What tests do patients and donors need to do before kidney transplantation?

Source: Xinte Pharmacy News Author: Baekje Browse: 24 1 Release Time: 2005-2-16 5438+0:17: 00 Kidney transplantation is a very complicated operation, and most patients are very weak before kidney transplantation. As a patient, we should first understand some basic knowledge of kidney transplantation, and then help doctors to do all the preparations before transplantation. Preoperative preparation for renal transplantation mainly includes: 1. Choosing the most suitable operation opportunity is the hope of every patient waiting for transplantation. However, to achieve the highest success rate, the average dialysis time should be about half a year, the cardiothoracic ratio and blood pressure tend to be normal, the cardiopulmonary function is normal, and patients can get out of bed and take care of themselves, so kidney transplantation is more appropriate. A longer dialysis time may reduce the immune antibodies produced by the recipients after transplantation. 2. Preoperative dialysis. Dialysis should be performed before transplantation of end-stage renal disease. Dialysis types can be different, that is, hemodialysis or peritoneal dialysis (CAPD) does not affect the transplantation effect. All uremic patients have azotemia, hypoproteinemia, acidosis, water and sodium retention and hyperkalemia, which need to be corrected by dialysis to maintain the stability of patients' internal environment and create ideal conditions for kidney transplantation. Routine hemodialysis patients must increase dialysis once within 24 hours before transplantation, while peritoneal dialysis patients generally continue peritoneal dialysis until before transplantation. Ensure the electrolyte balance in the body, so that patients can tolerate surgery. 3. Blood transfusion and correction of anemia and hypoproteinemia Patients with end-stage renal disease are often accompanied by anemia and hypoproteinemia, which must be corrected, otherwise it will affect the survival of transplanted kidneys. In recent years, it is considered that preoperative whole blood transfusion can improve the survival rate of transplanted kidney, but blood transfusion also has disadvantages, which will increase the chance of infection with viral hepatitis, malaria, AIDS and other infectious diseases. In recent years, the clinical application of erythropoietin can better correct anemia and greatly reduce the number of patients receiving blood transfusion before transplantation. For patients with malnutrition and proteinemia before operation, human albumin can be given before operation, and corrected proteinemia can be used after operation to promote the postoperative recovery of patients. 4. Tissue matching In the human body, there is a perfect immune system, and "self" and "non-self" substances are distinguished by the recognition function of immune cells. If it is an "autologous" substance, it will not cause an immune response; But if it is a "non-self" substance, it can cause an immune response and remove it. Unless they are identical twins, it is very unlikely that the tissue differences between people are exactly the same, so donor-recipient kidney transplantation will inevitably lead to rejection. If the difference between donor and recipient is smaller, the postoperative rejection will be smaller. Therefore, strict tissue matching and selection of the most suitable donor and recipient are necessary before renal transplantation. There are four commonly used tissue types: (1)ABO blood group matching: ABO system is the most important blood group of human beings, and it is also closely related to transplantation. Before kidney transplantation, strict blood type test must be carried out to make the donor and recipient have the same blood type. The principle of blood type matching is as follows. (2) Human leukocyte antigen system (HLA): Human leukocyte antigen is the main histocompatibility complex of human beings, and it is also an antigen system closely related to transplantation. It plays a very important role in allogeneic transplantation. In human living kidney transplantation, HLA is the same among siblings, but antigens of different HLA loci play different roles. At present, HLA-DR antigen is the most important, followed by HLA-A and HLA-B antigen. Because of the difficulty in obtaining the standard serum of HLA-A, B, DR and DQ, this experiment is limited. However, it is one of the necessary items in kidney donation by relatives; However, in cadaver transplantation, most hospitals did not carry out this kind of matching test. With the vigorous development of kidney transplantation, tissue matching will be improved continuously. In order to further improve the long-term survival rate of renal transplantation, HLA matching network will be established. (3) Complement-dependent lymphocyte toxicity cross matching test: This test has the characteristics of strong specificity and high sensitivity, and can detect the antibody with the highest dilution and get the result quickly. The principle of the test is: after the antibody in serum binds to the corresponding antigen on the cell surface, it activates the complement system, damages the cell membrane, increases the permeability of the cell membrane and dissolves the cell. This kind of