How does kidney transplant surgery work? - Alexander H. Toledo

翻译人员: Eric Ma 校对人员: Manlin Fang

In the 1930s, doctors began experimenting with a procedure

在20世纪30年代， 医生们开始尝试一种

long thought to be medically impossible:

长期以来被认为 在医学上不可能实现的手术：

an organ transplant.

器官移植

Many pioneering surgeons focused on the kidney,

许多开创性的外科医生 将重点放在肾脏上

taking a healthy one from a living or recently deceased person

他们从活人或刚去世的人 身上取出一个健康的肾脏

and transplanting it into a patient dying from kidney failure.

并将其移植到因肾衰竭 濒临死亡的病人身上。

But these early surgeries faced a major problem:

但这些早期手术 面临一个重大问题：

patients’ immune systems would quickly recognize the new kidney

患者的免疫系统 会迅速将新肾脏

as a foreign object and start to destroy it.

识别为异物， 并开始破坏它。

Few patients survived past the first few days.

很少有患者能在术后 存活超过几天。

Then, in 1954, Joseph Murray attempted a type of kidney swap

然后，在1954年， 约瑟夫·默里尝试了一种

that no doctor had tried before.

此前从未有医生尝试过 的肾脏交换手术。

The surgery was a success,

手术取得了成功，

and the patient would go on to live the next 8 years with the transplanted organ,

患者随后带着 移植的器官生活了8年，

thanks to one key factor: it came from his identical twin

这要归功于一个关键因素： 移植的肾脏来自他的双胞胎兄弟。

70 years later,

70年后，

upwards of 100,000 kidneys are transplanted annually in the US alone.

仅在美国，每年进行的 肾脏移植数量超过10万例。

So how does this surgery work today?

那么这种手术今天 是如何进行的呢？

Kidneys are true workhorses—

肾脏是真正的工作站--

these fist-sized organs filter

这两个拳头大小的器官

the equivalent of an entire bathtub’s worth of blood each day.

每天过滤相当于 一个整个浴缸的血液量。

In addition to removing this waste and extra fluid through urine,

除了通过尿液排除废物 和多余的液体外，

the kidneys also regulate the production of red blood cells, vitamin D,

肾脏还调节红血球、 维生素D

and other hormones.

和其他激素的产生。

Certain medical conditions can prompt the kidneys to work overtime,

某些医疗状况可能 导致肾脏超负荷工作，

leading to gradual deterioration.

进而导致逐渐恶化。

For example, in diabetes, higher blood sugar concentrations can trigger

例如，在糖尿病中， 较高的血糖浓度可能引发

increased kidney filtration, swelling, and inflammation.

肾脏过滤增加、肿胀和炎症。

High blood pressure can constrict and damage

高血压可以收缩并损害

the organ’s delicate blood vessels.

肾脏脆弱的血管。

Over time, people can lose complete function of their kidneys

随着时间的推移，人们可能 会完全失去肾脏功能，

and must rely on a treatment called dialysis to survive.

必须依赖一种叫做 透析的治疗来维持生命。

Yet dialysis is time consuming

然而，透析既费时

and fraught with serious medical complications.

又伴随严重的医学并发症。

A kidney transplant offers a more permanent solution

肾脏移植提供了一种 更为永久的解决方案，

with a dramatically improved quality of life.

显著改善了生活质量。

Once a patient is approved for the surgery,

一旦患者获得手术批准，

the search for a suitable organ begins.

便开始寻找合适的器官供体。

Historically, the biggest barrier was finding a donor

从历史上看， 最大的问题是找到

whose immune system makeup closely resembled that of the patient’s,

一个免疫系统构成 与患者相似的捐献者，

like an identical twin, as to reduce the risk of organ rejection.

比如像同卵双胞胎一样， 以减少器官排斥的风险。

But today, thanks to medical advances,

但今天，随着医学进步，

a patient’s family member, friend, or even a stranger

患者的家庭成员、朋友， 甚至陌生人

can donate one of their kidneys.

