Kidney Transplantation Center

The Kidney Transplantation Center was founded in 1991. This center is the only center in Russia specializing in children's kidney transplantation. There are 10 kidney transplantation centers for adults in our country where you can transplant kidneys to teenagers, as well. But only in the Center attached to the RCCH do we take into account the specific character of kidney transplantations for children. More than 250 kidney transplantations have been made in the Center in the years of its operation.

Reasons for transplantation
  Children with various diagnoses, which lead to kidney deficiency, come to this section of RCCH. These can be congenital diseases like developmental problems, absence of a kidney, and also different acquired sicknesses. There can be about 5 such people per million each year. On a large scale like Russia, kidneys of 500-750 people stop functioning yearly. Unfortunately, most of such children die in the provinces. They even fail to be diagnosed in time. So, about 10 children a year make it to the Transplantation Center at RCCH where from 10 to 20 transplantations are made a year. When children whose kidneys cease to function enter the Center it usually means that they have been already treated elsewhere. Kidney failure leads to the fast poisoning of the patient's body with the products of vital functions, which inevitably leads to the patient's death. In order to save the patient's life, he is given substitutive therapy, i.e. the treatment substituting the function of the kidneys. There are different methods for that (different kinds of dialysis). 

Dialysis
  Hemodialysis, when a patient is attached to a special blood-cleaning machine (an artificial kidney), is given to most of the patients. This procedure should be done to a patient 2-3 times a week; it lasts from 2 to 5 hours. There is also a different kind of dialysis - peritoneal dialysis when a special blood cleaning solution is introduced into the patient's peritoneum. The peritoneal dialysis is more physiological. It is better for the body because it works in the regime close to the natural kidney functioning regime. Another advantage of this kind of dialysis is that after training, the parents of the child can do it themselves at home. The peritoneal dialysis is prescribed to the children who are not able to take hemodialysis for certain reasons. Unfortunately, the government in our country does not fund the peritoneal dialysis. That is why all of the materials used for it are bought at the expense of the parents. If they don't have enough money, which is true in most of the cases, we need to look for donations. The cost of the materials for the peritoneal dialysis (bags with special solution, spirit, disposable gloves) is $ 10,000 - 20,000 a year. Patients waiting for a kidney transplantation and those who cannot have one are treated with the method of dialysis. Those are the patients with severe infections or defects of the lower urinary tract.

Transplantation
  However, the main method of treating patients of the Center is the kidney transplantation. A person, who died, usually as a result of an injury, becomes a donor. In some countries, they transplant a kidney from a relative according to his or her assent but we do not practice this method in Russia. All patients who need kidney transplantations are put on a waiting list. It runs up to several hundred people. Recently, the waiting time has been growing. It is caused by the fact that the number of places offering dialysis treatment in Moscow and in Russia is growing but the number of donors stays the same. Therefore, it turns out that more and more patients claim donor's organs. Whereas in the beginning of 90s the waiting period was 2-4 months, now it's a year on average. Unfortunately, there are patients waiting for a kidney for as long as 2 years. Here is how we get a donor kidney. For example, a person dies of a cranial trauma. This person has to be young and healthy enough and preferably known that he or she has good, functioning kidney. He or she must die within a small circle of hospitals in the Moscow region where they are officially authorized to state a brain's death and extract the donor's organs. A team from the Center of organ extractions comes to this hospital and carries out special investigation diagnosing the brain's death. After the brain's death is stated, a kidney is extracted and specially preserved. It now can be stored for up to 24 hours at +4 degrees Celsius. During this time, the necessary search should be done directed to determine the compatibility of this donor's organ with a very wide circle of potential recipients that are on the waiting list in different hospitals in Moscow. As a result of this research, the patients most compatible with the donor are determined, and the kidney is offered to the doctors of those patients. If a doctor is satisfied with different parameters of the donor and his patient, the transplantation takes place. The kidney is transplanted into the area lower than the usual location of healthy person's kidneys. The operation itself lasts for 3 to 6 hours. Almost immediately after the surgery it becomes clear if the kidney is accepted or not. Although the host may at any time have a condition in which the kidney could be rejected. The kidney can be rejected any time after the surgery. Because children have more mobile immunity system, they reject transplanted kidneys more often. In those cases it is possible to make a second transplantation. The surgery is a very important element of the transplantation, but the post-surgery treatment is as important. A person with a transplanted kidney has to take medicine slowing down the reaction of rejection, for instance, Ciclosporine A. The special feature of this medicine is that a small dose of it is useless whereas a too large dose is deadly dangerous. Therefore, the concentration of this chemical in the blood must be carefully monitored. The life of a family of a person with a transplanted kidney is in many ways complicated and our government does not help those patients much. In particular, they fail to administer the ciclosporine A concentration tests for free to those patients. 

Problems
  It is necessary to mention that the kidney transplantation center faces a lot of problems, which it cannot deal with by own strength. Unfortunately, it all boils down to the lack of financing. Doctors do not have all the equipment they need for surgeries. The substantial difference of a kidney transplantation surgery from many others is that, in addition to the general narcosis, it is necessary to do the antibacterial therapy and the treatment subduing the patient's immunity, some during the surgery. There are about 6 medicines, which have to be introduced simultaneously and in precise doses. This is done with the help of special devices - infusomats. For successful operation of the center it needs 6 infusomats. Each infusomat costs $ 3,000.
  In addition, we need the device monitoring the condition of a patient during a surgery, showing his or her heart contraction frequency, pressure in different media, breathing and temperature. Such a device costs $ 15,000. We need a device that takes a biopsy of the donor's and the host's kidneys. The device we bought several years ago is now broken. Those devices have to be sterilized every 3 days; therefore, we need 3 such devices to provide continuous sterility. Its cost (disposable needles are included) is $ 10,000.
  We are also short of medications. The government only provides the patients with ciclosporine A. But according to the standards of civilized countries, it's not enough to follow up with a child after the kidney transplantation. They all need the ALG medicine treatment. If ALG is used the transplanted kidney will last longer. ALG is prescribed according to the weight of a child, and a child who weighs 30 kg (66 pounds) has to be treated with 10 small bottles (500 German marks each). Presently we treat only a chosen group of children who have a greater chance of rejecting the transplanted kidney with this medicine bought with donated money.

  The kidney transplantation center at RCCH shows very high results, as high as analogous centers of European countries. It's a shame that nearly the only Center in Russia, where children with deadly kidney diseases return to their full lives, suffers a critical shortage of equipment, materials, and medications. If the center were to be supplied with necessary materials in a proper time, the results of the treatment here would be better.