Organ Transplant Center

Organ Transplantation Center

Liver transplantation Center

Liver transplantation is the definitive treatment for acute liver failure, cirrhosis, liver tumors, hepatic insufficiency, and other liver-related problems. This procedure exclusively involves a living donor, representing the final stage of surgical interventions to save a patient’s life.

Liver transplantation is one of the most effective surgical interventions for saving a patient’s life and is a globally recognized treatment for patients with liver failure. Countless individuals worldwide are enjoying life after liver transplantation and returning to their normal, active lives every day.

Liver transplantation is an attempt to save a patient’s life by replacing a diseased liver lobe with a healthy lobe from a living donor.

The liver is the only organ in the body capable of regenerating itself while simultaneously performing its vital functions. Given the liver’s ability to quickly grow to its normal size, large portions (60-70% of the entire liver) can be safely removed from donors and individuals with liver tumors or other liver diseases. For this reason, liver transplantation is considered one of the safest procedures for both the donor and the recipient.

While liver transplantation is a risky procedure due to the patient’s overall condition and the complexity of the surgery, the risk increases with the severity of the disease requiring the transplant. Patients are usually debilitated and in poor condition. However, without surgery, the patient is likely to lose their life. Liver transplantation offers hope for a new life for these patients.

If the transplant is performed on patients before their condition deteriorates, the risk of surgery decreases and their lifespan increases, especially if the transplant is performed early. Therefore, choosing the right timing for the patient is crucial.

Liver transplantation is typically performed between donors with matching blood types. Although liver transplantation can be performed between individuals with incompatible blood types to save lives in extremely urgent situations, this option is considered a last resort due to the complexity of the procedure.

Today, all patients with end-stage liver disease and a life expectancy of less than one year are accepted as candidates for liver transplantation. Therefore, surgical intervention for liver transplantation is recommended as soon as possible, as half of patients with this condition die within a year due to the disease or its complications.

The liver must be healthy. Located in the abdomen under the ribs on the right side, the liver performs numerous vital functions, acting like a factory in the body:

• Glucose metabolism: The primary source of energy and sugar
• Protein: The basic building block of the body
• Clotting factors
• Bile: A fluid stored in the gallbladder that helps absorb fats and vitamins.

The liver stores vitamins and minerals as the largest solid organ in the body and acts as a filter, removing toxic substances from the blood. It performs metabolism and removes toxins from food introduced into the body. When these essential functions weaken, liver dysfunction occurs, significantly impacting the patient’s health and lifestyle, necessitating a liver transplant.

Living Donor Liver Transplantation

What is a living donor liver transplant?

A living donor liver transplant involves taking a portion of a healthy person’s liver and transplanting it into a patient with liver disease. The donor, typically a close family member or friend, willingly donates part of their liver to save the life of the recipient.

Why choose a living donor?

• Faster transplant: Living donor transplants often have shorter wait times compared to deceased donor transplants.
• Better outcomes: In some cases, living donor transplants may have better outcomes.

The procedure:

• Donor selection: Potential donors undergo rigorous medical and psychological evaluations to ensure their suitability.
• Surgery: A portion of the donor’s liver is removed. The remaining liver regenerates to full size. The recipient’s diseased liver is removed and replaced with the donor liver.

Benefits of living donor liver transplantation:

• Reduced wait time: Living donor transplants can be scheduled more quickly than deceased donor transplants.
• Improved outcomes: In some cases, living donor transplants may have better outcomes.

Requirements for living donors:

• Close relationship: The donor must be closely related to the recipient, typically within the first, second, or third degree of kinship.
• Good health: The donor must be in excellent health and free from any medical conditions that could compromise the surgery or recovery.
• Psychological evaluation: Donors must undergo a psychological evaluation to ensure they understand the risks and benefits of the procedure.

Risks for both donor and recipient:

• Donor: The donor may experience complications such as infection, bleeding, and pain. Recovery time can vary.
• Recipient: The recipient may experience complications such as infection, rejection of the transplanted liver, and blood clots.

Benefits for the recipient:

• Improved quality of life: A successful transplant can significantly improve the recipient’s quality of life and life expectancy.
• Increased chance of survival: For patients with end-stage liver disease, liver transplantation can be lifesaving.

What is the best time to undergo a liver transplant? It is crucial for a liver transplant surgery to be performed as soon as possible, especially for patients suffering from acute liver failure, as failure to undergo the surgery often leads to death.

According to international guidelines, any patient with cirrhosis should be evaluated for a liver transplant after at least one year. The severity of liver diseases is classified from A to C, and generally, all patients with Hepatitis C and many with Hepatitis B are eligible for transplantation.

Patients showing any symptoms of liver failure should visit a specialist. This way, a liver specialist can determine whether a transplant or other treatment is appropriate for them.

In any case, the better the patient’s condition during the transplant process, the more successful the surgery will be. A timely transplant with a suitable donor liver has an approximate success rate of 90%.

Liver transplantation should be performed for patients with end-stage liver failure, considering global criteria after completing various imaging and biochemical tests under medical supervision.

One of the most important steps to increase the success rate of a liver transplant is “not delaying.”

What is the blood type compatibility before undergoing a liver transplant? For a liver transplant, blood type compatibility is essential. The Rh factor is not important in the process.

• Blood type O negative (ORh (-)) is the universal donor.
• Blood type AB positive (ABRh (+)) is the universal recipient.

Blood Type	Patient’s Blood Type	Donor’s Blood Type
O	O	A-B-O-AB
A	O-A	A-AB
B	O-B	A-O-B-AB
AB	AB	O-AB

Pre-Transplant Consultations: Liver specialists usually recommend this evaluation when liver disease is diagnosed at an advanced stage. The evaluation consists of three stages, which usually takes 5 to 7 days in the hospital.

1. Final diagnosis, determining the severity of liver diseases, and confirming the need for a liver transplant.
2. Assessing the patient’s suitability for transplantation, including testing other body organs such as the heart, lungs, and kidneys, along with a blood count, and eliminating any infection if present.
3. The final stage requires the patient to be mentally and physically prepared, with the patient and their family informed about the transplant process, possible post-surgery monitoring, and follow-up care.