antibody is called cytotoxic antibody. During the experiment, when the serum containing cytotoxic antibodies is co-cultured with lymphocytes and complement, lymphocytes are killed, the permeability of cell membrane is increased, and dyes can enter the cells through the cell membrane to stain the cytoplasm, which is called dead cells. The more dead cells, the worse the histocompatibility between recipients and donors. The normal value of lymphocyte toxicity cross matching test is less than 10%, and greater than 15% is positive. This test is the most important reference index in the existing test. Under normal circumstances, try to choose the recipient with the lowest value for transplantation. (4) Group reactive antibody (PRA): PRA is a commonly used index to judge the immune status of transplant patients. It is necessary to detect whether there is HLA antibody in serum before renal transplantation. According to the test results, the immune status and sensitization degree of patients were judged. The sensitization degree is divided into: non-sensitization PRA = 0-10%; Moderately sensitized PRA =11%-40%; Allergy PRA= >40%. At present, it is considered that moderate and high sensitization is closely related to clinical superovulation. Your transplant team will discuss and decide the above matching work with you. 5. Psychological preparation Kidney transplantation is different from general surgery. General surgery, postoperative wound healing, stitches can be restored to normal life, without long-term medication. Kidney transplantation is different. Under the condition of ensuring the smooth operation and wound healing, it is necessary to take medicine for a long time to protect the function of the kidney and prevent rejection. Therefore, patients must know the relevant knowledge before operation, and have full understanding and psychological preparation for the possible complications after operation, so as to better cooperate with the treatment of medical staff and recover faster. When patients decide to have a kidney transplant, they should start to understand the basic knowledge about kidney transplant, including preoperative preparation, operation process, matters needing attention in postoperative recovery and possible problems. By understanding this knowledge, we can reduce the fear and anxiety of surgery, ensure good emotional and psychological preparation before transplantation, and report the illness to the doctor accurately and timely after operation. When necessary, patients and their families can consult professionals and ask them to give guidance to reduce anxiety. Many foreign organ transplant centers had full-time nurses to give health education and psychological guidance to patients waiting for transplantation a month ago. 6. Prepare articles for patients waiting for transplantation, keep in touch with your transplant doctor at any time, tell the doctor where you are going, and ensure that the doctor can inform you as soon as possible before transplantation. Moreover, when registering to join the waiting list of transplant patients, you should prepare a bag containing all kinds of articles necessary for hospitalization to avoid the rush and panic when you receive the notice of admission. The package may include the following items: 1) toiletries, such as toothbrushes, toothpaste, towels, soap, etc. 2) changed clothes; 3) Men's razors, women's sanitary napkins, etc. 4) slippers; 5) Books and small radios that you usually like to read. 7. Preoperative operation 1) Nephrectomy unless necessary, such as renal tumor, giant polycystic kidney, massive hematuria, multiple or giant kidney calculi complicated with intractable infection, severe renal tuberculosis, etc. Bilateral nephrectomy before transplantation is no longer advocated. 2) Prostate hypertrophy and urethral valve in lower urinary tract surgery need surgical treatment to relieve urinary tract obstruction. 3) Repeated bleeding or severe peptic ulcer during gastrointestinal surgery, and intestinal diverticulum with repeated infection should be surgically removed. Some patients have no typical history and symptoms of ulcer, especially elderly patients. Barium meal examination should be done routinely before transplantation. 4) Cholecystectomy Cholelithiasis with recurrent infection or biliary obstruction requires cholecystectomy, and no infected person needs treatment. 8. Preoperative examination of uremia patients, although dialysis treatment has been carried out, all systems in the whole body have been seriously affected and may change at any time. Therefore, a comprehensive physical examination and some necessary auxiliary examinations are needed before operation, mainly including: 1) various routine examinations, such as blood routine, urine routine, stool routine, etc. 2) Surface antigens of viral hepatitis such as renal function, liver function, hepatitis B and hepatitis C, cytomegalovirus, etc. 3) blood dielectrics, such as potassium, sodium, chlorine, calcium, phosphorus, etc. ; 4) culture of bacteria and fungi in throat swab, sputum and urine; 5) ECG, chest X-ray, etc. Eliminate serious heart and lung diseases; Fibrogastroscopy was performed to exclude active peptic ulcer; 6) Immunological examination, such as T cell subsets, lymphocyte toxicity test and group reactive antibody detection.