Heart transplantation
March 22, 2019
Liver transplantation
March 22, 2019

Kidney transplantation

Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ.

Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient.

Exchanges and chains are a novel approach to expand the living donor pool. In February 2012, this novel approach to expand the living donor pool resulted in the largest chain in the world, involving 60 participants organized by the National Kidney Registry. In 2014 the record for the largest chain was broken again by a swap involving 70 participants.

 

Read more about : Kidney transplantation in Iran

Kidtransplant.svg

Indications

The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause. This is defined as a glomerular filtration rate below 15 ml/min/1.73 m2. Common diseases leading to ESRD include malignant hypertension, infections, diabetes mellitus, and focal segmental glomerulosclerosis; genetic causes include polycystic kidney disease, a number of inborn errors of metabolism, and autoimmune conditions such as lupus.

Diabetes is the most common known cause of kidney transplantation, accounting for approximately 25% of those in the United States. The majority of renal transplant recipients are on dialysis (peritoneal dialysis or hemodialysis) at the time of transplantation. However, individuals with chronic kidney disease who have a living donor available may undergo pre-emptive transplantation before dialysis is needed. If a patient is put on the waiting list for a deceased donor transplant early enough, they may also be transplanted pre-dialysis.

 

About Iranian Surgery

Iranian surgery  is an online medical tourism platform in Iran aiming to help people all around the globe to receive quality healthcare services as well as offering patients its medical consultation. In fact, it is a user-friendly online website providing people from all walks of life with lots of useful information about the best hospitals and professional surgeons in Iran.

 

Contraindications and requirements

Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease and some cancers. Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications.

Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age (e.g. the person must be under a certain age to enter the waiting list) and require that one must be in good health (aside from the kidney disease). Significant cardiovascular disease, incurable terminal infectious diseases and cancer are often transplant exclusion criteria. In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant. People with mental illness and/or significant on-going substance abuse issues may be excluded.

HIV was at one point considered to be a complete contraindication to transplantation. There was fear that immunosuppressing someone with a depleted immune system would result in the progression of the disease. However, some research seem to suggest that immunosuppressive drugs and antiretrovirals may work synergistically to help both HIV viral loads/CD4 cell counts and prevent active rejection.

 

Read more about : Kidney Cancer Treatment

 

Sources of kidneys

Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors in the United States is on the rise. In 2006, 47% of donated kidneys were from living donors. This varies by country: for example, only 3% of kidneys transplanted during 2006 in Spain came from living donors. In Spain all citizens are potential organ donors in the case of their death, unless they explicitly opt out during their lifetime.

Living donors

Approximately one in three donations in the US, UK, and Israel is now from a live donor. Potential donors are carefully evaluated on medical and psychological grounds. This ensures that the donor is fit for surgery and has no disease which brings undue risk or likelihood of a poor outcome for either the donor or recipient. The psychological assessment is to ensure the donor gives informed consent and is not coerced. In countries where paying for organs is illegal, the authorities may also seek to ensure that a donation has not resulted from a financial transaction.

The relationship the donor has to the recipient has evolved over the years. In the 1950s, the first successful living donor transplants were between identical twins. In the 1960s–1970s, live donors were genetically related to the recipient. However, during the 1980s–1990s, the donor pool was expanded further to emotionally related individuals (spouses, friends). Now the elasticity of the donor relationship has been stretched to include acquaintances and even strangers (‘altruistic donors’). In 2009, US transplant recipient Chris Strouth received a kidney from a donor who connected with him on Twitter, which is believed to be the first such transplant arranged entirely through social networking.

The acceptance of altruistic donors has enabled chains of transplants to form. Kidney chains are initiated when an altruistic donor donates a kidney to a patient who has a willing but incompatible donor. This incompatible donor then ‘pays it forward’ and passes on the generosity to another recipient who also had a willing but incompatible donor. Michael Rees from the University of Toledo developed the concept of open-ended chains. This was a variation of a concept developed at Johns Hopkins University. On July 30, 2008, an altruistic donor kidney was shipped via commercial airline from Cornell to UCLA, thus triggering a chain of transplants. The shipment of living donor kidneys, computer-matching software algorithms, and cooperation between transplant centers has enabled long-elaborate chains to be formed.

 

Read more about : Cancer treatment in Iran

 

In carefully screened kidney donors, survival and the risk of end-stage renal disease appear to be similar to those in the general population. However, some more recent studies suggest that lifelong risk of chronic kidney disease is several-fold higher in kidney donors although the absolute risk is still very small. A 2017 article in the New England Journal of Medicine suggests that persons with only one kidney, including those who have donated a kidney for transplantation, should avoid a high protein diet and limit their protein intake to less than one gram per kilogram body weight per day in order to reduce the long-term risk of chronic kidney disease. Women who have donated a kidney have a higher risk of gestational hypertension and preeclampsia than matched nondonors with similar indicators of baseline health. Traditionally, the donor procedure has been through a single incision of 4–7 inches (10–18 cm), but live donation is being increasingly performed by laparoscopic surgery. This reduces pain and accelerates recovery for the donor. Operative time and complications decreased significantly after a surgeon performed 150 cases. Live donor kidney grafts have higher long-term success rates than those from deceased donors. Since the increase in the use of laparoscopic surgery, the number of live donors has increased. Any advance which leads to a decrease in pain and scarring and swifter recovery has the potential to boost donor numbers. In January 2009, the first all-robotic kidney transplant was performed at Saint Barnabas Medical Center through a two-inch incision. In the following six months, the same team performed eight more robotic-assisted transplants.