When evaluating a patient with cirrhosis, it is recommended to consult a specialist to begin the transplantation process. The better the patient’s condition before surgery, the better the outcome of the liver transplant. Thus, timely transplantation is essential for achieving good results. Under these circumstances, the success rate of the operation can reach 80%.

Liver Transplantation in Children

Liver diseases requiring transplantation are not limited to adults; children can also suffer from such conditions and may need a liver transplant.

Symptoms of liver failure may begin during infancy or later. After diagnosing a child with cirrhosis and failure of all treatments, the need for a liver transplant becomes urgent, which, as in adults, involves a living donor who is a relative of the child. Here are more details about this process:

• It is best to perform the liver transplant at an appropriate and planned time, before the child’s condition worsens.
• Liver transplantation can be done for children of all ages and weights.
• Post-surgery complications are more common in younger and lighter children, but these difficulties can be managed in experienced centers.
• Given the small body weight of children, a small portion of the liver can be transplanted, and it will regrow in a short period.
• Although the chances of surgical problems after the procedure are higher in children than in adults, they remain within acceptable limits.
• Despite the challenges surrounding liver transplants for children, the success rate ranges from 85% to 90%.
• The child is usually taken to the ICU within 2-3 days after the procedure.

Diseases that require a liver transplant in children: The most common reason for liver transplantation in children is biliary atresia, which means the congenital absence of the bile duct. This condition is suspected when neonatal jaundice persists for more than 15 days. Other causes include:

• Genetic diseases like Wilson’s disease, Alpha-1 antitrypsin deficiency, and Tyrosinemia.
• Metabolic diseases like Hypercholesterolemia, Crigler-Najjar syndrome, etc.
• Liver and bile duct diseases.
• Liver tumors: Hepatoblastoma, malignant endocrine tumors.
• Acute liver failure.

Fungal poisoning and viral hepatitis are significant contributors to liver dysfunction in children.

What is the appropriate age for a liver donor? For a living donor, the donor should be a relative of the patient, aged between 18 and 60 years, with a compatible blood type, and weighing between 50 and 99 kg. The donor should also be in good health and free from any diseases.

What is the risk for a liver donor? As mentioned earlier, if the donor is in good health and does not suffer from any diseases, the global risk percentage for the donor is around 1-4%.

Consultations – Exams – Tests – and Analysis Needed for Liver Transplantation: If a patient presents to the hospital or emergency room, the doctor will request blood tests, liver function tests, and kidney function tests. The doctor will also take a blood sample to measure the blood levels of immunosuppressive drugs to ensure they are at the required levels.

If there is a possibility of infection, precautions against viruses, bacteria, fungi, and other organisms are taken. Therefore, urine, sputum, and blood samples may be tested.

Pre-transplantation tests are conducted to determine the stage of the patient’s condition and to determine their place on the waiting list. After completing these initial tests, the transplant candidate is referred to liver transplant specialists for evaluation.

While the patient is on the waiting list, additional tests are performed before moving forward with the transplant procedure:

• Abdominal CT scan: This technique captures computerized images of the liver, helping doctors detect abnormalities, including liver tumors, which can affect the liver’s size and the success rate of the transplant.
• Ultrasound liver imaging: This method reveals the shape of the liver and surrounding organs using sound waves, as well as the condition of the blood vessels that transport blood to and from the liver.
• Electrocardiogram (ECG): This test reveals the electrical activity of the heart.
• Blood tests: These include a complete blood count, blood chemistry, viral studies, and blood type determination.
• Gynecological examination: The patient’s physician may assist with this.

Conditions that prevent liver transplantation: Liver transplantation should not be performed in the presence of the following conditions:

• Alcohol or drug abuse
• Advanced lung or heart diseases
• Any infections
• HIV/AIDS
• Severe liver failure (in cases of excessive brain edema, liver transplantation is not possible)
• Individuals who do not match the AB-O blood type (except in emergency cases)
• Individuals over 60 years old or under 18 years old
• Volunteers
• Overweight individuals
• Those with psychiatric disorders
• Cancer patients
• Chronic hepatitis patients (viral, autoimmune, metabolic, cryptogenic)
• Uncontrolled diabetes patients
• Bleeding disorders, especially those with fat in the liver biopsy, or those with liver shrinkage
• Pregnant women
• Patients with active infections outside the liver
• Patients with cancer outside the liver
• Patients with end-stage heart or lung failure
• Patients with large hepatocellular carcinoma (greater than 5 cm) or multiple lesions (more than 3 tumors)
• Patients with portal vein thrombosis

Causes of liver diseases leading to liver failure: There are several causes of liver diseases that, over time, damage liver tissues and functions, leading to cirrhosis, the last stage of the disease. At this stage, the only treatment is a liver transplant.

Cirrhosis is one of the leading causes of death in many countries. High alcohol consumption in Western Europe and North America is the primary cause of the disease, along with viral hepatitis, which represents a significant public health problem in many other parts of the world. The primary cause of cirrhosis is viral hepatitis.

In the case of liver failure (final stage), some or all of the following symptoms may appear:

• Mild fever
• Nausea and vomiting
• Edema (swelling)
• Sudden bleeding from the nose or gums
• Redness and bruising on the body
• Loss of appetite
• Muscle spasms
• Weakness and fatigue
• Itching
• Enlarged breasts (gynecomastia in men)
• Hair loss
• Changes in sexual behavior
• Weight loss or gain
• Low blood pressure
• Slowness in movements and speech

Who are the suitable candidates for liver donation?

Liver donation to save a patient’s life is a noble and humanitarian act, but some potential liver donors may initially feel anxious. However, there is no need to worry, as the donor’s liver begins to grow quickly after surgery and can return to its original size within about 3 months. Similarly, the transplanted liver in the recipient’s body grows and can reach its normal size within 3 months.

For a person who decides to become a liver donor, a suitable match is verified after medical evaluations. Organ donation is not acceptable if there is any risk or suspicion of risk for either the recipient or the donor.

