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Advancements in Surgical Techniques for Liver Transplantation

Liver transplantation has evolved significantly since its inception, offering hope to countless patients suffering from end-stage liver disease. As a leading Liver Transplant Surgeon in Pune, Dr. Aniruddha Bhosale has witnessed and contributed to the remarkable advancements in this life-saving procedure. This article delves into the latest surgical techniques that are enhancing outcomes and improving the quality of life for liver transplant recipients.

Historical Context

The first successful liver transplant was performed in 1967 by Dr. Thomas Starzl. Since then, the field has progressed from high-risk experimental surgeries to a well-established and routinely performed procedure. The introduction of immunosuppressive drugs like cyclosporine in the 1980s marked a significant milestone, reducing the risk of organ rejection and improving patient survival rates. Today, ongoing innovations in surgical techniques continue to push the boundaries of what is possible in liver transplantation.

Laparoscopic Liver Transplantation

Laparoscopic surgery, a minimally invasive technique, has revolutionized various surgical fields, including liver transplantation. This approach involves making small incisions through which specialized instruments and a camera are inserted, allowing the surgeon to operate with enhanced precision. The benefits of laparoscopic liver transplantation are manifold:

Reduced Blood Loss: Smaller incisions lead to less bleeding during surgery.

Shorter Recovery Time: Patients experience less postoperative pain and a faster return to normal activities.

Lower Infection Risk: The minimally invasive nature of the procedure reduces the likelihood of infection.

Dr. Aniruddha Bhosale has been at the forefront of adopting laparoscopic techniques, ensuring that his patients benefit from these advancements.

Robotic-Assisted Liver Transplantation

Robotic-assisted surgery represents the cutting edge of surgical innovation. This technique utilizes robotic systems to assist surgeons in performing complex procedures with greater accuracy and control. The da Vinci Surgical System is one such example, providing a 3D high-definition view and enhanced dexterity through its robotic arms.

Enhanced Precision: Robotic systems allow for meticulous dissection and suturing, minimizing the risk of complications.

Greater Flexibility: Surgeons can perform intricate maneuvers that are difficult to achieve with traditional methods.

Improved Outcomes: Studies have shown that robotic-assisted liver transplants can lead to better graft survival and reduced postoperative complications.

Dr. Aniruddha Bhosale's expertise in robotic-assisted liver transplantation ensures that patients in Pune receive the highest standard of care.

Living Donor Liver Transplantation (LDLT)

Living Donor Liver Transplantation has emerged as a viable solution to the shortage of deceased donor organs. In LDLT, a portion of a healthy donor's liver is transplanted into the recipient. The donor's liver regenerates to its original size within a few months, as does the transplanted portion in the recipient.

Reduced Waiting Time: LDLT significantly reduces the time patients spend on the transplant waiting list.

Improved Graft Function: Living donor livers are typically healthier and function better than deceased donor livers.

Planned Surgery: The transplant can be scheduled electively, ensuring optimal timing for both donor and recipient.

Dr. Aniruddha Bhosale's proficiency in LDLT has provided many patients with a timely and effective treatment option, demonstrating excellent outcomes in terms of graft survival and patient recovery.

Split Liver Transplantation

Split liver transplantation is another innovative technique addressing organ scarcity. In this procedure, a deceased donor liver is divided into two segments, each transplanted into a different recipient. Typically, the larger segment goes to an adult, while the smaller segment is suitable for a pediatric patient.

Maximizing Donor Organs: This approach allows a single donor liver to save two lives.

Efficient Use of Resources: It optimizes the use of available donor organs, reducing waiting times for patients.

Dr. Aniruddha Bhosale's involvement in split liver transplantation highlights his commitment to maximizing the lifesaving potential of donor organs.

Normothermic Machine Perfusion (NMP)

Normothermic Machine Perfusion is a groundbreaking technique that preserves donor livers outside the body by perfusing them with oxygenated blood at body temperature. This method offers several advantages over traditional cold storage.

Extended Preservation Time: NMP allows for longer preservation times, facilitating better logistical planning for transplant surgeries.

Improved Organ Quality: The continuous perfusion maintains liver function and reduces ischemia-reperfusion injury.

Assessment and Repair: Surgeons can assess the liver's viability and even perform therapeutic interventions to improve organ quality before transplantation.

