Kidney transplantation

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient's surgeon, and Hartwell Harrison, surgeon for the donor. Murray was awarded a Nobel Prize in Physiology or Medicine in 1990 for this and other work. In 2018, an estimated 95,479 kidney transplants were performed worldwide, 36% of which came from living donors.

Before receiving a kidney transplant, a person with ESRD must undergo a thorough medical evaluation to make sure that they are healthy enough to undergo transplant surgery. If they are deemed a good candidate, they can be placed on a waiting list to receive a kidney from a deceased donor. Once they are placed on the waiting list, they can receive a new kidney very quickly, or they may have to wait many years; in the United States, the average waiting time is three to five years. During transplant surgery, the new kidney is usually placed in the lower abdomen (belly); the person's two native kidneys are not usually taken out unless there is a medical reason to do so.

People with ESRD who receive a kidney transplant generally live longer than people with ESRD who are on dialysis and may have a better quality of life. However, kidney transplant recipients must remain on immunosuppressants (medications to suppress the immune system) for as long as the new kidney is working to prevent their body from rejecting it. This long-term immunosuppression puts them at higher risk for infections and cancer. Kidney transplant rejection can be classified as cellular rejection or antibody-mediated rejection. Antibody-mediated rejection can be classified as hyperacute, acute, or chronic, depending on how long after the transplant it occurs. It is important to regularly monitor the new kidney's function by measuring serum creatinine and other tests; these should be done at least every three months. Donor-derived cell-free DNA (dd-cfDNA) blood testing can be done to detect early rejection. If rejection is suspected, a kidney biopsy should be obtained.

One of the earliest mentions about the possibility of a kidney transplant was by American medical researcher Simon Flexner, who declared in a reading of his paper on "Tendencies in Pathology" in the University of Chicago in 1907 that it would be possible in the then-future for diseased human organs substitution for healthy ones by surgery, including arteries, stomach, kidneys and heart.

In 1933, surgeon Yuriy Vorony from Kherson in Ukraine attempted the first human kidney transplant, using a kidney removed six hours earlier from a deceased donor to be reimplanted into the thigh. He measured kidney function using a connection between the kidney and the skin. His first patient died two days later, as the graft was incompatible with the recipient's blood group and was rejected.

It was not until 17 June 1950, when a successful transplant was performed on Ruth Tucker, a 44-year-old woman with polycystic kidney disease, by Dr. Richard Lawler at Little Company of Mary Hospital in Evergreen Park, Illinois. Although the donated kidney was rejected ten months later because no immunosuppressive therapy was available at the time, the intervening time gave Tucker's remaining kidney time to recover and she lived another five years.

A kidney transplant between living patients was undertaken in 1952 at the Necker hospital in Paris by Jean Hamburger, although the kidney failed after three weeks. The first truly successful transplant of this kind occurred in 1954 in Boston. The Boston transplantation, performed on 23 December 1954 at Brigham Hospital, was performed by Joseph Murray, J. Hartwell Harrison, John P. Merrill, and others. The procedure was done between identical twins Ronald (the donor) and Richard Herrick (the recipient), which reduced problems of an immune reaction. For this and later work, Murray received the Nobel Prize for Medicine in 1990. Richard Herrick's death eight years after the transplant was unrelated to the transplant.

In 1955, Charles Rob, William James "Jim" Dempster (St Marys and Hammersmith, London) carried out the first deceased donor transplant in United Kingdom, which was unsuccessful.^{[citation needed]} In July 1959, "Fred" Peter Raper (Leeds) performed the first successful (8 months) deceased donor transplant in the UK. A year later, in 1960, the first successful living kidney transplant in the UK occurred, when Michael Woodruff performed one between identical twins in Edinburgh.