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The Kidney Transplantation Center of the Russian Children's
Clinical Hospital was founded in 1991. This is the only center in Russia specializing
in kidney transplantations to children. Actually, there are 10 kidney transplantation
centers for adults in our country, and transplantations to teenagers
can also be performed in them. But only specialists of our center make
allowance for all
the specific aspects of kidney transplantations in children. More than
350 kidney transplantations have been made at the Center during the first
years of its functioning. When children with kidney failure arrive at our center, it usually means that they have already received some treatment elsewhere. Kidney failure results in fast poisoning of the patient's body with metabolic products, which inevitably leads to death if not treated. In order to save the patient's life, substitutive therapy is used, which means treatment substituting the kidney function. There are different methods of such therapy, i.e., different kinds of dialysis. Dialysis is the method used for treating patients who are waiting for kidney transplantation or may not have such a transplantation (e.g., patients with severe infections or defects of the lower urinary tract). All patients who need kidney transplantation are included in the waiting list. It amounts to several hundred people. Earlier, some patients had to wait for a kidney for two years or so. Now the average waiting time is 2 to 4 months, sometimes half a year. How do we get a donor kidney? For example, a person dies, say, of a cerebral injury. This person has to be young and healthy enough, and it should preferably be known that he or she has good, functioning kidney. He or she must die at one of the few hospitals in the Moscow region that are officially authorized to state the brain death and to extract donor organs. A team from the organ extraction center comes to this hospital and carries out a special investigation confirming the brain death. After the brain death is stated, a kidney is extracted and specially preserved. It can now be stored up to 24 hours at +4 C. During this time, search should be done to determine the compatibility of the donor organ with organisms of numerous potential recipients in the waiting lists of various Moscow hospitals. As a result of this search, patients most compatible with the donor are determined and the kidney is offered to the doctors of those patients. If the doctor is satisfied with the parameters of the donor and patient, transplantation takes place. The kidney is transplanted into the iliac area much lower than the usual location of a healthy person's kidney. The operation itself lasts for 3 to 6 hours. Almost immediately after the surgery, it becomes clear if kidney has been accepted by the organism or not. Although the host may experience kidney rejection any time after the surgery. Since children have a more mobile immune system, they reject transplanted kidney more often. In such cases, it is often possible to make a second transplantation. The surgery is a very important element of the transplantation, but the postsurgical treatment is no less important. A person with a transplanted kidney has to take medicines suppressing the rejection reaction, such as Cyclosporin A. A specific feature of this medicine is that a small dose of it is useless, whereas an excess dose may be fatal. Therefore, the concentration of this chemical in the blood should be carefully monitored. The state provides only Cyclosporin A and CellCept for the patients, but, according to contemporary standards accepted in Western countries, this is not enough for normal treatment of children after kidney transplantation. All of them also need a course of ATG, which prolongs the lifetime of the transplanted kidney. The dose of ATG is calculated according to the child's weight. For example, a 30-kg child should receive 10 vials of this medication (300 euro per vial). However, presently this drug (bought mostly thanks to the sponsors' help) is used only in treatment of selected patients, those who have a higher chance of rejection. The kidney transplantation center at the RCCH shows very high results, no worse than analogous centers in European countries. It's a shame that probably the only center in Russia providing survival of children with lethal kidney diseases sometimes experiences shortage of equipment, consumables, and medications. If the center were supplied with necessary materials in due time, the results of the treatment would be better. |
Head of the Kidney Transplantation Center Dr. Alexei L. Valov is telling:
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