Kidney and liver failure – organ transplants

The kidneys perform a number of physiological functions, ranging from filtering the blood and removing waste products to maintaining the electrolyte balance and regulating the production of red blood cells via the hormone erythropoietin. Organ failure means that an organ loses the capacity to perform its physiological functions, and this creates a potential threat to both the quality of life and the survival of the patient. 

Chronic kidney failure

The severity of renal impairment is usually quantified through laboratory analyses, ranging from mild (stage 1–2) to serious chronic kidney failure (stage 5). The latter has two possible therapeutic options, either dialysis or transplantation. The first option is a palliative treatment which entails an external machine taking over the kidneys' filtering function. While dialysis is an effective method for the majority of patients, it entails frequent hospital visits for time-consuming and unpleasant sessions. Transplantation entails an operation where a new and functioning kidney (transplanted) is inserted so that the patient recovers the lost function.

Liver failure

For patients with liver failure,  the situation is even more complex. A functioning liver is absolutely essential for survival and for patients with severe heptatic impairment there is currently no palliative therapy that corresponds with dialysis treatment for kidney patients. The only therapeutic approach is therefore a transplant. In distinction from renal transplant, the old liver is removed and replaced with a new organ.

Transplantation and availability of organs

Two important limiting factors for transplants are availability of organs, which is still considerably lower than demand, and the biological and immunological compatibility between the transplant and the recipient. Physiologically, the immune system protects the body from external pathogens by being able to distinguish between what belongs to the host (own tissue) and what does not (foreign tissue). This mechanism is crucial for the body's capacity to defend a healthy individual, but in patients receiving a transplant from a donor (i.e. foreign tissue), this mechanism leads to the immune system attacking the transplanted organ (rejection).

Immunosuppressive drugs

Currently, the standard treatment to prevent organ rejection consists of a combination of immunosuppressive drugs which lowers the immune system's reactivity sufficiently to avoid rejection, but not so much that the risk of opportunistic infections is increased. The treatment is administered for as long as the transplanted organ is functioning. The average survival of a transplanted kidney is about 10 years, while it is slightly less for a transplanted liver. A triple combination of immunosuppressant drugs is currently used after a transplant.

CYSTISK FIBROS (CF)

Cystisk fibros är en ärftlig genetisk sjukdom som innebär att en mutation i CF-genen orsakar förändringar i ett protein kallat CFTR. Detta protein finns i alla kroppens organ och reglerar transporten av natriumklorid och vatten genom cellmembran. Sjukdomen påverkar främst lungorna och bukspottkörteln. I lungorna blir sekretet tjockt och klibbigt, vilket skapar en idealisk miljö för bakterier som Pseudomonas aeruginosa och leder till att den sjuke lättare drabbas av återkommande infektioner och inflammationer. Det kan i sin tur orsaka allvarliga tillstånd som till exempel lunginflammation. Med tiden kan den kroniska inflammationen skada lungvävnaden och försämra andningsfunktionen, vilket är den vanligaste dödsorsaken hos dessa patienter. En infektion kan ge många olika symtom som varierar från person till person och från tid till annan: långvarig hosta, andningssvårigheter, upphostningar av slem, minskad uthållighet vid fysisk aktivitet, dålig aptit, allmän sjukdomskänsla och feber.

Cardiology – Ischaemic heart disease

Ischemic heart disease is a common disease in the Nordic countries.  The disease causes insufficient blood supply to the heart, resulting in angina. The condition can manifest itself in both stable and acute disease states. Ischaemic heart disease can be treated in a number of ways, ranging from traditional drug treatment to procedures such as open surgery and a catheter-based procedure called Percutaneous Coronary Intervention (PCI). It is also known as balloon dilatation of the coronary artery, and

it has become increasingly common. In recent years, there has been rapid method development in the field of instruments, implants, procedures and pharmaceuticals. The catheter-based method is used in both scheduled and emergency procedures, for example in connection with acute heart attack. 

It has many advantages, but is also associated with certain complications. Most patients undergoing a PCI procedure will receive treatment involving stents. The stent is a thin metal tube that serves to stabilise the blood vessel so that blood flow can be restored. Despite this, there is a risk of clotting in the stent, known as stent thrombosis. Effective antiplatelet therapy can minimise the risk of this complication.