To become a liver donor, the following conditions must be met:

• The donor must be between 18 and 60 years old, depending on the general health condition of both the donor and the recipient.
• The donation must be voluntary.
• There must be a familial relationship between the patient and the donor (first, second, or third-degree relative).
• The donor and recipient must have compatible blood types (same group or type).
• The donor should have no medical history of chronic illness.
• The donor should not be infected with chronic hepatitis.
• The donor’s body mass index (BMI) should preferably not exceed 30.
• Required tests for the donor before the liver transplant:

 

Before the liver transplant is performed from the donor to the recipient, several tests must be conducted to ensure that the donor is in good health and there is no risk associated with the donation. These tests include:

• Blood and urine tests
• Tumor markers
• Liver function tests
• Hepatitis virus tests
• Infectious disease tests (such as HIV/AIDS)
• Chest X-ray
• Echocardiogram (heart ultrasound)
• Abdominal ultrasound
• Doppler ultrasound of liver vessels
• CT scan to assess liver size
• Angiography of liver vessels (if necessary)
• MRI of bile ducts (if necessary)
• Liver biopsy (if necessary)

The minimum age for liver donation is 18 years, and the maximum age is 60 years, but the essential condition for liver transplantation is blood type compatibility.

The table below illustrates blood type compatibility:

Patient’s Blood Type     Donor’s Blood Type

O         O

A         A, O

B          B, O

AB       A, B, O, AB

Preparations Before a Liver Transplant Surgery

Several tests will be conducted when you arrive at the hospital. These procedures are standard preparations for the surgery and aim to detect any infections that were not previously evident. You will undergo a general physical examination and will be asked to provide urine and blood samples.

An electrocardiogram (ECG) will be taken, and then you will be asked to wash your entire body with antiseptic soap, while the nurse will shave the surgical area.

The liver transplant surgeon and the anesthesiologist will discuss the surgery and any potential risks with you.

You will be asked to sign a consent form confirming your agreement to the surgery. After the transplant team’s approval, you will be informed of the following instructions:

• You must refrain from eating and drinking.
• Inform your family members.
• Refrain from smoking.
• Go to the hospital immediately.
• Remain calm.

Medications for the Donor After the Liver Transplant Surgery

Although the donor will not need medication immediately after the surgery, they will spend several days receiving intravenous fluids and supportive treatment (pain relievers, stomach protectants, etc.). Once the donor feels comfortable, the fluid support is stopped, and soft food is introduced orally.

Post-Liver Transplant Surgery Care

After the surgery, the patient will be transferred to the intensive care unit (ICU) and may be connected to a ventilator, depending on the condition of their lungs. If everything goes well, the ventilator will be gradually removed. In addition to the endotracheal tube, there may be other drainage tubes in your abdomen during the post-surgery period.

These tubes are used to drain fluids around the liver and are usually removed before discharge. Patients are often transferred to a regular ward after one or two days in the ICU and can be discharged after an average of 7-10 days. During this time, the patient will be monitored for signs of organ rejection, such as high fever, pain, jaundice, fluid accumulation, medication side effects, and liver dysfunction.

The recovery period after the surgery involves intensive physical and mental rehabilitation. Your efforts during this period will be crucial for recovery and response as soon as possible.

Dietary Plan After Liver Transplant Surgery

In the early stages, a diet rich in protein and carbohydrates is planned. Afterward, there is no strict dietary requirement for the patient, though maintaining a balanced diet is recommended.

Personal Care After Liver Transplant

In addition to general hygiene rules, it is recommended to avoid crowded places, especially in winter and during outbreaks, and to wear a mask if necessary.

In general, moderate preventive measures are sufficient. In the summer, swimming in the sea is not harmful for liver transplant patients, but it is important to take sufficient precautions to protect from sun exposure, such as using high SPF sunscreen.

Even if all bodily functions are normal, patients should not rush into sexual activity after surgery and should consult with their doctor, as each case may differ.

On average, sexual activity can be resumed approximately two months after the surgery. The most suitable method of contraception is the use of condoms. Birth control pills and intrauterine devices (IUDs) are not recommended, and pregnancy should be avoided in the early post-transplant period.

Since pregnancy naturally involves weight gain, it is important that the newly transplanted liver is not affected by this additional stress. This topic should be discussed with the doctor.

Post-Liver Transplant Patient Care

After undergoing liver transplant surgery, it is essential to take good care of the incision site and keep it clean using antiseptic soap. If you notice redness, swelling, or fluid formation at the incision site, you should immediately inform your doctor.

Follow-up and Care for Biliary Stents

• If a stent has been placed for bile drainage, the skin around the insertion site may become infected.
• Clean the area around the stent with antiseptic soap.
• Avoid violent movements that may damage the incision or displace the stent.
• If you experience any of the following issues with the biliary stent, contact your doctor immediately:
• Redness around the stent area.
• Warmth in the biliary stent area, with discharge.
• Breakage of the suture that connects to the stent, causing visible change in the stent’s length.

Monitoring Temperature

If you feel feverish, shivering, discomfort, or pain anywhere in your body, these may be signs of infection or organ rejection. If you have a fever above 38°C that lasts more than a day, you should contact your transplant team or doctor immediately. Do not take any medication without your doctor’s approval.

Blood Pressure and Pulse Monitoring

Your nurse will teach you how to measure your blood pressure and pulse. It is important to know your normal blood pressure and pulse. If you notice any changes in these values, inform your doctor.

Remote Follow-up After Liver Transplant

After being discharged from the hospital following a liver transplant, patients should visit the surgeon who performed the surgery or a hematologist at least once a week for the first three months. Afterward, the follow-up schedule may be adjusted by the primary doctor.

Ideally, the transplant surgeon and hematologist will monitor the patient’s condition through blood tests and medication levels. Follow-up appointments will continue after one year post-surgery.

If the patient experiences any unexpected symptoms (fever, jaundice, dark urine, abdominal pain, nausea, or vomiting), they should visit the emergency department.

Home Care After Liver Transplant

Returning home after a liver transplant is usually an emotional and happy event. However, during the first few weeks, feelings of happiness may be accompanied by anxiety or even mild depression. It is essential to understand that recovery is a process that takes several weeks, and both the patient and their family need time to adjust to the new lifestyle.

