and suitable for kidney transplant patients with delayed renal function recovery and high risk. Continuous use of immunosuppressants is necessary for long-term survival of the transplanted kidney. Kidney transplant patients must not discontinue medication arbitrarily and should regularly visit the hospital for follow-up examinations, report their condition and medication status to the doctor.