In 2004 the FDA approved the Cedars-Sinai High Dose IVIG therapy which reduces the need for the living donor to be the same blood type (ABO compatible) or even a tissue match. The therapy reduced the incidence of the recipient’s immune system rejecting the donated kidney in highly sensitized patients.

In 2009 at the Johns Hopkins Medical Center, a healthy kidney was removed through the donor’s vagina. Vaginal donations promise to speed recovery and reduce scarring. The first donor was chosen as she had previously had a hysterectomy. The extraction was performed using natural orifice transluminal endoscopic surgery, where an endoscope is inserted through an orifice, then through an internal incision, so that there is no external scar. The recent advance of single port laparoscopy requiring only one entry point at the navel is another advance with potential for more frequent use.

 

Read more about : Female Pelvic Laparoscopy In Iran

 

Organ trade

In the developing world some people sell their organs illegally. Such people are often in grave poverty or are exploited by salespersons. The people who travel to make use of these kidneys are often known as ‘transplant tourists’. This practice is opposed by a variety of human rights groups, including Organs Watch, a group established by medical anthropologists, which was instrumental in exposing illegal international organ selling rings. These patients may have increased complications owing to poor infection control and lower medical and surgical standards. One surgeon has said that organ trade could be legalised in the UK to prevent such tourism, but this is not seen by the National Kidney Research Fund as the answer to a deficit in donors.

In the illegal black market the donors may not get sufficient after-operation care, the price of a kidney may be above $160,000, middlemen take most of the money, the operation is more dangerous to both the donor and receiver, and the buyer often gets hepatitis or HIV. In legal markets of Iran the price of a kidney is $2,000 to $4,000.

An article by Gary Becker and Julio Elias on “Introducing Incentives in the market for Live and Cadaveric Organ Donations” said that a free market could help solve the problem of a scarcity in organ transplants. Their economic modeling was able to estimate the price tag for human kidneys ($15,000) and human livers ($32,000).

Jason Brennan and Peter Jaworski of the CATO Institute have also argued that any moral objections to a market for organs are not inherent in the market, but rather the activity itself.

Now monetary compensation for organ donors is being legalised in Australia and Singapore. Kidney disease organisations in both countries have expressed their support.

 

Read more about : Balloon Valvuloplasty Surgery In Iran

 

Deceased donors

Kidney donor cards from England, 1971–1981. The cards were made to be carried by donors as evidence that they were willing to donate their kidneys should they, for example, be killed in an accident.

Deceased donors can be divided in two groups:

  • Brain-dead (BD) donors
  • Donation after Cardiac Death (DCD) donors

Although brain-dead (or ‘heart beating’) donors are considered dead, the donor’s heart continues to pump and maintain circulation. This makes it possible for surgeons to start operating while the organs are still being perfused (supplied blood). During the operation, the aorta will be cannulated, after which the donor’s blood will be replaced by an ice-cold storage solution, such as UW (Viaspan), HTK, or Perfadex. Depending on which organs are transplanted, more than one solution may be used simultaneously. Due to the temperature of the solution, and since large amounts of cold NaCl-solution are poured over the organs for a rapid cooling, the heart will stop pumping.

‘Donation after Cardiac Death’ donors are patients who do not meet the brain-dead criteria but, due to the unlikely chance of recovery, have elected via a living will or through family to have support withdrawn. In this procedure, treatment is discontinued (mechanical ventilation is shut off). After a time of death has been pronounced, the patient is rushed to the operating room where the organs are recovered. Storage solution is flushed through the organs. Since the blood is no longer being circulated, coagulation must be prevented with large amounts of anti-coagulation agents such as heparin. Several ethical and procedural guidelines must be followed; most importantly, the organ recovery team should not participate in the patient’s care in any manner until after death has been declared.

Compatibility

In general, the donor and recipient should be ABO blood group and crossmatch (human leukocyte antigen — HLA) compatible. If a potential living donor is incompatible with their recipient, the donor could be exchanged for a compatible kidney. Kidney exchange, also known as “kidney paired donation” or “chains” have recently gained popularity.

In an effort to reduce the risk of rejection during incompatible transplantation, ABO-incompatible and densensitization protocols utilizing intravenous immunoglobulin (IVIG) have been developed, with the aim to reduce ABO and HLA antibodies that the recipient may have to the donor.

In the 1980s, experimental protocols were developed for ABO-incompatible transplants using increased immunosuppression and plasmapheresis. Through the 1990s these techniques were improved and an important study of long-term outcomes in Japan was published. Now, a number of programs around the world are routinely performing ABO-incompatible transplants.

The level of sensitization to donor HLA antigens is determined by performing a panel reactive antibody test on the potential recipient. In the United States, up to 17% of all deceased donor kidney transplants have no HLA mismatch. However, HLA matching is a relatively minor predictor of transplant outcomes. In fact, living non-related donors are now almost as common as living (genetically)-related donors.

Procedure

Kidney transplant

In most cases the barely functioning existing kidneys are not removed, as removal has been shown to increase the rates of surgical morbidity. Therefore, the kidney is usually placed in a location different from the original kidney. Often this is in the iliac fossa so it is often necessary to use a different blood supply:

  • The renal artery of the new kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac artery in the recipient.
  • The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.