Dr. Aniruddha Bhosale's use of NMP reflects his dedication to leveraging cutting-edge technology to enhance transplant outcomes.

Innovations in Immunosuppression

Advancements in immunosuppressive therapies are crucial for the long-term success of liver transplants. Traditional immunosuppressive drugs, while effective, can have significant side effects. Recent innovations aim to minimize these adverse effects while maintaining efficacy.

Targeted Therapies: Newer drugs specifically target immune pathways involved in organ rejection, reducing collateral damage to the patient's immune system.

Personalized Medicine: Genetic and biomarker studies enable personalized immunosuppressive regimens tailored to individual patient profiles.

Tolerogenic Approaches: Research into inducing immune tolerance aims to reduce or eliminate the need for lifelong immunosuppression.

Dr. Aniruddha Bhosale stays abreast of these advancements, ensuring his patients receive the most current and effective treatment protocols.

Postoperative Care and Rehabilitation

The success of liver transplantation extends beyond the operating room. Comprehensive postoperative care and rehabilitation are critical for optimal recovery and long-term health. This includes:

Multidisciplinary Approach: Coordinated care involving hepatologists, transplant surgeons, nutritionists, and physical therapists.

Patient Education: Informing patients about medication adherence, lifestyle modifications, and recognizing signs of complications.

Regular Monitoring: Routine follow-ups and lab tests to detect any issues early and adjust treatment plans accordingly.

Dr. Aniruddha Bhosale emphasizes a holistic approach to postoperative care, recognizing its importance in ensuring successful liver transplant outcomes.

Conclusion

The field of liver transplantation is continually evolving, with advancements in surgical techniques playing a pivotal role in improving patient outcomes. From laparoscopic and robotic-assisted surgeries to innovative preservation methods and personalized immunosuppressive therapies, these innovations are transforming the lives of patients with liver disease.

As a leading Liver Transplant Surgeon in Pune, Dr. Aniruddha Bhosale remains at the forefront of these advancements, committed to providing his patients with the highest standard of care. His expertise and dedication ensure that liver transplant recipients receive the best possible chance for a healthy, fulfilling life post-transplant.For more information or to schedule a consultation, visit Dr. Aniruddha Bhosale's clinic and take the first step towards a new lease on life.

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Liver Disease: Types, Causes, Symptoms, and Treatment

Introduction

The liver is the largest internal organ in the body, located in the upper right side of the abdomen. It performs essential functions such as filtering blood, producing bile for digestion, storing vitamins and minerals, and metabolizing medications and toxins. When the liver is affected by disease, it can lead to significant health problems.

Understanding the Liver

Before delving into the specifics of liver disease, it's important to have a basic understanding of the liver's structure and functions. The liver consists of various lobes and is composed of hepatocytes, which are responsible for the liver's metabolic and synthetic activities. It receives blood from two sources: the hepatic artery, which carries oxygenated blood, and the portal vein, which transports nutrient-rich blood from the digestive system. Liver treatment depends on what kind of disease the patient is going through, Dr. Aniruddha Bhosale and his team provide Liver Disease Treatment in Pune and all kinds of preventive measures to keep your liver fit, even if your liver is completely healthy or fight against any liver disease.

Common Types of Liver Disease

Liver disease encompasses several conditions, each with its own causes and consequences. Here are some of the most common types:

Alcoholic Liver Disease

Alcoholic liver disease is caused by excessive alcohol consumption over a prolonged period. It includes fatty liver, alcoholic hepatitis, and cirrhosis. Long-term alcohol abuse can lead to inflammation and scarring of the liver, compromising its ability to function properly.

Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease refers to the accumulation of fat in the liver of individuals who consume little to no alcohol. It is commonly associated with obesity, insulin resistance, high cholesterol, and diabetes. NAFLD can progress to non-alcoholic steatohepatitis (NASH) and eventually result in cirrhosis.

Hepatitis

Hepatitis refers to inflammation of the liver and can be caused by viral infections (hepatitis A, B, C, D, and E), autoimmune conditions, or exposure to toxins and certain medications. Chronic hepatitis can lead to liver cirrhosis or liver cancer if left untreated.