Once the initial sensitive period (around three months) ends, almost all liver transplant patients can return to their pre-disease life. However, it is crucial to apply the lessons learned and continue follow-up with the transplant team at the hospital.

The Importance of Choosing a Liver Transplant Center

When a patient starts looking for a liver transplant center, several factors come into play, with the choice of the right center being crucial for the success of the surgery. We ensure that the patient has come to the right place as our center is one of the largest and most successful liver transplant centers in Turkey, thanks to our highly skilled medical team, including specialists trained in the United States.

Liver transplant surgeries are performed daily at our center with complete success. We also conduct liver transplants for children, which are riskier than for adults, with great success.

The key to the success of the surgeries performed at our hospital is the advanced infrastructure and modern equipment that meets international standards.

Kidney transplantation Center

What is Kidney Transplant?

A kidney transplant is performed when the kidney loses its function in the human body. This often occurs in cases of end-stage kidney failure or renal insufficiency, which is the stage where kidney function is completely impaired. In such cases, patients spend their lives undergoing dialysis to remove toxins from the body, which is a burdensome and difficult process. In these situations, the best treatment option to save the patient’s life is a kidney transplant from a living donor.

The kidney transplant procedure is performed using the best surgical methods, where the kidney is taken from a donor (usually a family member) and transplanted into the patient’s body.

Although dialysis (including hemodialysis and peritoneal dialysis) seems like an alternative to kidney transplantation, the primary purpose of these methods is to keep the patient alive until a suitable donor from the family becomes available. Once a donor is found, kidney transplantation is performed in a timely manner.

Kidney transplantation is important for the patient’s well-being, saving their life and offering hope for a healthy life, making the danger of kidney failure less overwhelming.

Difference Between Dialysis and Kidney Transplantation:

Dialysis patients can only remove toxins from their bodies for a few hours, a few days each week, while being connected to a dialysis machine. On the other hand, a patient who undergoes a successful kidney transplant can live a normal life after the procedure.

Kidney Transplant Diagnostic and Care Center

The Kidney Transplant Center at the Turkey Healthcare Group provides comprehensive services to patients with kidney failure or insufficiency, offering diagnosis and treatment for both adults and children, with a focus on saving the patient’s life. Our center is equipped with advanced technological equipment in the kidney transplant department.

At our center, we take the kidney from the donor using the latest surgical methods, most commonly through laparoscopic surgery, known as “closed surgery.”

If the female donor is suitable for the donation procedure, the kidney is taken through a vaginal surgery. We ensure that kidney transplants are carried out using the most advanced techniques to save lives and ensure that the donor undergoes the procedure with the latest medical technologies.

When is a Kidney Transplant Performed?

Patients diagnosed with end-stage kidney failure are evaluated to see if they are suitable for a kidney transplant. At this stage, the patient’s kidney function is permanently impaired, and the patient’s life is at risk.

The only solution for kidney failure or renal insufficiency patients is a kidney transplant from a healthy donor. Once the patient decides to undergo a transplant, a healthy family member must be present to donate a kidney. Both the patient and the donor must undergo compatibility tests before proceeding.

When Can a Kidney Transplant Not Be Performed?

A kidney transplant cannot be performed under the following conditions:

• If the kidney failure patient is being treated with other methods or medications.
• If the patient has an active infection (inflammatory conditions) as kidney transplants are not performed in such cases.
• If the patient has a recent malignant cancer that cannot be treated.
• If the patient’s life expectancy is short.
• If the patient’s heart or lungs are too weak to withstand transplant surgery.
• If the patient is using drugs.
• In cases of oxalosis or excessive urine production (in these cases, a combined kidney and liver transplant may be required).

For all patients without these conditions, the transplant is performed in the best way possible and at the right time.

Stages of the Kidney Transplant Procedure

After confirming the diagnosis of kidney insufficiency, the patient is prepared for a kidney transplant from a donor. It is essential to obtain a compatible kidney from a family member.

First, the left kidney of the donor is examined. If the kidney is suitable, the surgeon chooses to take the kidney from the left side of the donor. Then, the transplant kidney is prepared for the patient.

After the transplant, the patient can be discharged from the hospital on the fifth day, and the donor is discharged on the third day.

There are no risks to pregnancy or childbirth within one to two months after a kidney transplant.

What to Consider After a Kidney Transplant?

After discharge, the patient will need to take certain medications for the rest of their life to prevent the body from rejecting the new kidney.

If these medications are not taken, regardless of the time that passes, the patient’s body will reject the new kidney. For this reason, the patient needs to pay attention to what they eat and the medications they take. When a new medication is necessary, the kidney specialist at the Kidney Transplant Center must be informed.

Things to Consider After Kidney Transplant:

• Blood pressure should be maintained at normal levels, and the diet should be chosen accordingly.
• Fatty and carbohydrate-rich foods should be avoided.
• Grapefruit should be avoided as it may reduce the effectiveness of the medications that are taken continuously.
• Regular exercise, especially walking, should be done.
• Heavy physical work or intense sports should be avoided.
• Diabetic patients should monitor and control their blood sugar levels.
• If you need more information about kidney transplantation, initial consultations, or treatment plans, you should directly contact the Kidney Transplant Center at Turkey Healthcare Group.

When Should a Kidney Transplant Be Performed?

Patients who have been on dialysis for 3-4 years should be recommended for kidney transplantation as soon as possible.

The most ideal treatment for patients with kidney failure is to undergo a kidney transplant from a living donor before starting dialysis.

It is easy to understand the importance of finding a kidney that continually filters toxins from the blood post-transplant compared to undergoing dialysis three times a week.

Dialysis patients may become exhausted as their bodies undergo dialysis treatment, eventually becoming unable to undergo transplantation due to the development of health issues.

How Long Should Kidney Transplant Follow-up Be?

At the Kidney Transplant Center, the preparation phase for both the patient and the donor for a living kidney transplant can be completed within one week.

The duration of the kidney transplant procedure depends on the family donor, and the surgery date is scheduled in advance. The donor and patient are admitted to the hospital the day before the procedure.

