Question 4 (20 pts) This question is in part based on your Reading \"Kindey Tran

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Question 4 (20 pts) This question is in part based on your Reading "Kindey Transplant. It is a sad truth that every year thousands of people die in the US while waiting for a kidney transplant (are you identified as a donor on your drivers' license?!). Even among the patients lucky enough to receive a kidney transplant, rejection and failure rates have remained stubbornly high. Your Reading uses histological investigations to identify risk factors that may result in long- term renal allograft failure. Please (i) explain briefly the study methodology, (ii) describe the observed histological findings, and (ii) summarize the results of the study. Lastly (iv), come up with some ideas on how our residents could be encouraged to become organ donors. Feel free to reference your reading assignment and other sources but avoid extensive quotes-they are bad style and will not be considered part of "your"answer-paraphrase and cite instead (see your Plagiarism Exercise to see the difference between quoting and paraphrasing).

Explanation / Answer

                                KIDNEY TRANSPLANT AND ITS METHOLOGY

During kidney transplant surgery, a surgeon places a healthy kidney into your body. You’ll receive general anesthesia  before the surgery.

The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.

If you’re on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.

If a family member or friend is donating the kidney, you’ll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.

THE PROCESS

1. Tell your doctor or nurse you want to have a kidney transplant.

2. Your doctor will refer you to a transplant center for tests to see if you’re healthy enough to receive a transplant. Living donors need to be tested to make sure they’re healthy enough to donate a kidney.

3. If you don’t have a living donor, you’ll be placed on a waiting list to receive a kidney. You’ll have monthly blood tests while you wait for a kidney.

                              Kidney transplant failure

It is an important cause of dialysis initiation in the United States. In 2011, this group represented 4.7% of patients new to dialysis, a 30% increase in the number of patients initiating dialysis after transplant failure since 2000

1. Improvements in short-term kidney allograft survival have surpassed improvements in long-term graft survival

2. Therefore, the transplant failure dialysis population will continue to increase because of a relatively fixed duration of graft survival, an increasing number of kidney transplants performed

3. Quantifying the morbidity and mortality of patients with transplant failure needs to be interpreted in the context of the control group against which the mortality risk is being compared

4. The risk is highest in the early period after dialysis initiation, and is particularly driven by higher susceptibility to infection-related morbidity

Conclusions comparing the mortality risk of patients with transplant failure relative to transplant-naïve incident dialysis patients are less clear. Inherent differences between the two groups in terms of the duration of uremia cannot be fully accounted for. Reports from the dialysis registry data in Canada comparing the mortality risk between all transplant-naïve patients versus all patients with transplant failure demonstrated similar survival

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