The donor ureter is anastomosed with the recipient bladder.

There is disagreement in surgical textbooks regarding which side of the recipient’s pelvis to use in receiving the transplant. Campbell’s Urology (2002) recommends placing the donor kidney in the recipient’s contralateral side (i.e. a left sided kidney would be transplanted in the recipient’s right side) to ensure the renal pelvis and ureter are anterior in the event that future surgeries are required. In an instance where there is doubt over whether there is enough space in the recipient’s pelvis for the donor’s kidney, the textbook recommends using the right side because the right side has a wider choice of arteries and veins for reconstruction. Smith’s Urology (2004) states that either side of the recipient’s pelvis is acceptable; however the right vessels are ‘more horizontal’ with respect to each other and therefore easier to use in the anastomoses. It is unclear what is meant by the words ‘more horizontal’. Glen’s Urological Surgery (2004) recommends putting the kidney in the contralateral side in all circumstances. No reason is explicitly put forth; however, one can assume the rationale is similar to that of Campbell, i.e. to ensure that the renal pelvis and ureter are most anterior in the event that future surgical correction becomes necessary.

Kidney-pancreas transplant

Kidney-pancreas transplant

Occasionally, the kidney is transplanted together with the pancreas. University of Minnesota surgeons Richard Lillehei and William Kelly perform the first successful simultaneous pancreas-kidney transplant in the world in 1966. This is done in patients with diabetes mellitus type 1, in whom the diabetes is due to destruction of the beta cells of the pancreas and in whom the diabetes has caused renal failure (diabetic nephropathy). This is almost always a deceased donor transplant. Only a few living donor (partial) pancreas transplants have been done. For individuals with diabetes and renal failure, the advantages of earlier transplant from a living donor (if available) are far superior to the risks of continued dialysis until a combined kidney and pancreas are available from a deceased donor. A patient can either receive a living kidney followed by a donor pancreas at a later date (PAK, or pancreas-after-kidney) or a combined kidney-pancreas from a donor (SKP, simultaneous kidney-pancreas).

Transplanting just the islet cells from the pancreas is still in the experimental stage, but shows promise. This involves taking a deceased donor pancreas, breaking it down, and extracting the islet cells that make insulin. The cells are then injected through a catheter into the recipient and they generally lodge in the liver. The recipient still needs to take immunosuppressants to avoid rejection, but no surgery is required. Most people need two or three such injections, and many are not completely insulin-free.

Post operation

The transplant surgery takes about three hours. The donor kidney will be placed in the lower abdomen and its blood vessels connected to arteries and veins in the recipient’s body. When this is complete, blood will be allowed to flow through the kidney again. The final step is connecting the ureter from the donor kidney to the bladder. In most cases, the kidney will soon start producing urine.

Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3–5 days to reach normal functioning levels, while cadaveric donations stretch that interval to 7–15 days. Hospital stay is typically for 4–10 days. If complications arise, additional medications (diuretics) may be administered to help the kidney produce urine.

Immunosuppressant drugs are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the recipient’s life. The most common medication regimen today is a mixture of tacrolimus, mycophenolate, and prednisolone. Some recipients may instead take ciclosporin, sirolimus, or azathioprine. The risk of early rejection of the transplanted kidney is increased if corticosteroids are avoided or withdrawn after the transplantation. Ciclosporin, considered a breakthrough immunosuppressive when first discovered in the 1980s, ironically causes nephrotoxicity and can result in iatrogenic damage to the newly transplanted kidney. Tacrolimus, which is a similar drug, also causes nephrotoxicity. Blood levels of both must be monitored closely and if the recipient seems to have declining renal function or proteinuria, a biopsy may be necessary to determine whether this is due to rejection  or ciclosporin or tacrolimus intoxication .

Imaging

Post operatively, kidneys are periodically assessed by ultrasound to assess for the imaging and physiologic changes that accompany transplant rejection. Imaging also allows evaluation of supportive structures such as the anastomosed transplant artery, vein, and ureter, to ensure they are stable in appearance.

The major sonographic scale in quantitative ultrasound assessment is with a multipoint assessment of the resistive index (RI), beginning at the main renal artery and vein and ending at the arcuate vessels. It is calculated as follows:

RI = (peak systolic velocity – end diastolic velocity ) / peak systolic velocity

The normal value is ≈ 0.60, with 0.70 being the upper limits of normal.

Diet

Kidney transplant recipients are discouraged from consuming grapefruit, pomegranate and green tea products. These food products are known to interact with the transplant medications, specifically tacrolimus, cyclosporin and sirolimus; the blood levels of these drugs may be increased, potentially leading to an overdose.

Acute rejection occurs in 10–25% of people after transplant during the first 60 days. Rejection does not necessarily mean loss of the organ, but it may necessitate additional treatment and medication adjustments.

Complications

Presence of lymphocytes within the tubular epithelium, attesting to acute cellular rejection of a renal graft. Biopsy sample.

Problems after a transplant may include: Post operative complication, bleeding, infection, vascular thrombosis and urinary complications

  • Transplant rejection (hyperacute, acute or chronic)
  • Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection
  • Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants)
  • Imbalances in electrolytes including calcium and phosphate which can lead to bone problems
  • Proteinuria
  • Hypertension
  • Other side effects of medications including gastrointestinal inflammation and ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a male-pattern distribution) with ciclosporin, hair loss with tacrolimus, obesity, acne, diabetes mellitus type 2, hypercholesterolemia, and osteoporosis.

