Stage G4 patients

Kidney disease is an increasing health risk that requires effective communication between all stakeholders to optimise detection, diagnosis and treatment and to provide the best possible care to affected patients. The impact of kidney disease on quality and duration of life is significant and renal replacement therapies are very costly. According to the current dialysis standards of the German Society of Nephrology (DGfN), it is necessary that patients in stage G4 renal failure and their relatives are informed about different renal replacement procedures, including kidney transplantation and living kidney transplantation(for this, see also KDIGO guideline on evaluation and management of kidney transplant candidates).

In abbreviated form, it could be said: as soon as the filtering capacity (glomerular filtration rate) of your kidneys is reduced to such an extent that you require dialysis, you will be reported by us directly to Eurotransplant for the waiting list of organ recipients. If a patient needs a new kidney and decides to have a transplant, all the details of this procedure are explained in our kidney transplant consultation.

The Transplantation Act and the resulting guidelines regulate the procedures from organ donation to allocation and transplantation. The Standing Commission on Organ Transplantation has the authority to issue guidelines. If a kidney transplant is considered, a presentation of the patient at the transplant centre will be planned during the counselling interview, where specific aspects of the transplant can be discussed. However, in accordance with the guidelines for organ transplantation under § 16 of the Transplantation Act, only adult patients who have reached the terminal stage of renal failure may be placed on the waiting list for a kidney transplant in Germany. Currently, patients registered for a transplant have to wait about 6 years to receive a donor kidney.

Exceptions exist for patients who are preparing for a living kidney transplant or a combined pancreas and kidney transplantation (glomerular (from a glomerular filtration rate [GFR] of 30 ml/min/1.73 m2 according to CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration]). It is therefore important that patients and their families are fully informed about their options in order to receive the best possible treatment.

Children whose glomerular filtration rate (GFR) is 20 ml/min/1.73 m2 or less according to the Schwartz formula may be preemptively scheduled for a kidney transplant from post-mortem donation. It is worth noting here that the Transplantation Act only permits organ removal from living persons if no suitable donation from a post-mortem source is available (subsidiarity principle of living donation). In addition, the guideline recommends that patients should be informed about the possibility of obtaining a second opinion from another transplant centre, especially if their inclusion on the waiting list has been rejected.

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A kidney transplant is an extraordinary event that is of great importance for both the recipient - and in the case of living donation, of course, also for the donor. Often the call comes completely unexpectedly and the wait has an abrupt end. Many people waiting for a kidney therefore always have a small suitcase packed with the most important utensils to be prepared for the longed-for call.

Once they arrive at the clinic, everything happens quickly and according to fixed rules. Before every transplant, there is a final compatibility test, also known as a cross-match, which is carried out by our immunological laboratory. This test takes about 3-4 hours and is crucial for the success of the operation. During this time, the patient undergoes dialysis and is presented to the transplant surgeon, nephrologist and anaesthetist.

Anaesthetists, the surgical nursing assistants and the surgeons work hand in hand. The transplantation of the donor kidney usually takes about 2 to 3 hours. The operation is usually performed in the right lower abdomen, but in some cases, e.g. in the case of previous operations, the recipient's left side can also be used. At the beginning, the connection of the renal vein to the recipient's pelvic vein is done, followed by the connection of the renal artery to the pelvic artery. Usually, the kidneys that are no longer functional remain in the patient's body while the new kidney is inserted into the pelvic fossa and connected to the blood vessels of the pelvis.After blood flow is released, the ureter is inserted into the urinary bladder and a ureteral splint is placed to complete the procedure.

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