Simultaneously with the patient’s preparation, compatibility tests between the patient and the donor are conducted. If the results are positive, the kidney transplant surgery is performed as soon as possible.

One of the most important aspects of kidney transplantation from a living donor is that there is no harm to the donor. Studies have shown that there is no increased risk to the individual donating the kidney in their future life.

People who wish to donate a kidney to their relatives at our center are examined by various specialists from different fields. This examination includes consultations from experts on the Organ Transplant Board, and the final decision is made about whether the person is suitable to donate a kidney.

Our kidney transplant follow-up program is not limited to the patients but also includes the donors, to ensure annual check-ups for both. The safety of kidney donors is our top priority in continuing kidney transplant surgeries with living donors. Kidney donors undergo advanced techniques performed by leading teams in Turkey, which are considered to be safer.

What Are the Pre-Transplant Procedures?

The Kidney Transplant Center is welcomed by the department head, who evaluates patients with end-stage kidney disease applying to the center. The suitability of the patients for a kidney transplant is assessed by our doctors after conducting detailed examinations.

Detailed Examinations Before Kidney Transplant

The detailed examinations include comprehensive tests, radiology tests, and heart examinations. These screenings are performed by specialists in various fields, especially nephrology. The transplant evaluation is conducted by the kidney transplant surgeon, a cardiologist, and other necessary specialists.

If a relative wishes to donate a kidney, the potential donor (your relative who wishes to give you one of their kidneys) will also undergo a detailed examination.

These tests are essential to ensure that the living donor will not suffer health deterioration and can return to a healthy and normal life after the transplant.

Thus, the kidney donor undergoes detailed blood and urine tests, CT scans, and abdominal examinations.

However, individuals deemed healthy are considered suitable kidney donors.

Post-Kidney Transplant Procedures

For successful kidney transplantation, not only the surgical procedure but also the post-transplant follow-up period is extremely important.

At our Kidney Transplant Center, we carefully follow every patient who undergoes the transplant procedure. The main goal of a kidney transplant is to preserve the health of the transplanted kidney for many years.

For this reason, the most important aspect that our center emphasizes is the regular follow-up program for both patients and donors after the transplant.

Our patients who have undergone kidney transplant surgery are typically discharged after six days. Before discharge, patients are provided detailed instructions about the medications they should take and the considerations for their new life.

The patient will leave the hospital with a medication schedule and a 24-hour contact phone number. Patients are required to come to the hospital for blood tests twice a week in the initial weeks.

For patients living in remote areas, blood tests can be performed locally and sent to the center. These blood tests will be repeated once a week in the second month, and once every six months thereafter.

Our patients are regularly called for kidney disease control. Additionally, they can contact our doctors at any time.

We also regularly follow up with kidney donors who have given the gift of life to their relatives. Kidney donors can return home within an average of three days after surgery.

They are invited back to the hospital for a follow-up exam one week after returning home, and further check-ups are scheduled six months later.

After that, they are asked to come for annual follow-ups. At our Kidney Transplant Center, we have a dedicated team that closely monitors kidney donors.

Life After Kidney Transplant

A new life and a new day… You are now at home with your loved ones and family.

The first biochemical test will be performed two days after leaving the hospital. After this first test, you must come to the hospital twice a week for biochemical tests.

The frequency of visits to the hospital will gradually decrease: once a week, then every 15 days, and eventually once a month.

The immunosuppressive medication doses will be adjusted according to your blood levels. Therefore, regular blood donation is crucial.

If you’ve had tests performed at another lab, the results must be forwarded to the Kidney Transplant Center, and the blood test timing will be adjusted based on the medications being used.

If you do not hear from us within 48 hours after your tests, please contact us.

If you are receiving insulin treatment, your follow-up will continue at the outpatient diabetes clinic after discharge. Additionally, skin staples will be removed one month after surgery. If you notice redness, swelling, or fluid formation at the wound site, contact us immediately.

It is essential to excrete at least 2000-3000 cc (2-3 liters) of urine daily. Always take medications at the times prescribed by your doctor, and never adjust the dosage or quantity on your own. Please reach out if you need to use any medications other than those we have provided.

You should contact us if you experience or face any of the following problems:

• Fever with a temperature higher than 38°C
• Decreased urine output, changes in urine color, or burning sensation while urinating
• Swelling of the ankles or wrists
• Sudden increases or decreases in blood pressure
• Frequent vomiting or diarrhea
• Coughing or shortness of breath

Advice for the Patient and Donor After Kidney Transplant

The success rate of kidney donors leaving the hospital and returning home safely is 99.8% in our healthcare system, with 97.4% success in the first year after surgery.

The success rate at the Turkey Healthcare Group’s transplant center is attributed to our experienced doctors and the performance of our team, with results comparable to the most successful centers in America and Europe.

Diet After Kidney Transplant Surgery

Post-Kidney Transplant Nutrition: Achieving a new and normal life has a positive impact on appetite. It is also important to remember that medications contain corticosteroids, which increase appetite. As a result, patients tend to gain weight by consuming more food after a kidney transplant, which increases the waste products created by the additional weight and metabolism, which are then eliminated by the kidneys. This creates an additional load on the kidneys. Additionally, overeating can cause an increase in blood sugar levels.

Things to be cautious about:

• Cook food with a small amount of salt unless otherwise directed by your doctor.
• Avoid foods that raise cholesterol levels (natural fats) in the blood.
• Cook meals using oils like olive oil, sunflower oil, and corn oil.
• Do not eat in places you are not sure about cleanliness.

What is Kidney Failure and Some Information About It: Kidney failure is when the kidneys are unable to perform their functions either partially or fully due to various diseases.

Types of Kidney Failure: Kidney failure can occur in two forms:

1. Acute Kidney Failure
2. Chronic Kidney Failure

Acute Kidney Failure: Acute kidney failure refers to the sudden loss of kidney function, where there is a rapid decline in kidney function. As a result, urea nitrogen, creatinine, and other urinary toxins accumulate in the blood.

A decrease in urine output during acute kidney failure is known as oliguria (less than 400 ml of urine per day). The amount of decreased urine output varies from person to person.

