The procedure is considered the most effective treatment for advanced renal failure and has been evolving with new techniques and improved survival.
Kidney transplantation is today the main alternative for patients with advanced stage chronic kidney disease. When the kidneys lose a large part of their function, the body stops eliminating toxins and adequately controlling fluids, mineral salts and hormones, compromising the body’s balance. Dialysis is capable of replacing part of these functions, but kidney transplantation is considered the best treatment alternative for many patients as it offers greater survival, more freedom in daily life and a better quality of life. In Brazil, according to the Ministry of Health, more than 160 thousand people undergo some type of dialysis regularly, but only 5% to 10% are actually able to undergo a kidney transplant — which shows the size of the challenge.
When is a transplant necessary and how does it work?
Kidney transplantation is indicated for patients in advanced stages of kidney failure, when the renal filtration rate is greatly reduced. 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 lower abdomen and connected to the recipient’s blood vessels and bladder. In general, diseased kidneys are not removed: they remain 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 blood typing and the HLA system (human leukocyte antigens), reducing the risk of rejection. After the transplant, the patient must use immunosuppressant medications continuously to prevent the immune system from attacking the new kidney. Although they increase vulnerability to infections, these medications are essential to guarantee transplant survival.
Advances, results and challenges in Brazil
In recent decades, kidney transplantation has advanced impressively. Today we have safer surgeries, more effective immunosuppressants against rejection and well-established monitoring protocols.
The success rates are consistent and encouraging. Data from large international registries show that more than 80% of patients have functioning kidneys five years after transplantation, with even better results when the kidney comes from a living donor and when the procedure is performed in experienced centers.
Transplantation also represents significant savings for the healthcare system, as dialysis costs more than monitoring a transplant patient.
Brazil has one of the largest public transplant programs in the world. The country occupies second place in the global ranking in number of surgeries, behind only the United States. Still, the waiting list is long: more than 30 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 toward increasingly personalized solutions. Xenotransplantation research, using kidneys from genetically modified animals, is advancing cautiously, but consistently. At the same time, tissue bioengineering and 3D printing seek to create organs from artificial structures or the patient’s own cells, which could expand access to treatment. These are not yet available solutions in clinical practice, but they point to a promising horizon: a scenario in which the lack of organs is no longer the main limit to kidney transplantation. Meanwhile, investing in the early diagnosis of kidney diseases, expanding access to treatment and strengthening donation policies are essential steps to ensure 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
