Kidney transplantation is today the most complete alternative for replacing kidney function for patients with advanced stage chronic kidney disease. When the kidneys lose their function, the body can no longer eliminate toxins and fluids adequately to maintain the body’s balance. At this stage, the person needs replacement treatment to survive: dialysis or transplant. Dialysis is capable of replacing part of these functions, but transplantation is the best treatment alternative for most patients with advanced chronic kidney disease, offering the best chance of regaining quality of life and longevity.
In Brazil, according to data from the Ministry of Health, around 170 thousand people undergo some type of dialysis regularly, but only around 20% are able to access kidney transplantation – which shows the size of the challenge.
When is a transplant necessary and how does it work?
Kidney transplantation is indicated for patients in end-stage renal failure, when the kidney has a very reduced renal filtration rate and is no longer able to maintain the body’s water-electrolyte balance.
Surgery consists of implanting a healthy kidney, from a living or deceased donor, to replace the function of the compromised organ. The transplanted kidney is placed in the pelvic region and connected to the recipient’s blood vessels and bladder. In most cases, diseased kidneys are not removed, remaining in the patient’s body without function.
The compatibility criteria between donor and recipient are fundamental to the success of the surgery. Blood tests evaluate factors such as blood type and HLA system (human leukocyte antigens), seeking to reduce the risk of rejection. After the transplant, the patient needs to use immunosuppressive medications continuously to prevent rejection of the new organ. Although these medications increase vulnerability to infections, they are essential to ensure transplant survival.
Advances, results and challenges in Brazil
In recent decades, advances in surgery, organ preservation methods, and the development of more effective immunosuppressants have considerably improved outcomes. Today, the survival rate of patients five years after transplantation exceeds 80% in reference centers, and many are able to resume daily activities, work and social life with full independence. Transplantation also represents significant savings for the healthcare system, as the cost of dialysis over the years is higher than that of keeping a transplant patient under follow-up.
In Brazil, we are a global reference in transplants carried out through the public system. The country occupies second place in the global ranking in number of surgeries, behind only the United States. Still, the
The waiting list is long: more than 40 thousand people are waiting for a kidney. Most transplants come from deceased donors, but transplants from living donors – usually compatible family members – offer better results by reducing waiting times and increasing the organ’s useful life. Awareness campaigns about organ donation continue to be essential to expand access.
The future of kidney transplantation is moving towards increasingly personalized solutions. Studies on xenotransplantation (use of organs from genetically modified animals), tissue bioengineering and even 3D printing of functional kidneys are already underway and could, in a few years, completely transform the scenario. Meanwhile, investing in early diagnosis of kidney diseases, expanding access to treatment and strengthening donation policies are the most important steps to ensuring that more patients have the chance to live fully after a transplant.
Dra. Carlucci Ventura – CRM/SP 75746
Nephrologist
Membro da International Society of Nephrology
Membro da Brazil Health