Why does Acute Kidney Failure occur? Acute kidney failure often develops for various reasons. Diseases that affect small kidney arteries, such as clotting, obstruction, vasculitis, uremic hemolytic syndrome, thrombocytopenic purpura, and disseminated intravascular coagulation, can lead to acute kidney failure.

Acute kidney failure can also occur due to traumatic causes. Some causes include prolonged dehydration, diarrhea, fluid loss due to vomiting, sudden blood loss, prolonged fever, severe burns, recurrent childhood throat infections, and long-term urinary failure due to prostate enlargement, all of which can cause acute kidney failure.

What are the Symptoms of Acute Kidney Failure? Acute kidney failure symptoms include the following: decreased urine output, edema due to fluid accumulation in the feet and knees, fatigue, weakness, loss of appetite, nausea and vomiting, chest pain, shortness of breath, mental changes, and coma.

How is Acute Kidney Failure Diagnosed? In diagnosing acute kidney failure, a physical examination is conducted first, followed by a careful review of the patient’s history. In the patient history review, detailed information is obtained from the patients.

Acute kidney failure diagnosis is confirmed through tests such as blood and urine analysis, abdominal ultrasound, CT scan of the abdomen, and MRI imaging.

How is Acute Kidney Failure Treated? The primary approach to treating acute kidney failure is managing the patient’s fluid balance by addressing the underlying cause and restoring kidney health through adequate nutrition.

Treatment for acute kidney failure is provided in a hospital setting. If the condition is caused by fluid loss and blood loss, fluids and blood are administered via IV. If swelling (edema) occurs in the legs, diuretic medications are used. It is important to maintain calcium and potassium balance in the blood. Temporary dialysis treatment may be applied to the patient to remove waste products from the blood.

Chronic Kidney Failure: Chronic kidney failure occurs due to kidney damage detected through urine and blood tests and imaging results over a period of more than three months. As with the rest of the world, the incidence rate in our country has gradually increased over the years.

Main Functions of the Kidneys: In addition to urine formation, the kidneys perform other crucial functions, including:

• Removing harmful waste products like urea and creatinine from the body via urine due to daily metabolic processes.
• Helping organs function properly and maintaining blood pressure balance by removing excess water from the body through urine, such as water, sodium, and potassium.
• Removing certain medications we take from the body through urine.
• Protecting the body from anemia by producing a hormone called erythropoietin, which helps mature red blood cells in the bone marrow.
• Ensuring bone resistance by regulating calcium and phosphorus balance through contributing to Vitamin D synthesis.
• Ensuring blood levels of certain hormones.

What Problems Arise in the Body Due to the Kidneys Not Performing Their Basic Functions?

As kidney function decreases over the years, chronic kidney failure occurs. The main causes of chronic kidney failure are diabetes and high blood pressure. A similar clinical picture may also occur in certain inflammatory kidney diseases known as chronic glomerulonephritis.

In patients with chronic kidney disease, complaints and symptoms may not appear for years.

It is important to detect high blood pressure, which often accompanies chronic kidney disease. Therefore, it is essential for everyone in the community to check their blood pressure and undergo regular health check-ups.

What are the symptoms of chronic kidney failure?

As chronic kidney failure progresses over the years and kidney function gradually declines, certain complaints and symptoms emerge. These include weakness, loss of appetite, nausea, vomiting, itching, and a tendency to sleep, as the kidneys fail to remove harmful substances from the body, leading to their accumulation in the bloodstream.

In the later stages of chronic kidney failure, the kidneys may not be able to remove enough water and salt from the body. As a result, swelling may occur in the eyelids, feet, and legs, often accompanied by high blood pressure. Additionally, fluid accumulation in the lungs can cause shortness of breath.

Furthermore, due to the kidneys’ inability to excrete potassium, life-threatening conditions may arise, ranging from weakness and paralysis to cardiac arrest.

One of the significant problems that may occur due to the kidneys’ failure to perform their functions in patients with chronic kidney failure is the development of anemia, which can cause weakness, fatigue, dizziness, difficulty concentrating, palpitations, and shortness of breath.

Also, in patients with chronic kidney failure, due to the inability to produce vitamin D and remove phosphorus from the body, calcium and phosphorus balance is disrupted. As a result, there may be excessive stimulation of the parathyroid glands, which are located behind the thyroid in the neck and regulate calcium and phosphorus balance. This condition is known as secondary hyperparathyroidism. Depending on the severity, bone deterioration and reduced bone resistance can occur.

What are the stages of chronic kidney failure?

To determine the stage of chronic kidney failure, a blood test is first required. Then, the serum creatinine level is measured. Following this, the glomerular filtration rate (GFR) is calculated using specific formulas, which helps to identify the stage of kidney failure.

Chronic kidney disease is classified into five stages based on kidney filtration function. The higher the stage, the less the kidneys function.

• Stage 1: Kidney damage with a glomerular filtration rate (GFR) of over 90 mL/min.
• Stage 2: Mild kidney damage, with a GFR between 60-89 mL/min.
• Stage 3A: Mild to moderate kidney damage, with a GFR between 45-59 mL/min.
• Stage 3B: Moderate to severe kidney damage, with a GFR between 30-44 mL/min.
• Stage 4: Severe kidney damage, with a GFR between 15-29 mL/min.
• Stage 5: End-stage kidney disease, where the kidney’s filtration function is severely impaired (GFR less than 15 mL/min), and dialysis or kidney transplantation is required.

What individual measures can be taken to prevent chronic kidney disease or delay its progression?

The most common cause of chronic kidney disease is diabetes, followed by high blood pressure. Additionally, some inflammatory kidney diseases, such as chronic glomerulonephritis, and genetic diseases like polycystic kidney disease, can lead to chronic kidney failure.

People at risk for chronic kidney disease include those who are overweight, have high blood pressure, are diabetic, and have a family history of kidney disease. The elderly are also at risk due to the aging of blood vessels and the increased risk of kidney failure.

Lifestyle changes are crucial in delaying the progression of chronic kidney disease. Since the kidneys are rich in blood vessels, measures that protect cardiovascular health also have a protective effect on the kidneys.