A patient’s age and health condition before transplantation affect the risk of complications. Different transplant centers have different success at managing complications and therefore, complication rates are different from center to center.

The average lifetime for a donated kidney is ten to fifteen years. When a transplant fails, a patient may opt for a second transplant, and may have to return to dialysis for some intermediary time.

Infections due to the immunosuppressant drugs used in people with kidney transplants most commonly occur in mucocutaneous areas (41%), the urinary tract (17%) and the respiratory tract (14%). The most common infective agents are bacterial (46%), viral (41%), fungal (13%), and protozoan (1%). Of the viral illnesses, the most common agents are human cytomegalovirus (31.5%), herpes simplex(23.4%), and herpes zoster (23.4%). BK virus is now being increasingly recognised. Infection is the cause of death in about one third of people with renal transplants, and pneumonias account for 50% of the patient deaths from infection.

 

30 Comments

  1. Avatar sarah rita says:

    herpes is a serious and recurring disease which can’t be cured through drugs or injections by the American doctors but the best way to deal with herpes is by taking natural herbs medicine for it and is only few American doctors that know about this herbal medicine from Dr Obudu.. I have read about Dr Obudu the great herbalist doctor from African who can cure disease with his powerful herbal medicine. for the people suffering from the following diseases, Herpes, Cancer, Also,Herpatitis, Diabetes, Hps,Infections ETC should contact him for his herbal medicine because i am a living testimony and i was cured of herpes. Although, i sent him what he requested and he sent me his medicine which i took for 1 weeks and today when i went for test i was tested herpes negative. you can reach him through his email drobuduherbalhome@gmail.com or whatsapp number:+2349023428871 he will help you out

    • Avatar patrice davis says:

      Just wanna say a big thank you patrice cythia for introducing me to Dr Idedia the great HERBALIST that helped me prepare home remedies that cured my herpes simplex virus (HSV1&2)

      I was infected with herpes for the past two years and i was not happy all day so i was desperate to get a cure so that i can live normal and get healthy.
      One day i was less busy so i decided to make latest research on herpes cure and i found a site were everyone was talking about Dr Idedia and has ability to cure Herpes, HIV, HPV, Cancer, ALS, COPD, Anthrax, genital wart, cold sore, Arthritis and all manners of diseases and virus.
      So i discussed with cythia and she explained to me that its very easy working with Dr Idedia so i contacted Dr Idedia via email
      dr.idediatraditionalhealinghome@gmail.com and he helped me just as he has helped others now I am now cured from herpes am very happy now.
      and i can also assure you that he can also help you. so if you need the service of DR Idedia kindly contact him dr.idediatraditionalhealinghome@gmail.com or whatsapp +2349074505296.

      visit his websites https://dr-idedia-traditional-healing-home9.webnode.com/ Or
      https://sites.google.com/view/dridediatraditionalhealinghome/

    • Avatar rosesharon says:

      I’m so exited to share my testimonies about the Good Work of Dr. Edidia who get me cured from herpes simplex virus (HSV1&2) with his herbs, I never thought that I will live on earth before the year runs out. I have been suffering from herpes, I had spent a lot of money going from one Hospital to another looking for way to get rid of this disease, the hospital have been my home everyday residence. Constant checks up have been my hobby not until this faithful day, I was searching
       through the internet, I saw a testimony on how Dr.Edidia helped someone in curing his herpes disease using his healing
       Herbs, quickly I copied his email just to give him a test I spoke to him, he told me that he is going to provide the herbal cure to me, which he 
      did, after i receive his herbs and i take it as instructed i was cure permanently from herpes my herpes disease was gone. so I decided to share my testimony, that nothing is impossible with God, God use a man to healed me. No matter what you are passing through, no matter how deadly the sickness is and no matter what the situation is God that did mine is still going to do yours, people suffering from herpes, brain tumor, kidney disease, pcos, AIDS, ALS,copd, asthma, athritis,herpes, Cancer,Hpv, any kind of disease, you can rich him now via ? Gmail address: dredidiaherbalhome@gmail.com or whatsapp +2349074505296.
      here is the Dr website http://dredidiaherbalhome.weebly.com/ https://dr-edidia-herbal-home.business.site/ also visit my facebook pages https://www.facebook.com/dredidiaherbs/?modal=admin_todo_tour OR https://www.facebook.com/HIV-CURE-1359918664158191/?modal=admin_todo_tour  blogs pages https://naturaltreatmentherpes.blogspot.com/ https://besherpestreatment.blogspot.com/ https://herbalproductforherpes.blogspot.com/

      I,m rosesharon and you can get intouch with me via rosesharon915@gmail.com  also view website to know him.

