Literatus: Changing kidneys

EVEN an ending life can be prolonged, given the right science, the right technology and certainly the right kind of prayer.

During the end-stage of renal disease (the point at which the condition of a kidney is a few steps toward failure) life can still be prolonged somehow. The best treatment for this condition is kidney replacement surgery. If a kidney is giving up, then replacing it can be wiser.

A serious risk with kidney replacement though, is with the body’s reaction to the donated kidney that can often come from sources not genetically related to the patient.

In the 24 years of kidney replacement history in Iran (1984-2008), 87.5 percent of kidneys used, came from living individuals not related to the patient.

Physicians who manage patients with kidney transplant use immunosuppressive drugs.

These temporarily suspend the inherent capability of the human defense system from attacking "foreign bodies" that enter the system. And a donated kidney is one such “threatening” foreign body. It is here where the crossroad toward survival or death begins.

Unfortunately though, this immunosuppressive therapy is one of the most important risk factors for developing malignancies, according to a recent study published in the Journal of Cancer (June 2012). When you suppress the ability of the human body to fight off invading foreign bodies—and that includes microorganisms and toxic substances—you are also making it powerless in fighting off infection, and in many cases cancer-producing substances. When your cells start to mutate into cancer cells, your body can only watch it happening and cannot do anything about it.

As of 2009, cancer was the second cause of death in renal transplant recipients. And scientists expect that it would become the first cause of death in the next 20 years.

In the same study, Behzad Einollahi and colleagues noted that 89.6 percent of those who developed cancer still had active kidney grafts (79.1 percent had not rejected the graft). But there was a lot of good news though. More than a third (38.6 percent) had their immunosuppressant therapy discontinued, and 27.8 percent had theirs reduced due to successful grafting. Almost half (44.7 percent) responded to cancer treatments (only 14.3 percent relapsed). More than 75 percent of these cancers did not metastasize.

The death rate though was still 25 percent after the development of cancer, and 20.5 percent died within the first year after tumor diagnosis.

That’s the general picture the multi-center study noticed. And an encouraging one somehow. I hope that our experience in the Philippines prove better or at least at par with this. Only our monitoring agency at the Department of Health can give us that.