Kidney and liver failure: Organ transplantation

Organ failure means that an organ loses the ability to perform its physiological functions, and this creates a potential threat to the patient's quality of life and survival.

The kidneys have a number of physiological functions, from filtering blood to removing waste products to maintaining electrolyte balance and regulating the production of red blood cells via the hormone erythropoietin. The severity of the renal insufficiency is usually quantified by laboratory analyses, from minor (stages 1–2) to severe chronic renal failure (stage 5). With chronic kidney failure, there are two treatment options, either dialysis or transplantation. The first option is a palliative treatment which involves the use of an external machine that takes over the kidneys’ filtration function. Dialysis is an effective method, although for most patients the frequent hospital visits are time consuming and the treatment is stressful. Transplantation involves an operation in which a new and functioning kidney (transplant) is implanted so that the patient recovers the lost function.

For patients with liver failure, the situation is even more complex. A functioning liver is vital for survival, and for patients with severely impaired liver function, there is no palliative treatment corresponding to kidney dialysis. The only treatment option is therefore transplantation. Unlike kidney transplants, the old liver is removed and replaced with a new one.

Two important limiting factors for transplantation are their availability, which is still much lower than the demand, and the biological and immunological compatibility between the graft and the recipient. Physiologically, the immune system protects the body from external pathogens by being able to distinguish between the host (own tissue) and all that is not (foreign tissue). Though critical in defending a healthy individual, in a transplanted patient receiving a graft from a donor (thus, strictly speaking, non‑self), this mechanism results in the immune system attacking the transplanted organ (rejection).

The current standard treatment to prevent organ rejection comprises a combination of immunosuppressive drugs that lowers the immune system’s reactivity in order to avoid rejection, but not so much as to increase the risk of opportunistic infections. Treatment is maintained as long as the transplanted organ works. The mean survival of a transplanted kidney is about 10 years, while it is slightly shorter for a transplanted liver.

The standard of care currently in use is based on a triple combination of immunosuppressant agents, of which tacrolimus represents the main pillar.

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.