  2. Avatar rosesharon says:

    Herpes is a serious and recurring disease which can’t be cured through drugs or injections by the American doctors but the best way to deal with Herpes is by taking natural herbs medicine for it, I have read about DR EDIDIA the great herbalist doctor who cure me from herpes with his powerful herbal medicine. i contacted him to know how he can help me and he told me never to worry
    that he will help me with the natural herbs from God!
    after 2 days of contacting him, he told me that the cure has been ready and
    he sent it to me via UPS SPEED POST and it got to me after 3 days!
    i used the medicine as he instructed me (MORNING and EVENING) and i was
    cured!
    its really like a dream but i am so happy! for the people suffering from the following diseases, Cancer, hypothyroidism, Herpes, COPD, HIV, Arthritis, Hpv, Infections,Liver Disease, Autoimmune Diseases, Parkinson’s disease,Lupus Canker sore and more should contact him for his herbal medicine because i am a living testimony and i was cured of herpes and his medicine is legit. i sent him what he requested and he sent me his medicine which i took for 3 good weeks and today am out here with negative result. when i went for test i was so happy after going through his medication. you can reach him through his email dredidiaherbalhome@gmail.com or call whatsapp number:+2349074505296 he will help you out. here is the Dr website http://dredidiaherbalhome.weebly.com/
    https://dr-edidia-herbal-home.business.site/ also visit my facebook pages https://www.facebook.com/dredidiaherbs/?modal=admin_todo_tour OR https://www.facebook.com/HIV-CURE-1359918664158191/?modal=admin_todo_tour

    blogs pages https://naturaltreatmentherpes.blogspot.com/ https://besherpestreatment.blogspot.com/

    I,m rosesharon and you can get intouch with me via rosesharon915@gmail.com also view website to know him.

  3. Avatar AMBIN says:

    Can competitive athletics continue after a kidney transplant?

    • Iranian Surgery Adviser Iranian Surgery Adviser says:

      We recommend that people avoid contact sports: football, basketball, wrestling, soccer, and certain other sports that could result in injury to the area of the body where the transplanted kidney has been placed.

  4. Avatar Elizabeth Matheus says:

    HELLO EVERYONE.. FEW MUNINETS TO REDY THIS INFOR ON HERPES CURE 2018..
    2017 MY MOTHER WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON HER MEDICATION TILL A POINT I EVEN LOST HOPE,BECAUSE MY MOTHER WAS GRADUALLY DYING AND LOST HER MEMORY TOO, I WAS SO DESPERATE TO GET MY MOTHER BACK TO NORMAL, ONE DAY MY UNCLE WHO LIVES IN LONDON UNITED KINGDOM TOLD ME ABOUT DR OLIHA ,WHO HELPED HIM GET RID OF HERPES /GENITAL WART WITH HERBAL MEDICINE AND HIS HERBAL SOAP ,I WAS SO SHOCKED WHEN HE TOLD ME ABOUT THIS ,ALTHOUGH I NEVER BELIEVE IN HERB BUT, I KEEP TO BELIEVE BECAUSE MY UNCLE CAN’T TELL ME LIES WHEN IT COMES TO HEALTH CONDITION I CONTACTED DR OLIHA VIA HIS EMAIL; OLIHA.MIRACLEMEDICINE@GMAIL.COM , YOU CAN TALK TO HIM VIA CALL OR WHATSAPP MESSENGER ON +2349038382931 , HE REPLIED AND ASK ME TO SEND MY HOME ADDRESS AND MY MOTHER’S DETAIL AND THEN I PURCHASED THE HERBAL MEDICINE,SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE USED IT FOR 2 WEEKS, AND 4 DAYS OF USAGE THE WARTS FELL OFF, MY MOTHER I NOW TOTALLY CURED AND MY MOTHER IS LIVING FREE AND HAPPY AGAIN. YOU CAN TALK TO DR VIA HIS MOBILE NUMBER OR WHATS APP HIM ON +2349038382931.ALL THANKS TO DOCTOR DR OLIHA

  5. Avatar mary morgan says:

    what a great Joy in my heart i never believe there is a cure for Herpes because my doctor tested me Herpes positive and she told me there is no cure, i’m very happy today that i’m having a free life without this disease, i can remember some years ago when i was crying all through the night and day that i can’t get cured from this sickness, i found this herbal man email on internet when i was doing research on cure for Herpes i contacted DR.Ehiaguna to found out if i can get help from this disease, i was so surprise when he told me that he have the cure to it and he sent me the herbal medicine i was so happy when i get someone giving me hope that he can cured me i took the herbal for just 14 days, when i went for test after taking the herbal i found out that i am cured, i was so happy and surprise, i want to use this opportunity to inform you that there is cured to Herpes you can also contact him for his help as soon as possible so that you can get rid of yours once and for all you can reach him through his email via drehiaguna@gmail.com or whatsApp him on +2348073908953 You can also contact him on any disease in this he have all the herbal cure to it..

    • Avatar garcia sharon says:

      I’m so exited to share my testimonies about the Good Work of Dr. Udebhu who get me cured from herpes simplex virus (HSV1&2) with his herbs, I never thought that I will live on earth before the year runs out. I have been suffering from herpes, I had spent a lot of money going from one Hospital to another looking for way to get rid of this disease, the hospital have been my home everyday residence. Constant checks up have been my hobby not until this faithful day, I was searching
       through the internet, I saw a testimony on how Dr.Udebhu helped someone in curing his herpes disease using his healing
       Herbs, quickly I copied his email just to give him a test I spoke to him, he told me that he is going to provide the herbal cure to me, which he
      did, after i receive his herbs and i take it as instructed i was cure permanently from herpes my herpes disease was gone. so I decided to share my testimony, that nothing is impossible with God, God use a man to healed me. No matter what you are passing through, no matter how deadly the sickness is and no matter what the situation is God that did mine is still going to do yours, people suffering from herpes, brain tumor, kidney disease, pcos, AIDS, ALS,copd, asthma, athritis,herpes, Cancer,Hpv, any kind of disease, you can rich him now via ? Gmail address: drudebhuherbalhome@gmail.com or whatsapp +2349051254152  

