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

譯者: Lilian Chiu 審譯者: Ruan Xiu Ze 阮修泽

In the 1930s, doctors began experimenting with a procedure

1930 年代，

醫生開始實驗一項醫界長年以來 都認為不可能實現的手術：

long thought to be medically impossible:

an organ transplant.

器官移植。

Many pioneering surgeons focused on the kidney,

許多當開路先鋒的醫生 把焦點放在腎臟上，

taking a healthy one from a living or recently deceased person

從活人或剛過世的人身上 取下一個健康的腎臟，

and transplanting it into a patient dying from kidney failure.

移植到因為腎衰竭 而瀕死的病人身上。

But these early surgeries faced a major problem:

但早期的這些手術面臨一個大問題：

patients’ immune systems would quickly recognize the new kidney

病人的免疫系統很快 就會發現新的腎臟，

as a foreign object and start to destroy it.

認定它是外來物，接著開始摧毀它。

Few patients survived past the first few days.

很少有病人能活過前幾天。

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

接著，在 1954 年，

約瑟夫‧墨瑞嘗試了一種換腎方法，

that no doctor had tried before.

以前沒有任何醫生嘗試過。

The surgery was a success,

手術很成功，

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

這位病人靠著移植的器官 又多活了八年，

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

這要歸功於一個關鍵因素： 這個腎臟來自他的同卵雙胞胎。

70 years later,

七十年後，

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

光在美國，每年就有 超過十萬例腎臟移植手術。

So how does this surgery work today?

現今這種手術是怎麼進行的？

Kidneys are true workhorses—

腎臟真的可說是辛勞的老黃牛——

these fist-sized organs filter

這些只有拳頭大小的器官

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

每天要過濾的血液量 相當於一整個浴缸的容量。

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

除了透過尿液將這些廢物 和多餘的液體排出體外，

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

腎臟還會調節紅血球的製造、 維生素 D 的合成，

and other hormones.

及其他荷爾蒙的分泌。

Certain medical conditions can prompt the kidneys to work overtime,

某些醫療病症可能會 促使腎臟加班工作，

leading to gradual deterioration.

讓腎臟漸漸退化。

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

比如，以糖尿病為例，

高血糖濃度可能會造成 腎臟過度過濾、

increased kidney filtration, swelling, and inflammation.

膨脹和發炎。

High blood pressure can constrict and damage

高血壓可能會讓腎臟內部 精細的血管收縮和受損。

the organ’s delicate blood vessels.

Over time, people can lose complete function of their kidneys

隨着時間流逝，腎臟的功能 可能會完全喪失，

and must rely on a treatment called dialysis to survive.

必須要用一種叫做透析的 治療方式才能存活。

Yet dialysis is time consuming

但透析很费時間，

and fraught with serious medical complications.

且會伴隨嚴重的併發症。

A kidney transplant offers a more permanent solution

腎臟移植是比較長久的解決方案，

with a dramatically improved quality of life.

且生活品質可以大大改善。

Once a patient is approved for the surgery,

一旦病人獲准進行手術，

the search for a suitable organ begins.

就會開始尋找適合的腎臟。

Historically, the biggest barrier was finding a donor

一直以來，最大的難題 就是要找到理想的捐贈者，

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

捐贈者的免疫系統構成 必須和患者很相似，

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

比如同卵雙胞胎， 才能減少器官排斥的風險。

But today, thanks to medical advances,

但如今，醫學的進步允許

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

病人的家人、朋友，

甚至陌生人，都可以 捐出其中一個腎臟。

can donate one of their kidneys.

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

新的藥物療法

可以有效抑制病人在移植前

before and long after the transplant,

和移植後很長一段時間的免疫反應，

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

意思就是，病人和捐贈者 不必是完全吻合的配對也行。

Still, the closer the match, the better.

不過，越吻合的配對仍然越理想。

So another option is a paired organ exchange,

另一個選擇是配對器官交換，

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

將兩組以上不相容的 捐贈者與病人交叉配對，

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

讓每位病人都能從另一組那邊 取得與自己更相容的腎臟。

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

一旦找到器官，手術本身則很簡單。

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

首先會使用微創技術， 通常由機器人操作，將腎臟

and often robotic techniques.

從活體捐贈者身上取出。

As for the transplant patient,

至於接受移植的病人，

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

開刀的位置會在下腹部， 接著將捐贈者的器官植入。

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

再將新腎臟的動脈和靜脈 與接收器官者的連接起來，

to create blood flow,

建立血液循環，

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

腎臟的輸尿管則連接到病人的膀胱。

The failed kidneys are typically left in place,

通常，衰竭的腎臟會被留在原處，

allowing them to continue to aid in filtration.

讓它們繼續協助過濾工作。

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

手術後的幾天都會 嚴密監測病人的狀況，

to ensure the new kidney starts filtering their blood,

確保新腎臟有開始過濾他們的血液，

and subsequently producing urine on its own.

且隨後也能自行產生尿液。

This new kidney typically lasts between 12 to 20 years.

新腎臟通常可以撐十二到二十年。

Some people will have multiple kidney transplants in their lifetime,

有些人一生中會進行 不只一次腎臟移植，

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

意即，在某個時點，他們體內 可能有四個或甚至五個腎臟。

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

大部分捐贈者可以在隔天就出院，

and can resume normal activity within a few weeks.

在幾週內即可繼續平時的活動。

While all surgeries carry risks,

雖然所有的手術都有風險，

most donors go on to lead normal, healthy lives,

但大部分捐贈者都會繼續 過著正常、健康的生活，

facing no, or relatively few, complications

沒有／很少有因為靠單一個腎臟 過生活而引起的併發症。

related to living with a single kidney.

But not all patients will have a willing living donor.

但並非所有病人都找得到 願意捐器官給他們的人。

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

光在美國，國家等候名單上 就有九萬個病人，

to be matched with a kidney from a deceased donor.

等著和過世的捐贈者配對。

While many people register as organ donors,

雖然許多人都登記為器官捐贈者，

only 0.3% will lose their lives in circumstances

當中卻只有 0.3% 的人

過世的條件能符合器官捐贈。

that allow for organ donation.

Due to this organ shortage,

因為器官短缺，

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

每天約有十七人會因為 等不到新腎臟而過世。

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

值得慶幸的是，醫生仍持續 努力挑戰現有技術的極限，

exploring new treatments

探索新的治療方式

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

以及有沒有可能使用實驗室培養、 3D 列印，甚至人工的腎臟。