Cirrhosis

Cirrhosis is the advanced stage of liver disease characterized by extensive scarring of the liver tissue. It can result from long-term alcohol abuse, chronic viral hepatitis, autoimmune diseases, or other causes. Cirrhosis impairs liver function and can lead to life-threatening complications.

Causes of Liver Disease

Several factors contribute to the development of liver disease. Understanding these causes is crucial for prevention and early intervention. The following are common causes of liver disease:

Alcohol Consumption

Excessive and long-term alcohol consumption is a leading cause of liver disease. The liver metabolizes alcohol, but chronic alcohol abuse can lead to inflammation, fatty liver, alcoholic hepatitis, and cirrhosis.

Obesity and Poor Diet

Obesity and an unhealthy diet high in fats and sugars can contribute to the development of non-alcoholic fatty liver disease. These lifestyle factors increase the risk of fat accumulation in the liver, leading to inflammation and liver damage.

Viral Infections

Viral infections, such as hepatitis A, B, C, D, and E, can cause acute or chronic inflammation of the liver. Hepatitis viruses are commonly transmitted through contaminated food or water, sexual contact, or exposure to infected blood.

Autoimmune Conditions

Autoimmune conditions occur when the immune system mistakenly attacks healthy cells in the body, including liver cells. Autoimmune hepatitis and primary biliary cholangitis are examples of liver diseases caused by autoimmune reactions.

Genetic Factors

Certain genetic disorders can affect the liver's structure or function, leading to liver disease. Examples include hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency. These conditions are often inherited and require specialized medical management.

Symptoms of Liver Disease

Liver disease may present with various symptoms, which can range from mild to severe. It's important to recognize these signs to seek timely medical attention. Common symptoms of liver disease include:

Fatigue and Weakness

Persistent fatigue and weakness are often early indicators of liver dysfunction. The liver's impaired ability to metabolize nutrients and remove toxins can lead to a feeling of tiredness and lack of energy.

Jaundice

Jaundice is characterized by yellowing of the skin and eyes due to a buildup of bilirubin, a yellow pigment produced during the breakdown of red blood cells. It is a common symptom of liver disease and indicates impaired liver function.

Abdominal Pain and Swelling

Liver disease can cause abdominal pain and discomfort, often accompanied by swelling or bloating. The liver's enlargement or the accumulation of fluid in the abdomen (ascites) can contribute to these symptoms.

Nausea and Vomiting

Digestive issues like nausea, vomiting, and loss of appetite may occur in individuals with liver disease. These symptoms can result from the liver's reduced ability to produce bile, which aids in digestion.

Changes in Urine and Stool Color

Liver disease can cause changes in urine and stool color. Urine may appear dark or amber, while stools may become pale or grayish. These changes indicate abnormalities in the liver's production and excretion of bile.

Diagnosis of Liver Disease

Accurate diagnosis of liver disease involves a combination of medical history, physical examination, and diagnostic tests. Here are some common methods used to evaluate liver health:

Physical Examination

During a physical examination, a healthcare provider may assess the liver's size, texture, and tenderness. They may also look for signs of jaundice or abdominal swelling.

Blood Tests

Blood tests, including liver function tests, can measure the levels of enzymes, proteins, and other substances that indicate liver damage or dysfunction. These tests help identify specific liver conditions and monitor their progression.

Imaging Tests

Imaging tests such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can provide detailed images of the liver's structure. These tests help identify abnormalities, such as fatty liver or liver tumors.

Liver Biopsy

In some cases, a liver biopsy may be necessary to obtain a small sample of liver tissue for microscopic examination. This procedure helps determine the extent of liver damage and diagnose specific liver conditions.

Treatment Options for Liver Disease

The treatment approach for liver disease depends on the underlying cause and the severity of liver damage. Here are some common treatment options:

Lifestyle Changes

For many liver diseases, lifestyle modifications are crucial. These may include abstaining from alcohol, adopting a healthy diet low in fats and sugars, losing weight, and exercising regularly. Lifestyle changes can help improve liver health and prevent further damage.

Medications

In certain cases, medications may be prescribed to manage liver disease. For example, antiviral medications can effectively treat hepatitis B and C. Other medications may help reduce inflammation, alleviate symptoms, or manage complications associated with liver disease.