To protect kidney health, the following measures should be taken:

• Regular physical activity
• Maintaining an ideal body weight
• Not smoking
• Reducing salt intake
• Ensuring adequate fluid intake
• Avoiding alcohol
• Not using medications without a doctor’s consultation
• Overuse of painkillers in the community accelerates kidney function deterioration. Some herbal products may also have harmful effects on the kidneys and liver.

Is early diagnosis possible for chronic kidney disease?

Chronic kidney disease is often insidious but can be diagnosed in its early stages with simple tests like regular blood pressure monitoring and urine analysis.

Early diagnosis allows both general and specific measures for chronic kidney disease and treatments for accompanying diseases to slow the progression of the disease to more advanced stages.

Diagnosis of Chronic Kidney Failure

The primary tests for diagnosing chronic kidney failure include blood tests (such as urea, creatinine, etc.), urine tests, and kidney imaging via ultrasound. Blood tests may not show abnormalities in early-stage kidney failure. However, urine tests may reveal abnormalities such as protein leakage or bleeding. Abnormal results in blood tests may appear as the disease progresses.

Ultrasound imaging of the kidneys provides information about the diagnosis of kidney failure (for example, smaller-than-normal kidneys) and the underlying condition (such as familial kidney diseases or congenital structural diseases).

How is Chronic Kidney Failure treated?

In chronic kidney failure, the kidneys gradually lose their function. The treatment approach for chronic kidney failure involves the following steps:

• Stopping the progression of kidney disease
• Supportive treatment for kidney failure
• Decision for dialysis and preparation for kidney transplantation

People who have risk factors (such as diabetes and high blood pressure) for kidney disease should have their kidney function closely monitored, with appropriate treatment of these risk factors to protect kidney function.

This process may provide an opportunity to prepare for various treatments if kidney function declines.

Kidney Transplant from a Living Donor

The technique used in kidney transplant surgery is retroperitoneal laparoscopic surgery. This technique has been developed in kidney transplant centers, making kidney donor surgeries safer and more comfortable.

The retroperitoneal laparoscopic technique is not only explained at medical conferences in our country but also at many international medical conferences in the USA and Europe.

Our organs (such as the stomach, intestines, and liver) are located in the abdomen within a membrane called the peritoneum. Thanks to the lubricating fluid inside this membrane, organs in the abdomen stay adjacent without sticking together.

Entering the abdomen during surgery can disrupt this balance within the peritoneum, potentially causing organs to stick together.

Thanks to the retroperitoneal laparoscopic technique, there is no damage to the peritoneal membrane. This prevents both the risk of accidental damage to abdominal organs and the risk of adhesions between abdominal organs. Also, using this technique, the scar can be placed under the underwear line. This resolves aesthetic concerns for kidney donors.

The benefits of kidney removal using retroperitoneal laparoscopic technique are as follows:

• Preventing damage to the peritoneal membrane
• Preventing damage to abdominal organs during surgery
• Eliminating the risk of reopening due to adhesions inside the abdomen
• Preventing gas and bloating in the intestines
• Preventing uterine adhesions that may pose a risk for women with children
• Reducing postoperative pain complaints
• Speeding up the return to normal life for the donor (people who donate kidneys via retroperitoneal laparoscopic technique can typically return home on the second or third day)

However, the retroperitoneal laparoscopic technique requires experience and attention. The main reason it is not easily applied in every center is that it requires removal of the kidney in a narrower area.

Tests and Examinations Required from the Living Donor

If you have a relative who wishes to donate a kidney, both you and your relative will be thoroughly evaluated by a nephrologist and a kidney transplant surgeon.

One of the most important principles in living organ donation is that the kidney donor, who is healthy and voluntarily makes a significant sacrifice for the life of a relative, should do so without harm. If the health of the living kidney donor is evaluated as good after the doctor’s examination, the donation can proceed.

First and foremost, blood tests are conducted, including biochemical and serological tests. If no health issues are detected in these tests, the structure of the kidneys and blood vessels is evaluated in detail using a 3D abdominal CT scan.

The living donor candidate is evaluated by a nephrologist, cardiologist, obstetrician, and psychologist. If necessary, evaluation by a pulmonologist and a gastroenterologist is also performed.

At the end of all these tests and evaluations, if there is no issue affecting the donor’s health, a living kidney transplant can proceed.

Blood Type Compatibility between Patient and Donor

For kidney transplantation, blood group compatibility (A, B, O) must be found between the recipient and the donor, similar to blood transfusion. Group O is the universal donor, and group AB is the universal recipient. According to this rule:

The Rh system does not matter in kidney transplantation. A person with Rh-negative blood can easily receive a kidney from a Rh-positive donor. Tissue typing is also performed for potential recipients. However, it should be known that tissue matching is not absolutely necessary for kidney transplantation.

Donor	Recipient
O	O
O or A	A
O or B	B
O, A, B, or AB	AB

Kidney transplantation is also an option for patients without blood group compatibility. When transplanting without blood type compatibility, the immune-related risks increase, which heightens the likelihood that the body may reject the transplanted kidney in the early stages.

However, today, kidney transplants without blood group compatibility can be performed using a treatment called blood separation (plasma cleaning) and medications that significantly suppress the immune system, by connecting the device to the bloodstream to introduce antigens against the blood group.

At our center, antibody levels of Anti-A and Anti-B are examined for patients without blood group compatibility. If these antibodies are low, kidney transplant surgery results without compatibility can be safer.

Risks for the Donor

The main goal of the organ donation center is to protect the donor from harm. Long-term follow-up with kidney donors has clearly shown that donating a healthy kidney does not shorten life or cause health deterioration.

Before kidney surgery, individuals who wish to donate a kidney voluntarily are thoroughly examined. Even if no complaints are present, problems discovered during detailed examination can be addressed early.

Candidates who will become kidney donors are monitored by our kidney transplant center for an extended period, and health standards are raised through regular check-ups.

In the kidney donation process, health awareness is increased, and social habits (such as smoking and weight gain) that can prevent donation are regulated. It is possible to organize lifestyles that will not change under normal circumstances in the long term.