  6. Avatar Marie Planta says:

    Greatest thanks to Dr Oyagu for his herbal drugs that he prepared for me and when i start using it in just 2weeks i was completely cured and that ended my HERPES SIMPLEX 1&2 DISEASE i am so happy and grateful to Dr Oyagu . after reading about him on a testimony of Jason Cash on a blogger. i knew suddenly Dr Oyagu was the right Doctor to cure my HERPES SIMPLEX 1&2 DISEASE. i discuss with Dr Oyagu and he prepared a herbal medicine for me and when it got sent to me in south korean . i used the herbal medicine and 2weeks and i went to check up again. after 15years of suffering from HERPES SIMPLEX 1&2 at last i am smiling once again. Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from your suffering. contact his WhatsApp line:+2348101755322 or his Email:Oyaguspellcaster@gmail.com

  7. Avatar sandra lopez says:

    I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. During the first year, I had faith in God that I would be healed someday.This disease started to circulate all over my body and I have been taking treatment from my doctor, a few weeks ago I came on search on the internet if I could get any information concerning the prevention of this disease, on my search I saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr. Silver and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so I wrote to Dr. Silver telling him about my (HERPES Virus) he told me not to worry that I was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later I started experiencing changes all over me as the Dr. assured me that I have cured, after some time i went to my doctor to confirmed if I have been finally healed behold it was TRUE, So friends my advice is if you have such sickness or any other at all you can email Dr. Silver (drsilverhealingtemple@gmail.com) sir I am indeed grateful for the help I will forever recommend you to my friends!!! with your lovely Email Address ( drsilverhealingtemple@gmail.com or whatsapp him on +2348123877102

  8. Avatar HARRY says:

    Hello,

    Are You seeking of urgent loan? Have you be denied of a loan from your bank or any Financial Firm? Do you need financial assistance Do you need a loan to pay off your bills or buy a home, or Consolidate your debt and be debt free? Do you want to have a Business of your own and you need Financial Loan Help? Contact us for your fast reliable loan at a low interest rate of 2%. We are willing to help you out, either Business or Personal Loans, with an affordable repayment plan.Contact Email: harrystevenloanfirm@yahoo.com OR harrystevenloanfirm@gmail.com

  9. Avatar Marie Planta says:

    Greatest thanks to Dr Oyagu for his herbal drugs that he prepared for me and when i start using it in just 2weeks i was completely cured and that ended my HERPES SIMPLEX 1&2 DISEASE i am so happy and grateful to Dr Oyagu . after reading about him on a testimony of Jason Cash on a blogger. i knew suddenly Dr Oyagu was the right Doctor to cure my HERPES SIMPLEX 1&2 DISEASE. i discuss with Dr Oyagu and he prepared a herbal medicine for me and when it got sent to me in south korean . i used the herbal medicine and 2weeks and i went to check up again. after 15years of suffering from HERPES SIMPLEX 1&2 at last i am smiling once again. Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from your suffering. contact his WhatsApp line:+2348101755322 or his Email via dr.Oyaguherbalhome@gmail.com

  10. Avatar Marie Planta says:

    Greatest thanks to Dr Oyagu for his herbal drugs that he prepared for me and when i start using it in just 2weeks i was completely cured and that ended my HERPES SIMPLEX 1&2 DISEASE i am so happy and grateful to Dr Oyagu . after reading about him on a testimony of Jason Cash on a blogger. i knew suddenly Dr Oyagu was the right Doctor to cure my HERPES SIMPLEX 1&2 DISEASE. i discuss with Dr Oyagu and he prepared a herbal medicine for me and when it got sent to me in south korean . i used the herbal medicine and 2weeks and i went to check up again. after 15years of suffering from HERPES SIMPLEX 1&2 at last i am smiling once again. Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from your suffering. contact his WhatsApp line: +2348101755322 or his Email:Oyaguherbalhome@gmail.com

  11. Avatar garcia sharon says:

    I’m so exited to share my testimonies about the Good Work of Dr. Udebhu who get me cured from herpes simplex virus (HSV1&2) with his herbs, I never thought that I will live on earth before the year runs out. I have been suffering from herpes, I had spent a lot of money going from one Hospital to another looking for way to get rid of this disease, the hospital have been my home everyday residence. Constant checks up have been my hobby not until this faithful day, I was searching
     through the internet, I saw a testimony on how Dr.Udebhu helped someone in curing his herpes disease using his healing
     Herbs, quickly I copied his email just to give him a test I spoke to him, he told me that he is going to provide the herbal cure to me, which he
    did, after i receive his herbs and i take it as instructed i was cure permanently from herpes my herpes disease was gone. so I decided to share my testimony, that nothing is impossible with God, God use a man to healed me. No matter what you are passing through, no matter how deadly the sickness is and no matter what the situation is God that did mine is still going to do yours, people suffering from herpes, brain tumor, kidney disease, pcos, AIDS, ALS,copd, asthma, athritis,herpes, Cancer,Hpv, any kind of disease, you can rich him now via ? Gmail address: drudebhuherbalhome@gmail.com or whatsapp +2349051254152  