Surgery and Liver Transplantation

In advanced cases of liver disease, surgical interventions or liver transplantation may be necessary. Liver transplantation involves replacing the diseased liver with a healthy donor liver. This procedure offers a chance of cure for end-stage liver disease.

Prevention and Management

Prevention and early management of liver disease are essential for maintaining liver health. Here are some preventive measures:

Limit alcohol consumption or avoid it altogether.

Maintain a healthy weight and follow a balanced diet.

Practice safe sex and take precautions to avoid hepatitis infection.

Avoid sharing needles or other drug paraphernalia.

Get vaccinated against hepatitis A and B.

Follow proper hygiene practices, such as washing hands regularly.

Take medications as prescribed and avoid excessive use of over-the-counter drugs.

Regular check-ups and screenings can help detect liver disease in its early stages, allowing for timely intervention and improved outcomes.

Conclusion

Liver disease encompasses various conditions that can have significant implications for overall health. Understanding the types, causes, symptoms, and treatment options for liver disease is crucial for prevention, early detection, and effective management. By adopting a healthy lifestyle, seeking medical care when needed, and following preventive measures, individuals can take proactive steps to maintain optimal liver health.

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A liver function test: what is it?

Liver transplant surgeon Dr. Aniruddha Bhosale practises in Pune. His affiliation with "The Sahyadri Centre for Organ Transplantation" dates to 2017. He has taken part in more than 200 liver transplant procedures, including those using living and deceased donors. He has also had kidney and pancreas transplants. His expertise also extends to pancreas surgery, bile duct surgery, and procedures for liver cancer.Being the most skilled liver transplant surgeon in Pune, Dr. Aniruddha Bhosale has successfully treated many liver disorders cases and given patients new leases of life.

A liver function test: what is it?

A liver function test is a blood test that analyses blood in a lab to determine the general health of the liver and any signs of liver disease. Whether or not the liver is working normally can be determined by the presence of particular substances in the blood.

What is the liver's purpose?

The liver performs a variety of tasks, including: blood filtration in the digestive system Using waste items to create energy eliminating toxins creating the proteins necessary for blood clotting the method through which glucose (blood sugar) is produced improves digestion

What are the results of a liver function test?

The quantity of proteins and enzymes in the blood is measured during a liver function test. The liver and other parts of the body include the enzymes alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT). High levels of these enzymes may be a sign of bile duct or liver disease.

Among the proteins made by the liver are prothrombin, albumin, and globulin. Low levels of these proteins may be a sign of liver injury. Blood clotting time is measured using a prothrombin time test.

A liver function test also measures glucose levels and platelet counts. (Platelets help blood clot, which helps to stop bleeding.)

The liver function test includes a measurement of bilirubin levels. A substance called bilirubin is created during the breakdown of red blood cells. The liver might leak bilirubin if it is injured. Jaundice, which causes the skin or eyes to turn yellow, may arise from this. High bilirubin levels might also cause urine to darken in colour.

How is a liver function test prepared for?

Your doctor might suggest that you abstain from eating, drinking, or taking certain medications in order to prevent changing the test results.

RESULT AND FOLLOW-UP

What are the typical ranges for laboratory liver function tests?

The lab that performs your test can utilise somewhat different normal ranges. For further information, speak with your healthcare provider.

What normal lab ranges are there for liver function tests?

The laboratory that conducts your test might utilise normal ranges that vary somewhat. Speak to your healthcare provider for more details.

What may result in unfavourable liver function test outcomes?

Several factors, including the following, could cause a liver function test to be abnormal:

Alcoholism

sweet diabetes

Obesity

A virus that damages the liver is hepatitis B.

A virus that affects the liver is hepatitis C.

side effects of medication

Acute hepatitis, specifically hepatitis A.

A form of celiac disease that requires a person to avoid gluten-containing meals is known as celiac sickness.

Hepatocellular carcinoma

Additional conditions and ailments

Speak with your doctor if you have any questions regarding the findings of your liver function test.

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What Is Cirrhosis?

Our livers are capable of self-healing and regeneration. However, as scar tissue eventually forms, it loses some of its ability to perform as intended. Circulatory flow to the liver reduces as the number of scars rises. The liver's fundamental functions are also impaired. This may occasionally result in liver failure and even death. Cirrhosis claims more than a million lives annually throughout the world.

