Terminal Chronic Kidney Disease (TCKD) is diagnosed when it presents a malfunctioning kidney which accumulates harmful substances and loses useful substances for the body.
 
Among the symptoms are presented in the TCKD are: urinate less times and less amounts, swollen eyelids early in the morning, fatigue, feeling sick and loss of appetite.

TCKD is diagnosed when the residual kidney function reaches 60 ml x minute. But when this function is reduced to 5 to 10 ml per minute the patient needs any of the alternative treatments to survive:

These three treatments for this disease are:

• PERITONEAL DIALYSIS: In the belly of the patient, the doctors place a plastic tube, to allow liquid to pass to the interior, they leave the liquid inside the body for a few moments and then later remove the liquid. That way the debris that the kidneys no longer can remove is eliminated.
• HEMODIALYSIS: It filters the blood through a machine, the procedure lasts between two and five hours and is performed three times a week or so.

Transplant: It consists of placing the kidney of another person (donor) in the lower right or left quadrant of the abdomen of the patient (host) with the result being that this new kidney filters the blood and eliminates the toxic substances in the body.

One of the realities facing Mexico is undoubtedly the hundreds of people dying daily, because of diseases whose only therapeutic treatment is organ transplantation.

It is estimated that in our country the growth rate of TCKD, discounting the deaths, has been approximately 11% per year.

If this increase continues, by 2010 the number of cases will have doubled affecting 70 thousand Mexicans.

In our state of Quintana Roo the most common causes of the TCKD is mellitus diabetes (51.23%), hypertension (8.42%), kidney stones (5.6%), and Unknown (9.47%)

In our country in 2007 kidney transplants were performed 1978 times of which 504 (25.4%) were cadaverous donors. In 2008 so far there have been kidney transplants preformed 1039 times with the same percentage of cadaverous donors.

The National Transplant Center (CENATRA) has estimated that 5000 kidney transplants should be carried out annually.

What is a transplant?

It is the replacement of an organ or tissue that is no longer working, with one that is, in order to restore lost functions. In many cases, transplant is the only way that someone else’s life can be saved or quality of life regained.

Transplant Protocol

At Galenia Hospital in the City of Cancun Quintana Roo there are 2 protocols kidney transplant:
 
• Protocol for renal transplant from live related donor (PRTLRD)
This is the protocol in which patients admitted with TCKD wanting a transplant have various possible kidney donors. According to the  health legislation in Mexico, these potential donors may be the patient's relatives (siblings, parents, children, cousins, etc.) or they can be emotionally related (spouse, friends).

• Protocol for kidney transplant from donor cadavers (PKTDC)
It's the protocol in which all patients admitted with TCKD wanting to receive a transplant and do not have a possible kidney donor.
The first contact with the Renal Transplant Service may be because the nephrologist (specialist in the functionality of the kidneys) refers the patient. Another way is direct consultation with specialists from Renal Transplant.

Study prior to transplantation.

• Medical studies.

Phase I: Laboratory studies (blood, urine and cultures). To help detect infections, kidney problems, liver, glucose, etc.
 
Phase II: complete studies (X-ray studies or ultrasounds that make it easier for doctors to see internal structures of your body in order to see if there is any anomaly, for this phase it will be necessary for you to stay in the hospital for a few days).

Phase III: This is the evaluations that are preformed by various specialties in the hospital: ENT (ear, nose and throat) Urology (urinary system), Gynecology (female reproductive system), Cardiology (heart), Anesthesia (avoid the pain), Nephrology (kidneys) and a Psychologist in transplantation.

• procedure for carrying out a transplant from a live related donor
 

Once all the medical and psychological studies have been preformed, an appointment is made with a kidney transplant Subcommittee, which is made up of medical specialists who will discuss the results of the studies, this allows necessary clarifications. When everything is ready the case is presented to an internal committee formed by experts in various medical and non-medical specialties where the case is discussed, approving and scheduling the date of transplant.

Procedure for carrying out a transplant from donor cadavers
 
The procedure for being placed on the waiting list for a transplant donation from a cadaver is as follows: once all of the medical and psychological studies have been completed, the Coordination Services of Renal Transplant approves the enrollement of the patient to the Institutions waiting list (Galenia Hospital) and therefore is also added to the federal list (National Center of Transplants CENATRA).
 
It is important to know that you can only be enrolled in ONE local list.
 
The time a patient remains on the waiting list varies. It can be influenced by multiple variables such as blood type, age, body size, a change in illness and position on the waiting list. Both receiving candidates as well as the donor are studied carefully and because of that everything is decided a few hours before transplantation.
 