  12. Avatar delores warner says:

    my husband and I have been married for about 7 yrs now. We were happily married with two kids, a boy and a girl. 3 months ago, I started to notice some strange behavior from him and a few weeks later I found out that my husband is seeing someone. He started coming home late from work, he hardly care about me or the kids anymore, Sometimes he goes out and doesn’t even come back home for about 2-3 days. I did all I could to rectify this problem but all to no avail. I became very worried and needed help. As I was browsing through the Internet one day, I came across a website that suggested that Dr jeffrey can help solve marital problems, restore broken relationships and so on. So, I felt I should give him a try. I contacted him and he did a spell for me. Two days later, my husband came to me and apologized for the wrongs he did and promise never to do it again. Ever since then, everything has returned back to normal. I and my family are living together happily again.. All thanks to Dr jeffrey . If you need a spell caster that can cast a spell that truly works, I suggest you contact him. He will not disappoint you. This is his E-mail:

    dctrjeffrey@gmail.com

    WhatsApp +2348162061202

  13. Avatar Melanie Case says:

    Hello everyone out there, I’m here to give my testimony about a herbalist doctor who helped me. I was infected with HERPES SIMPLEX VIRUS in 2011, I went to many hospitals to heal myself but there was no solution, so I was thinking how I can get a solution so that my body can be well. One day I was in the river thinking about where I can go to get a solution. so a lady walked towards me telling me why I’m so sad and I open everything by telling her my problem, she told me she could help me, she introduced me to a doctor who uses herbal medicines to cure the SIMPLEX HERPES VIRUS and gave me your email, so I sent you an email. He told me everything I had to do and also gave me instructions to take, which I followed correctly. Before I knew what was happening after two weeks, the SIMPLEX HERPES VIRUS that was in my body disappeared. therefore, if you also have a broken heart and need help, you can also send an email to {oliha.miraclemedicine@gmail.com}or whatsapp him number: +2349038382931 or Facebook page https://www.facebook.com/drolihamiraclemedicine/Contact him today and he will have a testimony … Good luck!
    Dr. OLIHA also cures:1. HIV / AIDS2. HERPES 1/23. CANCER4. ALS (Lou Gehrig’s disease)5. Hepatitis B6. chronic pancreatic7. emphysema8. COPD (chronic obstructive pulmonary disease)

  14. Avatar veronica gomez says:

    hello everyone,my name is veronica gomez,im from united state texas,im 59 years old,I want to sincerely appreciate Mr RICHARD COSMOS who helped me with an already Program hacked ATM CARD and i was so poor without funds that i got frustrated. One morning as i was browsing on the internet, i saw different comments,said the card can witdraw $5000 per day and $50,000.in a week. people testifying of how Mr RICHARD COSMOS helped them from being poor to being rich through this already hacked ATM CARD. I was skeptical if this was true, i decided to contact one of the people giving this testimony to see proof before i contact this hacker and they proved to me beyond all doubts that it was really for real so i urgently contacted his (ultimatehackersworld@gmail.com )and i got my already hacked atm card after i paid form the dilivery fee, if you are afraid that he is a scam, you can message me and ask me how i get the card my If you also want this BLANK ATM CARD i want you to contact the Hacker’s on they email address;{ultimatehackersworld@gmail.com}

  15. Avatar Rose says:

    I found out, that taking herbal treatment is the best to get rid of hpv as soon as i feel the symptoms of hpv is appearing, i took the healing process by contacting Dr OYAGU for natural treatment it works wonders, amazingly ever since I had the herbal treatment i have not feel these horrible disease anymore and my doc told me the virus is gone, i am glad i finally got cured out from this horrible disease. every hpv or herpes patients should also get in touch with this herbalist Dr to get ride of these disease forever his email.Oyaguherbalhome@gmail.com

  16. Avatar Angela says:

    Marriage restoration..Stop your marriage from breaking apart today. I lost my husband to another woman 2 weeks ago after 27 years of marriage . We had a lovely marriage but he started a relationship with a co worker who chased after him . He is living away near his work and her and refuses to talk to me or to come home . I am devastated and am finding it hard to cope . I wish I did not love him and that I could move on but I can’t . I don’t know how to stop feeling like this I wish I didn’t as its eating me away and I m starting to feel ill. I have degraded myself begging him to come home all to no avail. I became very worried and needed help. As I was browsing through the internet one day, I came across a website that suggested that Chief Dr Lucky can help solve marital problems, restore broken relationships and so on. So, I felt I should give him a try. I contacted him and he did a spell for me. two days later, my husband came to me and apologized for the wrongs he did and promise never to do it again. Ever since then, everything has returned back to normal. I and my family are living together happily again.. All thanks to Chief Dr Lucky. If you need a spell caster that can cast a spell that truly works, I suggest you contact him. He will not disappoint you. if you have any problem contact him, I give you 100% guarantee that he will help you, This is his details,Email him at: Chiefdrlucky@gmail.com you can also call him or add him on Whats-app: +2348132777335 

