Understand the kidney transplant that Faustão underwent – 02/28/2024 – Balance and Health

On Tuesday afternoon (27), Hospital Israelita Albert Einstein announced in a statement that presenter Fausto Silva, 73, underwent a new surgical transplant procedure. This time the organ was a kidney. Six months ago, Faustão had already had his heart transplanted.

According to experts, the need for a new kidney is common in patients who have already had an organ transplant before, as is the case with the presenter.

Although similar to the first procedure, kidney transplantation requires different care, preparation and post-operative care.

Understand what kidney transplant surgery is like and in which cases it is necessary.

Who needs a kidney transplant?

Kidney transplantation is recommended for patients with chronic kidney disease, an irreversible condition in an advanced stage, that is, when only 10% of the organ has the capacity to filter the body’s blood.

“There is no treatment that works in a patient who has less than 9% kidney function”, explains Lúcio Requião, doctor and general secretary of the SBN (Brazilian Society of Nephrology).

Furthermore, some legal criteria must be met for a patient to have the right to enter the technical registry of the Ministry of Health, the department that regulates the entire Brazilian transplant program.

In the case of minors and diabetic people who are not on dialysis, those whose kidneys have a filtration capacity of less than 15% are also on the list.

The main causes of chronic kidney disease in Brazil are uncontrolled hypertension and diabetes. There are other processes that chronically harm the kidney, such as the use of some medications for autoimmune diseases and even immunosuppressants used by those who have already had a transplant, in addition to some genetic conditions.

Medical coordinator of the transplant program at Hospital Israelita Albert Einstein, where Faustão underwent the procedure, José Eduardo Afonso Júnior explains that patients who use post-transplant medications, which are necessary to avoid rejection in the new organ, which has some toxicity against the kidney , can trigger a condition that progresses to a new transplant.

“Due to the toxicity of some medications for transplant recipients, chronic renal failure is much more common in this population”, he informs.

Who has priority in the process?

For both kidney and liver transplants, the donor can be a living or brain-dead patient. In the case of kidney transplantation from a deceased donor, some criteria, defined in legislation, prioritize more serious cases. One of them is HLA, an acronym in English that, translated, summarizes genetic compatibility.

“So, based on this criterion, a new queue is generated for each donor”, explains Requião. After this compatibility, a ranking is generated, from first to fifteenth.

In this list, the most serious condition is defined as a patient who no longer has venous access for dialysis, in some cases because all the veins are obstructed, making blood flow impossible. “When this happens, if the transplant is not performed, the patient dies,” says Requião.

In the state of São Paulo, specifically, there are two other rules that allow prioritization of kidney transplantation: patients who have already donated one of their kidneys and, for any reason after the procedure, lost the function of the other kidney —which experts say is rare— , and already transplanted patients, such as Faustão, who was 13th in line.

In the case of state legislation, 1,933 kidney transplants were performed last year and 34 were eligible for priority, according to Requião.

The doctor also informs that, in cases of deceased donors, two people on the list receive kidneys.

How is the procedure?

The surgical process changes depending on the donor’s condition. If the organ comes from a deceased person, the procedure usually takes a little longer.

Now when it is donated by a living person, the transplant tends to be quick. “It takes about three or four hours for the complete procedure,” says Requião.

The doctor also informs that the organ can be used for transplantation even if it remains outside the body for up to 36 hours, unlike, for example, the heart, which can last up to four hours.

During most surgeries, according to José Eduardo Afonso Jr., the old kidney, which no longer functions, is kept inside the patient, facilitating the surgical process because removal is not necessary.

“There is no need to waste time removing the old one, you implant the new kidney and it works without having to remove the old one”, he explains.

When can I receive an organ donated by a living family member?

Brazilian legislation also regulates kidney donation between family members. Living donor transplants can only be performed by relatives up to the fourth degree.

“It is only possible to carry out a transplant with a non-related donor if the situation is evaluated by an ethics committee at the hospital where the procedure will be carried out and as long as there is judicial authorization”, explains Requião.

In Brazil, 85% of transplants are carried out by deceased donors, according to the doctor, and in the 15% in which the donor is alive, the majority are family members of the recipient.

What is the recovery like for someone who has had a transplant?

After the procedure, patients usually stay in the ICU (Intensive Care Unit) for two days, according to Afonso Jr. “As soon as you receive the organ, you have to wait for the kidney to start working, which happens in about three days. For the release, the patient usually takes one to three weeks”, explains the doctor.

Upon returning home, the transplant recipient must strictly follow the prescribed medication, which generally needs to be taken for life.

“Immunosuppressants are essential for the immune system not to attack the new organ”, informs the coordinator of Albert Einstein.

What is the success rate?

According to experts, this number is measured according to the probability of the transplant patient having a functioning kidney within a year without the need for dialysis.

“This number is usually 95% in cases where the donor is deceased and 99% when the recipient has the kidney donated by a living person, such as a family member”, informs Requião.

For the doctor, the procedure has a high success rate compared to other transplants.

In cases of rejection, is a second transplant necessary?

Rejection of the new organ tends to be more common in the first months after the transplant, according to Afonso Jr. “This can happen if the patient does not take immunosuppressants correctly, for example.”

According to the expert, there are some types of rejection and this is not uncommon. In cases of confirmation, treatment is indicated, which is usually successful.

Cases of retransplantation can also occur, and it is important to be aware to understand that this does not necessarily compromise the patient’s life. “It’s difficult for the transplant recipient to die because he lost his kidney, he can go back to dialysis until he receives a new organ”, explains the doctor.