都可以捐赠其中一只肾脏。

New drug therapies can effectively suppress a patient’s immune response

新的药物治疗可以 有效抑制患者的免疫反应，

before and long after the transplant,

在移植前和移植后 很长一段时间内，

meaning that patients and donor pairs no longer must be perfect matches.

这意味着患者和捐赠者 不再必须是完美匹配。

Still, the closer the match, the better.

不过，匹配越接近， 效果越好。

So another option is a paired organ exchange,

另一个选择是 配对器官交换，

where two or more incompatible donor and patient pairs are matched up,

两个或更多不兼容的捐赠者 和患者配对被重新匹配，

allowing each patient to receive a more compatible kidney from the other pair.

使每个患者能够从另一个配对中 接受更兼容的肾脏。

Once an organ is found, the surgery itself is straightforward.

一旦找到合适的器官，手术 本身是直接的。

First, the living donor's kidney is removed using minimally invasive

首先，活体捐赠者的肾脏 通过微创手术，

and often robotic techniques.

通常采用机器人技术移除。

As for the transplant patient,

至于接受移植的患者，

an incision is made in their lower abdomen and the donor organ is implanted.

会在其下腹部做一个切口， 然后将捐赠的肾脏植入。

The new kidney’s artery and vein are connected to the recipient’s

新肾脏的动脉和静脉 与接受者的血管连接，

to create blood flow,

以确保血液流动，

and its ureter is attached to the patient's bladder.

同时其输尿管 与患者的膀胱连接。

The failed kidneys are typically left in place,

通常，失败的肾脏会 保留在原位，

allowing them to continue to aid in filtration.

继续帮助过滤。

After surgery, a patient is closely monitored for the next several days

手术后，患者将在接下来 的几天内接受密切监测

to ensure the new kidney starts filtering their blood,

以确保新肾脏开始过滤患者的血液，

and subsequently producing urine on its own.

并随后自行产生尿液。

This new kidney typically lasts between 12 to 20 years.

这颗新肾脏通常可以维持12到20年。

Some people will have multiple kidney transplants in their lifetime,

一些人在一生中 会接受多次肾脏移植，

meaning at some point they may have four or even five kidneys in their bodies.

这意味着在某些时候， 体内可能会有四个甚至五个肾脏。

As for donors, most leave the hospital the next day,

至于捐赠者， 大多数人在第二天就能出院，

and can resume normal activity within a few weeks.

并且在几周内 可以恢复正常活动。

While all surgeries carry risks,

虽然所有手术都有风险，

most donors go on to lead normal, healthy lives,

但大多数捐赠者会继续过上 正常、健康的生活，

facing no, or relatively few, complications

几乎没有或只有很少的有并发症，

related to living with a single kidney.

与单肾生活相关。

But not all patients will have a willing living donor.

但并不是所有患者 都有愿意的活体捐赠者。

In the US alone, around 90,000 patients sit on the national waiting list

仅在美国，大约有90,000名患者 在全国等待名单上，

to be matched with a kidney from a deceased donor.

等待与一位已故 捐赠者的肾脏匹配。

While many people register as organ donors,

尽管许多人注册成为 器官捐赠者，

only 0.3% will lose their lives in circumstances

但只有0.3%的人失去生命，

that allow for organ donation.

在允许器官捐赠的情况下。

Due to this organ shortage,

由于器官短缺，

about 17 patients die every day waiting for a new kidney.

约有17名患者每天在 等待新肾脏的过程中去世。

Thankfully, doctors continue to push against the limits of what's possible,

值得庆幸的是， 医生们不断突破可能的极限，

exploring new treatments

探索新的治疗方法，

and the potential of lab-grown, 3D printed, and even artificial kidneys.

以及实验室培养、 3D打印甚至人工肾脏的潜力。