FAQ (For Kidney, Liver and Bone Marrow Transplantation)

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KIDNEY TRANSPLANTATION

Kidneys for transplant may come from a person who has died (a deceased donor), or from a healthy living person like a family member or a friend who offers to donate a kidney (a living donor).

People with End Stage Renal Disease (ESRD) may potentially benefit from transplantation. It offers an alternative to dialysis therapy. Transplantation, in general, offers patients a longer, healthier and better quality of life compared to those on dialysis.

Treatment of kidney failure are three types: hemodialysis, peritoneal dialysis and kidney transplantation. However, the best treatment is “kidney transplant”. If a person has a chance of kidney transplantation it is best to have a transplant immediately. The treatment with transplantation offers a healthy life that will not break apart from personal work and social life.

In general, the sooner you get a kidney transplant, the better. The transplant team and your nephrologists will determine the best time for you.

Most transplanted kidneys start working immediately, but some start working slowly and you may need dialysis for one to three weeks after surgery. Nationally, 1 – 2 percent of transplants fail immediately, and 25 percent of patients on average in the nation require dialysis after surgery.

Blood typing (ABO compatibility): Blood typing is the first blood test that must show your blood and the donor’s blood is compatible.

Tissue typing: Tissue typing is a blood test that matches the number of antigens (genetic markers) the donor and recipient share.

Cross-matching: Cross-matching is a blood test you and the donor will have at least two different times to see if you will react to the donor’s kidney.

Antibody levels: If you are on the nationwide deceased donor list, you will need a PRA (panel reactive antibody) test. Antibodies are proteins made by your immune system to fight off bacteria and viruses.

Living kidney donation is a safe surgical procedure. There is a comprehensive process in our world to evaluate every potential live donor. During the evaluation, the transplantation team ensures that the surgical intervention for the potential donor is medically safe and appropriate, depending on the current living conditions.

The risks associated with general anaesthesia are as every major operation. Addition of immunosuppressive drugs (and possible side effects) to existing drugs. It needs continuous care by a kidney specialist. Transplantation is not therapy but treatment.

Kidney waiting list times vary depending on a variety of factors, such as the availability of deceased donor kidneys or your compatibility with a living kidney donor. Our team can give you an idea of the wait time for a kidney after you are assessed.

The entire procedure takes about three and a half hours, which is very similar to the old method of operation. Because the intestines must be moved out of the way to remove the kidney, it can sometimes be two or three days before donors feel like eating again. However, the laparoscopic approach has resulted in shorter hospital stays and significantly less pain and discomfort for the donor and a quicker return to normal activity (usually within two to three weeks).

If the person has live donor, the transfer can be done within 1 week.

Yes. BMI (body mass index) for the body to take the body fat mass ratio must be below 30.

Yes. There is no objection that a woman who has kidney and liver transplantation becomes pregnant after two years.

Yes. Hepatitis B and C patients may have kidney transplant; but the extent to which these diseases affect the liver should be controlled.

Post-transplantation period is as important as transplantation. There are certain medicines that kidney recipients need to use in post-transplant period to protect their health. These are the drugs that you will use to prevent organ rejection.

Yes. Transplantation offers you a healthy lifestyle where you can maintain your social and business life.

After the necessary test results and the reports are examined, the appropriate calendar is informed to the patient by satisfying the conditions.

LIVER TRANSPLANTATION

Anyone with a long-standing (chronic) or sudden onset (acute) severe liver disease leading to liver failure needs to be considered for a liver transplant. The common diseases requiring transplant are advanced liver disease due to Hepatitis C, Hepatitis B, or alcohol induced damage. The other diseases for which this is done are primary liver cancer and biliary problems as like primary sclerosing cholangitis, primary biliary cirrhosis and biliary atresia (children), metabolic diseases.

There is pain after liver transplant surgery, however it is generally not as severe as with other abdominal surgeries. This is because nerves are severed during the initial abdominal incision causing numbness of the skin around the abdomen. These nerves regenerate over the following six months and sensation returns. More common post-transplant discomfort is back pain associated with the length of time on the operating table. The team prescribes the appropriate pain medicine for each patient.

In most cases, the implant may be infected. Hepatitis is not one of the main indications for liver transplantation. If a patient has such indications, specialists may prescribe. In this case, antiviral drugs should be taken before and after a liver transplant to reduce the risk of re-development of the disease.

Rejection is a sign that your immune system has identified the new liver as a foreign tissue and is trying to get rid of it. Prevention of rejection with immunosuppressive drugs is our first priority. Rejection results in any symptoms and fewer liver function tests in routine blood tests. Therefore, in the first three months after transplantation, you need frequent blood tests and then regular tests.

This is a decision made in consultation with all individuals involved in the patient’s care, including the patient and/or family. The patient and family’s data are vital and they must clearly understand the risks involved in proceeding to transplantation.

Many couples are able to have children after liver transplantation with minimal risk to the mother and baby. Women are advised to wait at least one year following transplantation before trying to conceive. It is important to discuss such plans with the transplant team. They will need to carefully evaluate the health and medication regimen of women seeking to become pregnant. Often, changes in medications are recommended. Women becoming pregnant will need to be closely followed by their obstetrician and the transplant team. It is common to require monthly lab testing for pregnant transplant recipients. Babies born to immunosuppressed mothers tend to have lower birth weights than average, but are generally healthy. Planning the pregnancy and receiving close follow-up care throughout are key.

Certain liver diseases can reappear in the new liver. One example is hepatitis C. The transplant team can advise you on the incidence of recurrence of specific liver ailments.

