Acquired kidney disease - Kidney disease that develops as a result of disease or injury.
Altruistic donor – A transplant donor who is willing to give an organ to any recipient, rather than only to a relative or friend. The term means the same as a non-directed donor.
Anti-rejection drugs – Also known as immunosuppressive drugs these medications inhibit or prevent activity of the immune system. By interfering with the immune system, they prevent the recipient’s body from rejecting a transplanted organ. When the immune system senses foreign tissue or organs, numerous chemical chain reactions occur which can result in rejection. Immunosuppressant drugs interfere with those chemical reactions. These drugs can be classified according to their specific molecular mode of action. The three main immunosuppressant drugs currently used in organ transplantations are the following: FK 506 (Prograf) which acts by inhibiting T-cell activation, thus preventing T-cells from attacking the transplanted organ; MMF (Cellcept) which disrupts the synthesis of DNA and RNA and cell division and corticosteroids such as prednisolone (Deltasone, Orasone) which suppress the inflammation associated with transplant rejection
Dialysis – A process to filter the blood of impurities and toxins when the body’s kidneys no longer do the job. The process, which takes about 3-5 hours, must be repeated about three times a week.
Domino KPD – A variation of the paired KPD which starts with an altruistic donor giving to an incompatible pair. The donor of that pair then gives to another incompatible pair and so on. The final kidney from the last incompatible pair in the group usually goes to a recipient who is at the top of the UNOS waiting list.
End-stage kidney disease – Kidney disease that leads to the total loss of function in a kidney, thus requiring some form of renal replacement therapy in order to sustain life.
Endocatch bag – A bag that is used to remove a kidney once it has been surgically separated from the donor. The bag is placed around the kidney and then the bag is pulled through a small incision in the abdomen. That bag helps removed the kidney and helps protect it during removal.
Incompatibility – This term refers to mismatches between potential donor and recipient of blood type or HLA antigens.
Incompatible pairs – This term refers to a recipient who has a willing donor for whom they are not a compatible match.
Ischemia – This term refers to a condition in which blood flow to tissue or an organ is stopped. The amount of time an organ is without blood flow – following removal from a donor, for example – affects the health of the organ. The shorter the time the better.
Kidney Paired Donation (KPD) – A process pioneered at Hopkins that helps donors of incompatible pairs find kidneys. The process uses a formula to identify potential matches in a large group of individuals. The result is that recipients will get a compatible kidney from a stranger in exchange for their incompatible donors giving a kidney to a stranger.
Laparoscopic procedure -- Laparoscopic donor nephrectomy surgery a technique invented at Johns Hopkins in 1995 -- also called minimally invasive surgery -- is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. The abdomen is usually filled with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon elevating the abdominal wall above the internal organs like a dome. The key element in laparoscopic surgery is the use of a laparoscope, which is a tube inserted through a small hole in the abdomen that contains a light and a camera so surgeons can see their work. Two surgical tools are also placed through small holes in the abdomen. A final incision is made to remove the kidney. The gas used is CO2, which is common in the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrical devices are commonly used in laparoscopic procedures.
Nephrectomy -- The surgical removal of a kidney. The surgery can be done as open surgery, with one relatively large abdominal incision, or as a laparoscopic procedure, with smaller incisions. The ureter and blood vessels are disconnected, and the kidney is then removed.
NOTES – Natural Orifice Translumenal Endoscopic Surgery – A new approach to surgery pioneered at Hopkins in which surgeons use natural orifices in the body such as the throat and vagina, in order to access the thoracic and abdominal cavity. That advantage – since these surgeries don’t require large incision these types of surgeries can often have faster healing times.
Organ Rejection –Rejection occurs to some degree in all transplants (except those between identical twins). It is caused by mismatched proteins – called HLA antigens -- which are present on all cells of the body. There are a large number of different forms of these proteins, so a perfect match between the donor tissue and the recipient's body is extremely rare. When proteins don’t match the body can sense a foreign substance in the body and produces antibodies that attack and destroy the organ. The transplant doctors use immunosuppressive medications to prevent or lessen rejection.
Organ transplantation – The first successful organ transplant, performed in 1954 by Joseph Murray, M.D. Murray transplanted a kidney from one brother to his twin at Peter Bent Brigham Hospital in Boston. The transplant was successful because the donor and recipient were identical twins, and therefore there was no risk of rejection.
Plasmapheresis -- Plasmapheresis is a process by which blood is circulated outside of the body through a cell separator to separate antibody-laden plasma from blood cells. This plasma is replaced by antibody-free fluids which are returned to the body along with the blood cells.
Reperfusion – this term refers to restoring blood flow to tissue or an organ. In kidney transplant surgery it refers to the point in the surgery when doctors allow blood to flow into the new kidney.
United Network of Organ Sharing (UNOS) – A national organization that maintains a data base of patients in need of transplants, establishes guidelines for ethical transplantation and keeps statistics on organ donation and transplant services.
UNOS waiting list – This is a list that tracks all the people who are waiting for an organ. Patients are currently rated on this list based on need, blood type, previous waiting time on the transplant list, and also the Panel Reactive Antibody levels (PRA). PRA is based on the patient’s sensitization history or essentially, the amount of predisposed harmful antibodies they have developed against foreign kidneys - this means that the higher the PRA levels is, the longer the patients will wait for a kidney.
Ureter -- The ureters are muscular ducts that propel urine from the kidneys into the urinary bladder.
The Johns Hopkins Incompatible Kidney Transplant Program