Трансплантация почек

18.03.2012

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Трансплантация почек необходима, когда заболевание почек приводит к абсолютной потере их функции. В этом случае пациент находится на постоянном диализе, который, однако, не является окончательным решением проблемы. При дальнейшем ухудшении состояния пациента , трансплантация становится жизненно необходимой. Кто может быть донором почки и как живется людям после трансплантации?

Трансплантация почек

Заболевания почек могут  привести к полной потере их функции. В таких случаях пациент вынужден находиться на диализе. Диализ – это лечебная процедура, компенсирующая функцию почек, при которой происходит очищение крови от продуктов обмена веществ. В сущности, диализ – это искусственная почка, которая, однако, не является идеальным решением проблемы нарушения функции почек, так как ощутимо ограничивает нормальную активность пациента и выполняет далеко не все функции почек. Оптимальным решением в таких ситуациях как раз является трансплантация почек. Но и тут есть целый ряд трудностей и ограничений.

Донор и реципиент (получатель) почечного трансплантата

Для трансплантации почек необходима тщательная подготовка не только реципиента, но и донора. На выбор подходящего реципиента новой почки влияет целый ряд факторов, которые оценивает команда врачей. В первую очередь оценивается общее состояние здоровья реципиента, особое внимание обращается на состояние сердца, легких и печени.  Далее проводятся пробы на совместимость групп крови донора и реципиента и ряд других иммунологических  тестов. Перед трансплантацией у реципиента целенаправленно ищут всевозможные очаги инфекции и проводят соответствующее лечение. Это включает санацию полости рта, заживление трофических язв голени (в основном у диабетиков) и лечение хронических и острых инфекций мочевых путей. Реципиент должен бросить курить, так как при иммуносупрессивной терапии, которая подавляет иммунную систему организма, многократно увеличивается риск возникновения недоброкачественных опухолей и различных осложнений на сердце.

Кто может быть донором почки

Почечный трансплантат можно взять либо у живого донора, либо у мертвого. Живым донором в большинстве случаев является кто-то из близких родственников, потому что в этом случае повышается вероятность иммунологической совместимости. Почка от живого донора обычно бывает в более хорошем состоянии, чем от мертвого. Взятие почки проводится лапароскопически, то есть специальными тонкими инструментами через маленькие отверстия в брюшной стенке. Благодаря такому методу донор находится в больнице менее длительный срок, уменьшается риск возможных осложнений и шрамы по заживлении будут меньше. Мертвый донор должен быть в возрасте от 6 до 45 лет и его почки должны нормально функционировать. После взятия почку консервируют в специальном растворе, охлаждают до температуры около 4оС, укладывают в стерильный бокс и транспортируют к реципиенту. Время от консервации до трансплантации не должно превышать 10 часов. Трансплантация почек сегодня является рутинной операцией. У реципиента почка помещается в область таза, то есть ниже, чем обычно находятся в теле почки. Кроме того,  левую почку обычно помещают на правую сторону, а правую - на левую для удобства оперирующего врача. После того как почку живого донора нашьют на кровоток реципиента, она начинает функционировать практически сразу.  Почка мертвого донора постепенно восстанавливается в течение нескольких часов (а иногда и дней) от недостатка крови, которым она страдала при перевозке, и после этого начинает нормально работать.

Жизнь после трансплантации почки.

После трансплантации почки у пациента начинается новый режим. Он должен регулярно принимать лекарства для подавления иммунитета, так называемые, иммуносупрессоры. Чаще всего это кортикоиды и циклоспорин. Эти лекарства не дают иммунной системе реципиента нападать на чужой орган в теле. Если бы пациент не принимал эти лекарства, то его организм расценил бы новую почку  также  как, например, бактерии в крови, атаковал бы ее и уничтожил, так что пришлось бы вернуться к диализу. Побочными эффектами иммуносупрессии  являются повышенная склонность пациента к инфекционным заболеваниям, возможность развития сахарного диабета, набор веса, повышение кровяного давления и возрастание риска возникновения злокачественных опухолей. Поэтому необходимо, чтобы пациент придерживался всех рекомендаций лечащего врача, вел здоровый образ жизни, не курил и старался минимизировать риски заражения различными инфекциями. Трансплантация почек – это очень успешное лечение, которое возвращает пациента к нормальной жизни.

Необходимость в иммуносупрессивах, нужных для сохранения пересаженного органа, к счастью,  через несколько месяцев после трансплантации снижается, но определенный уровень иммуносупрессии должен присутствовать и через много лет! Без разрешения врача никогда нельзя переставать принимать лекартва или изменять дозировку, так как это может поставить под угрозу почечный трансплантат.

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