In addition to managing difficult liver surgeries, Dr. Aniruddha Bhosale Head of Liver Transplant and HPB Surgery  at His Hospital in Pune, has decades of experience treating liver cirrhosis as well. He is renowned for offering the best Liver cirrhosis treatment in Pune. due to his extensive training and experience.

Let's learn more about cirrhosis today, including its diagnosis and treatment.

Cirrhosis of the liver is a disorder brought on by persistent liver injury. The liver becomes hard and nodular in this syndrome. Fibrosis replaces the liver tissue. When cirrhosis develops, liver damage is permanent. The cirrhotic liver can no longer regenerate.

Cirrhosis classification

1. Compensated Cirrhosis

It is simply a liver that has been damaged yet is still largely functional.

2. Defamed Cirrhosis

The beginning of the signs and symptoms of liver dysfunction is represented by the advanced stage of cirrhosis.

Why may cirrhosis be harmful?

Cirrhosis causes a number of complications, including

Ascites (abdominal fluid)

Edoema (limb fluid)

(Vomiting blood) Variceal bleeding

The encephalopathy of confusion

Hepatorenal Syndrome, or malfunction of the kidneys

Lung condition (Hepatopulmonary syndrome, Hepatic hydrothorax)

liver tumour

The signs of cirrhosis

The symptoms of liver disease that progresses from early fibrosis to cirrhosis typically take years to appear. Early on, there are frequently few, if any, symptoms.

When symptoms appear, they are occasionally misdiagnosed, disregarded, or linked to additional potential causes. However, if the condition worsens, the symptoms could become more obvious. These signs consist of:

Fatigue Confusion

Weakness

Itching

reduced appetite

Loss of weight

Nausea

Simple bruising

Jaundice

ankle, foot, and leg swelling

Bloating due to ascites in the abdomen

Cirrhosis causes

Cirrhosis is most frequently brought on by:

1. Alcohol-related liver disease: This condition is often brought on by   years of heavy drinking.

2.Hepatitis B is a common contributor to cirrhosis.

3.Hepatitis C is the main predictor of liver transplants and one of the    common causes of cirrhosis.

4.Non-alcoholic fatty liver disease: Cirrhosis is more common in people who have diabetes, high blood pressure, obesity, and high cholesterol. With the prevalence of lifestyle disorders rising in our community, this is fast becoming one of the most common causes of liver cirrhosis.

Among the uncommon causes of cirrhosis are:

First Sclerosing Cholangitis

Wilson's disease and other hereditary illnesses

Hepatitis auto-immune

Hemochromatosis

Celiac illness

Medication

Cirrhosis diagnosis

1: liver biopsy

It is the most precise method for determining the stage of cirrhosis. Nowadays, liver biopsies to diagnosis cirrhosis are rarely performed due to advances in radiological techniques.

2. Magnetic resonance elastography or an ultrasound

These methods for detecting cirrhosis are non-invasive.

3. Blood examinations and imaging devices (CT and MRI)

These can be used to track the development of diseases.

Cirrhosis of the Liver Treatment

In Pune, cirrhosis is frequently treatable before it worsens and a liver transplant is necessary.

The cause and severity of the disease play a major role in cirrhosis therapy.

But after diagnosis, treatment should start right away.

The only known treatment for cirrhosis is liver transplantation.

To slow the growth of liver scarring, you should follow the steps listed below, which include:

Avoid consuming alcohol and drugs that can harm the liver.

Avoid over-the-counter herbal supplements and medications because some of them have been linked to liver damage.

The risk of liver damage from prescription drugs is increased by cirrhosis. As a result, the effects on the liver of every prescription should be carefully considered.

Avoid eating raw shellfish that might have bacteria in it. In those with advanced liver disease, it can potentially result in a serious infection.

Exams and hepatitis A and B vaccinations

antiviral medication for treating hepatitis B and C.

Detection and treatment of bile duct obstructions caused by ursodiol, one of the secondary causes of cirrhosis.

Regarding the treatment of people with cirrhosis, nutrition is crucial.

As soon as you receive a cirrhosis diagnosis, you should start treatment. To get the finest care after the diagnosis, you should always speak with a skilled and experienced liver specialist in Pune.