During the first 3 months after transplantation, you will need to be monitored as closely as possible. It is important that you are familiar with the drugs and report side effects. Not all patients who receive liver transplants receive the same drugs or have the same side effects.

After liver transplantation, regular blood tests and sometimes liver biopsies will be performed to ensure that your body does not reject the new liver. In addition, these tests will indicate whether liver cancer is in remission. It is very important that you follow the instructions of the transplant team closely.

Most cancers of the liver begin somewhere else in the body and spread to the liver. These are not curable with a liver transplant. Likewise, the tumours that start in the liver have usually spread to other organs by the time they are detected, and are rarely cured by liver transplantation. Transplantation at an early stage of liver cancer results in long-term survival for patients with less than four tumours, each of which are less than 5 cm in size.

Yes, eating protein will help you maintain as much muscle mass as possible and keep you nourished.

Recovery depends in part on how ill the individual was prior to the surgery. Most patients should count on spending a few days in an intensive care unit and a minimum of about 11 days in the hospital (although the range is five days to six weeks). In cases where there is a risk of recurrence the transplant team will monitor you very closely to help prevent recurrence.

As with other physical activities, sexual activity may be resumed when desired.

Many patients can travel safely. However, they are advised to ask their doctor and inform the transplant coordinator of their destination, contact address and phone numbers before they leave.

It depends on how quickly you recover at home. We advise people to plan on being out of work three to six months after the transplant. Some people are able to go back sooner; some, unfortunately, will not be able to return to work. Our goal is for every patient to return to a productive professional and personal life.

In this regard, the best time schedule is considered by completing the necessary procedure and looking at the patient’s decisions. Therefore, it seems very difficult to determine the time in advance.

BONE MARROW TRANSPLANTATION

Stem cell or the Bone Marrow transplantation is done with two methods- Autologous and Allogenic. In Autologous, the stem cells and the bone marrow used for the surgery is the person’s own. The cells are stored and freezed before the transplant. After the transplantation, the cells are given back through the veins. In Allogenic, stem cells of someone else and with whom the tissue matches are used for the transplant. Suitable donor can be siblings or the closest relative.

The first thing to understand is that there are two different types of transplants. Your physician will recommend the best type of transplant for you, depending on your disease and treatment goals. An Autologous Transplant is when you donate and receive back your own cells. An Allogeneic Transplant is when you receive stem cells from another person. A stem cell donor may be your brother, sister, or even someone unrelated. Your donor needs to have similar tissue typing to you.

The purpose of Bone Marrow Transplantation (BMT) and Peripheral Blood Stem Cell Transplant (PBSCT) in cancer treatment is to enable patients to receive safely very high doses of chemotherapy and/or radiation therapy. High doses of chemotherapy and radiation therapy will destroy cancer cells and some healthy cells. BMT and PBSCT replace healthy stem cells that were destroyed by these treatments. The healthy, transplanted stem cells can restore the bone marrow’s ability to produce the blood cells the patient needs. In essence, this gives the patient a new immune system.

The bone marrow used for autologous transplantation must be relatively free of cancer cells. The harvested marrow is often treated before transplantation with anticancer drugs in a process known as “purging” to get rid of cancer cells. This minimizes the chance of cancer coming back due to transplanting bone marrow that contains undetected cancer cells. Because purging may damage some healthy marrow cells, more marrow is obtained from the patient before the transplant so that enough marrow will remain after purging has been completed.

Factors such as the control status of the disease, the presence of active infection, and the functions of the vital organs are taken into account when determining bone marrow compliance. The optimal time for bone marrow transplantation may vary according to the disease.

There are general age limits accepted for bone marrow transplantation, but it is the general condition of the patient that is more important than age. Although age is appropriate for transplantation, there are patients who cannot be transplanted due to the limitations of vital organs functions. Age may not constitute a significant obstacle, especially in autologous transplant candidates.

Your blood type reflects molecules that are on the surface of your red blood cells. (eg you might be A +). Your tissue type is determined by the molecules present on the surface of the cells in your body. The other name for tissue type is the HLA type (Human Leukocyte Antigen). You inherit six of these molecules from each of your parents (6 pairs in total). Three of these pairs are more important in determining how you accept someone else’s tissue or bone marrow. If you and you sister or brother inherit the same three pairs it is a six out of six matches. Even if you are a 6 out of 6 match you can have a different blood type but this is not important in determining whether someone will make a suitable bone marrow donor.

Nowadays we can make irrelevant donor searches from international bone marrow donor records. There are many patients who benefit from transplantation of bone marrow or stem cells and donated at international centres and brought to our country.

Approximately two to four weeks after your transplant you can expect to see signs of your bone marrow “engrafting” or beginning to grow. The first sign of this is the production of white blood cells. Platelets often take a little longer to begin developing. Once you have engrafted and your condition is stable, you will be discharged from the hospital.

We strongly recommend that you plan to stay in Turkey for at least 3 weeks.

Children born with Thalassemia major usually develop symptom of severe anaemia within the first year of life. Symptoms may appear as they grow:

  • Paleness of the skin
  • Poor Appetite
  • Irritability
  • Fatigue
  • Bone deformity
  • Failure to drive
  • Delayed puberty.

The process is followed by a second opinion after informing the patient about the reports, without losing time with our specialists.

The length of stay in Turkey, will be determined according to data in your report and the procedures. Therefore, the duration of stay varies. The patient follow-up process is performed quickly.

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