While you're on the waiting list you must attend your monthly checkup in which you will be receive medical and psychological evaluation with the aim of assessing whether you're apt to stay on the waiting list for the month, however, if you are not apt, remember that you can rejoin the waiting list the next month.

The Cadaverous Donor is subjected to multiple laboratory testings and committee tests with the aim of ensuring the right characteristics of tissues and organs and to ensure that they are free from infection or tumors, for which complex protocol and tests are preformed and crossed with the different potential receivers in order to decide the most suitable and compatible patient.

In the Multi-organic Extraction Surgery, organs and tissues can be taken, which are used in the different programs that the hospital has.  If there is not an appropriate match or the organs or tissues can not be taken advantage of, these are then made available to CENTRA.  They along with the Coordination of the Donation of Organs at Galenia Hospital with do the pertinent medical and legal formalities for the assignment of these organs to other states in the States of the Republic. 

The admission of a patient to the waiting list requires a great effort from both the transplant team and the patient himself so that once he’s entered the list is important that he is reachable, as the transplantation of a cadaverous donor there is no surgery planned and that in an emergency can be done any day, at any time.

THE kidney transplant.
In the case of living related donor transplantation, one or two days before the transplant you will be admitted to the hospital for the preoperative studies, sometimes, during these days dialysis or hemodialysis sessions are administered in order to prepare for surgery. Because each body is different, the duration of each surgery is variable.

The success rate of having a related living donor transplant is 95% while the success rate of a cadaverous donor transplant is 85%. The transplant team will contact your family once the surgery is completed.
 
After surgery will be located an isolated area located in the Intensive Care Unit.  Your time in that area will depend on your progress, you could be hospitalized anywhere from four days up to a month; remember that the important thing is that you come out of this in good condition and not the amount of time you remain hospitalized.               

LAPAROSCOPIC NEFRECTOMY
The Program of Renal Transplant at Galenia Hospital has the technology and the specialists trained in transplantation to offer a more modern surgical technique and an international stature as is the laparoscopic NEFRECTOMY.

Previous studies have demonstrated the benefits of laparoscopic surgery in nephrectomy when comparing it with the open technique, the conclusions show a lower morbidity, less need of analgesics, less intraoperative bleeding, an early oral tolerance, shorter stay in the hospital and that they are able to resume daily activities faster.

Immunosuppression. The immune system attacks the foreign agents (viruses, bacteria, fungi) that invade our bodies. But what happens when our body needs "a strange agent" to recover lost health? We refer to a kidney transplant. The immune system attacks with identical force for viruses as for a kidney transplant, making it necessary to reduce or abolish this system and this is achieved by immunosuppressive drugs which, dropping defenses prevent rejection of the kidney, while it increases susceptibility to infectious diseases for which you should follow the self-care behaviors that you are listed below. The rejection is the attempt of your immune system to attack and destroy the kidney. To prevent rejection, you must take immunosuppressive drugs as prescribed, for the lifetime of the kidney.

Care POST TRANSPLANT
• Closely monitor your temperature, blood pressure, weight and amount of urine.
• Stay in an isolated room at home for two months.
• Take medicines as the doctor has prescribed, because otherwise the rejection would begin immediately.
• Attend medical consultations and if feeling some discomfort (temperature, pain in the area of graft, changes in the urine) visit the medical team, do not self medicate.
• Drink from two to three liters of pure water a day, remember that water should always be boiled or chlorinated.
• Follow the food guidelines and avoid eating out! Your diet should include fruits, vegetables, grains, dairy products and lean meats.
• Wash your hands before and after using the toilet and cooking or eating.
• Bathe daily with warm water.
• Use face mask when you go out.
• Avoid contact with people carrying contagious diseases.
• When the doctor tells you exercise (walking three times a week). If you experience any of the following symptoms, stop exercising and consult your doctor: chest pain, a lot of fatigue, shortness of breath or dizziness.
• You should avoid activities that your kidney at risk: contact sports, motorcycle, horseback riding, etc..
• Avoid contact with animals.
• Avoid vaccines with live viruses.
• Avoid alcoholic beverages because they can damage your liver.
• Do not smoke, if you do, join a support group for quitting.
• Use a sun protective lotion of at least SPF 15.
• You should use condoms to reduce the risk of sexual infections.

More Information contact Hospital Galenia’s Renal Transplant Service

transplants.coordination@hospitalgalenia.com
Please call us: (52) 998 8915200 Ext. 432