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Kidney transplant in Pune

A kidney transplant is a surgical procedure where a healthy kidney from a donor is transplanted into a recipient who has a damaged or failed kidney. The procedure is performed when the patient's kidneys are no longer able to function properly due to chronic kidney disease, acute kidney injury, or other medical conditions.

Before the transplant, the patient undergoes a series of medical tests to determine their overall health, the type of kidney they need, and whether they are a suitable candidate for the procedure. The donor can be a living donor, usually a family member or a friend, or a deceased donor whose kidney has been donated after their death.

Blood filtration, blood pressure control, and haemoglobin levels are just a few of the vital functions carried out by our kidneys. Chronic Kidney Disease (CKD), another name for kidney failure, denotes chronic and irreversible kidney damage that is permanent. All of the kidneys' functions are compromised by this illness. This worsens blood pressure, anaemia, and bone disease while also causing more kidney damage.

Which factors contribute most to kidney failure?

There are various explanations for why renal failure happens. These danger variables are:

1. Diabetes: Diabetes is the main risk factor for CKD. In this situation, diabetes is discovered in its later stages, by which time other organs like the kidneys would have been impacted, due to a lack of awareness and a proactive approach regarding routine health checks.

2. Hypertension: When left untreated, hypertension poses a very significant risk of renal failure. On the other hand, hypertension is not a significant risk factor when it is under control.

3.Family History: Having chronic kidney disease raises the likelihood of contracting renal failure from a family member.

4.Infections: Repeated kidney or urine infections are further warning signs of this condition.

5. OTC drugs: Taking tablets without the guidance of a trained medical professional can have disastrous consequences on the kidneys as well as numerous other negative side effects.

6.Glomerular disease: The presence of proteins in the urine is an early warning indication of kidney damage and, if left untreated and undiscovered, kidney failure.

What are the indications that your kidneys may be in trouble?

The typical warning signs and symptoms are:

1. Undiagnosed anaemia

2.Weakness

3.Tiredness

4. Issues with sleeping

5. Chest ache

6. Breathing difficulty

7. Appetite loss

alterations in urine

9. Facial and foot swelling

10. Constant nausea

11. Reflux

12. Unaccounted-for weight loss

By the time the patient experiences symptoms and seeks medical attention, the kidney has typically already suffered serious damage. This is the rationale behind not waiting for symptoms to show before having your kidneys examined.

How can renal failure be identified early?

To stop this disease from progressing further, it is essential to have a diagnosis early on before it aggravates. The diagnostic methods comprise:

1. Blood tests: to determine the quantity and concentration of chemicals like urea and creatinine.

2. Urine tests are done to assess the amounts of albumin, creatinine, and blood proteins in the urine to see how effectively the kidneys are working.

3. Imaging tests: CT, MRI, and ultrasound scans can help provide an image of the kidneys and aid in the search for any blockages or anomalies.

4.Biopsy: A little kidney sample is taken, and it is examine

7 Absurdly Efficient Ways to Maintain Healthy Kidneys

What options are there for treating kidney failure?

The stage of the disease determines the course of treatment for CKD.

1. The first three phases of kidney failure are those of early onset, during which the underlying cause must be addressed but no special medications for renal failure are given. For instance, blood sugar levels need to be controlled if a person has diabetes. The same holds true with high blood pressure.

2. Giving up smoking is a crucial first step. The earliest possible investigation must be made into any kidney or urine infections.

3. Kidney function may be impaired by up to 60–70% in the latter stages. In these situations, blood pressure regulation and avoiding kidney-harming substances should be prioritised.

4.Some drugs have been shown to stop further advancement, including angiostein-converting enzyme (ACE) inhibitors and angiostein receptor blockers.

5.Medications are ineffective in stage 5, where kidney loss has reached 80–90%, and the only options are dialysis or, if the patient is healthy enough, a kidney transplant.

6. Exercise can indirectly benefit CKD patients since it helps maintain healthy blood pressure, sugar levels, and weight, all of which slow the disease's progression. moderate workouts, such as

7. As kidney disease progresses past stage 4, the possibility of renal failure increases, and it must be managed with particular drugs and dietary modifications like reducing salt and fluid intake as well as looking for any indicators of cardiac problems. Dialysis and kidney transplantation are the only available treatments for kidney failure.