However, these measures do not mean that the donor candidate is without risk during surgery. Since even the simplest surgical interventions carry risks, it is clear that kidney donors also bear some risk, though it is low.

The fact that a completely healthy person takes such a risk, even though it is low, is the most sensitive aspect of living kidney donation.

For this reason, it is essential to carefully evaluate the kidney donor candidate, conduct a proper risk analysis, and ensure the procedure is performed at a well-experienced center equipped with the latest technological techniques.

Kidney Transplant from a Paired Donor

If a patient and their donor are family members but there is a mismatch in blood type and tissue compatibility between them, and there is no other family donor available, there is an alternative solution to save the patient’s life. This solution involves paired kidney donation, where two patients and two donors exchange kidneys to save each other’s lives. These kidney transplant procedures are referred to as “Kidney Swap.”

What is Paired Kidney Donation?

This method is applied to patients who do not have a compatible donor due to blood type or tissue incompatibility with their family members. The transplant is organized considering tissue compatibility at the organ transplant center of the hospital, even if the blood types of the donors do not match.

For example, a blood type A recipient might receive a kidney from a donor with blood type B for another patient with blood type B, while a donor with blood type A from the second patient would donate a kidney to the first patient.

Patients with blood types A or B can become candidates for paired kidney donation when there are no compatible blood type donors available.

An important point to note here is that patients with blood types O or AB have fewer chances of being involved in paired kidney donation.

Why Is Paired Kidney Donation Not Always Possible?

Even though a donor is a living kidney donor, the main reasons for unsuccessful kidney transplants are:

• Blood type incompatibility between the donor and recipient: For a kidney transplant from a living donor to occur, the blood types between the donor and recipient must match. Blood types A and O are particularly important for successful matching.
• Crossmatching incompatibility due to antigens in the blood: This could lead to severe rejection of the organ.
• The kidney transplant needs to consider various factors, such as age and tissue compatibility, to ensure a successful procedure.

Kidney Transplant in Children

Kidney transplants in children are less frequent than in adults, and there are fewer centers specialized in pediatric kidney transplants.

Turkey Healthcare Group offers a state-of-the-art center equipped with advanced technology, where experienced doctors perform kidney transplants in children as soon as a diagnosis is made, to prevent growth delays and ensure a new life for the child.

Children undergoing dialysis due to kidney failure can face several complications. Issues like access to blood vessels in children without peritoneal dialysis, bone metabolism disorders, and future orthopedic surgeries can arise. In addition, living a different life from their peers may lead to psychological issues.

Kidney transplantation in children plays a crucial role in preventing growth delays and issues like bowed legs. However, the timing of the transplant is critical, especially when the child is underweight.

Children weighing more than 20 kg can typically receive a kidney from a parent easily, but for those weighing less, the situation needs to be carefully evaluated due to the challenges of placing a large kidney into a small body, which may affect the circulatory system.

Successful pediatric kidney transplants require an experienced surgical team, anesthesiologists, pediatric nephrologists, and specialists working together in the same center.

Causes of Kidney Failure in Children

The most common causes of kidney failure in children include:

• Urinary tract diseases due to urethral valve issues
• Metabolic diseases
• Congenital abnormalities related to the urinary bladder
• Recurrent infections
• Developmental kidney abnormalities

Who Cannot Be Kidney Donors?

Individuals under 18 years old, people with high blood pressure, diabetes, kidney stones, kidney abnormalities, chronic diseases (such as lung disease or cancer), obesity (over 30% of ideal body weight), a history of blood clots, psychiatric disorders, or a strong family history of diabetes, hypertension, or kidney diseases are not eligible to donate kidneys.

How Is a Kidney Transplant Performed?

Today, kidney transplants are performed similarly around the world. The donor’s kidney is removed using laparoscopic techniques. Over the past decade, the retroperitoneal laparoscopic technique has emerged as the most advanced method for kidney transplants globally.

We are proud to be one of the pioneers of this technique, and it is applied to kidney donors in our country.

In a living donor kidney transplant, the donor is prepared first, and once the first part of the surgery is complete, the recipient is transferred to the operating room.

During the removal phase, the kidney is prepared for transplantation into the recipient. The kidney must be transferred quickly while blood flow is cut off. Once the kidney reaches the recipient’s table, the transplant procedure is complete.

What Tests Are Required for the Patient and Donor for a Kidney Transplant?

Through remote follow-up, an appointment request file will be created, and a consultation appointment will be scheduled at the organ transplant center. A date will be provided for the patient to be examined by a kidney specialist.

If the kidney doctor performs a physical examination and further testing is needed, additional tests will be requested.

When you come to our transplant center, preparations are usually made within two weeks.

The required tests for the patient and donor for a kidney transplant include the following:

• Comprehensive blood and urine tests
• Chest X-ray
• CT scan of the chest
• Angiography of the heart vessels and arteries
• 3D CT scan of the abdominal vessels and arteries
• Electrocardiogram (ECG)
• Echocardiogram (ECHO)
• Upper and lower abdominal ultrasound, thyroid ultrasound
• Tissue matching tests
• Special immunology and tissue analysis tests
• Consultations with specialists in the following areas:
  • Nephrologist
  • Kidney transplant surgeon (head of the kidney transplant department)
  • Cardiologist
  • Gynecologist (if the patient or donor is female)
  • Pulmonologist
  • Urologist
  • Psychiatrist

If additional specialist consultations are needed, the patient or donor will be referred to another doctor.

Additional Tests for the Donor:

• 24-hour urine collection
• Kidney imaging via CT scan

The kidney transplant surgeon, nephrologist, immunology and tissue matching laboratory supervisor, anesthesiologist, and other specialists will discuss and assess the suitability of the transplant procedure.

 

For inquiries and medical consultations regarding your treatment, please send all medical information, tests, and reports about the patient’s condition via our social media platforms (WhatsApp, Viber). You can also contact our medical consultants directly through the numbers available on the website.

Once we receive the required information, we will assess the patient’s condition within 24 hours and provide you with all the details about the treatment plan, treatment costs, length of stay in Turkey, and other services provided by our institution.

 

 

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