  17. Avatar MICHELLE HUFF says:

    Some days, things do not happen the way you want them to be. They fall
    apart, and you start to worry. Worse, you feel discouraged and lonely,
    thinking that there is no other way to straighten things up Natural herbs
    have cured so many illness that drugs and injection can’t cure I’ve seen
    the great importance of natural herbs and the wonderful work natural herbs
    have done in people’s lives. i read a lot of people’s testimonies online on
    how they were cured of Herpes, HIV, Diabetics, Lymphoma, Fibroid, Cancer
    etc by Dr voodoo herbal medicine, so i decided to contact the doctor Dr
    voodoo also cured me from HIV I will recommend Dr. voodoo to everyone
    reading this article because this herbal healer is capable to heal anything
    email Dr voodoo at: voodoospelltemple66@gmail.com also his whatsApp
    +2348140120719

  18. Avatar pena says:

    Greatest thanks to Dr bante for his herbal drugs that he prepared for me and when i start using it in just 2weeks i was completely cured and that ended my HERPES SIMPLEX 1&2 DISEASE i am so happy and grateful to Dr bante . after reading about him on a testimony of Jason Cash on a blogger. i knew suddenly Dr bante was the right Doctor to cure my HERPES SIMPLEX 1&2 DISEASE. i discuss with Dr bante and he prepared a herbal medicine for me and when it got sent to me in south korean . i used the herbal medicine and 2weeks and i went to check up again. after 15years of suffering from HERPES SIMPLEX 1&2 at last i am smiling once again. Dr bante also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr bante and be free from your suffering. contact his WhatsApp line: +2349063962262 or his Email: bantespelltemple@gmail.com  
    visit

  19. Avatar Turner Torries says:

    Hi Viewers Get your Blank ATM card that works in all ATM machines all over the world.. We have specially programmed ATM cards that can be used to hack ATM machines, the ATM cards can be used to withdraw at the ATM or swipe, at stores and POS. We sell this cards to all interested buyers worldwide, the card has a daily withdrawal limit of $1,000 on ATM and up to $20,000 spending limit in stores depending on the kind of card you order for, we are here for you anytime, any day. Email; (blankatm002@gmail.com) I’m grateful to Mike because he changed my story all of a sudden . The card works in all countries except, contact him now (blankatm002@gmail.com)

  20. Avatar fatelynn says:

    I never thought that there will be a miracle on the internet until i came in contact with Priest Babaka, finally i made it with his help, with his spiritual power which was recommended by a lady in baby center he help before, i never believe it was real until i confirm it now because i have tried so many things to make sure i get pregnant but no luck, immediately i contact him. he did some spiritual prayers and send me a medicine which i took, i got pregnant three weeks after, and i now have a son to show. thank you so much priest and i recommend Priest Babaka for everyone out there that is willing to have a child of her own out there. contact him for help too he is real and powerful, i have confirmed it, contact him on email: babaka.wolf@gmail.com or Facebook at priest.babaka

  21. Avatar Elizabeth Matheus says:

    HELLO EVERYONE.. FEW MUNINETS TO REDY THIS INFOR ON HERPES CURE 2018..
    2017 MY MOTHER WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON HER MEDICATION TILL A POINT I EVEN LOST HOPE,BECAUSE MY MOTHER WAS GRADUALLY DYING AND LOST HER MEMORY TOO, I WAS SO DESPERATE TO GET MY MOTHER BACK TO NORMAL, ONE DAY MY UNCLE WHO LIVES IN LONDON UNITED KINGDOM TOLD ME ABOUT DR OLIHA ,WHO HELPED HIM GET RID OF HERPES /GENITAL WART WITH HERBAL MEDICINE AND HIS HERBAL SOAP ,I WAS SO SHOCKED WHEN HE TOLD ME ABOUT THIS ,ALTHOUGH I NEVER BELIEVE IN HERB BUT, I KEEP TO BELIEVE BECAUSE MY UNCLE CAN’T TELL ME LIES WHEN IT COMES TO HEALTH CONDITION I CONTACTED DR OLIHA VIA HIS EMAIL; OLIHA.MIRACLEMEDICINE@GMAIL.COM , YOU CAN TALK TO HIM VIA CALL OR WHATSAPP MESSENGER ON +2349038382931 , HE REPLIED AND ASK ME TO SEND MY HOME ADDRESS AND MY MOTHER’S DETAIL AND THEN I PURCHASED THE HERBAL MEDICINE,SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE USED IT FOR 2 WEEKS, AND 4 DAYS OF USAGE THE WARTS FELL OFF, MY MOTHER I NOW TOTALLY CURED AND MY MOTHER IS LIVING FREE AND HAPPY AGAIN. YOU CAN TALK TO DR VIA HIS MOBILE NUMBER OR WHATS APP HIM ON +2349038382931.ALL THANKS TO DOCTOR DR OLIHA  

  22. Avatar CHYNA LEE says:

    I am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS . I was positive to the deadly Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw Dr EDES testimony online on how he was cured so many persons from Herpes Disease. so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i’m so happy! that’s the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drdeshome@gmail.com) you can
    He also cure the below listed sickness;
    (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA…

  23. Avatar Elizabeth Matheus says:

    HELLO EVERYONE.. FEW MUNINETS TO REDY THIS INFOR ON HERPES CURE 2018..2017 MY MOTHER WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON HER MEDICATION TILL A POINT I EVEN LOST HOPE,BECAUSE MY MOTHER WAS GRADUALLY DYING AND LOST HER MEMORY TOO, I WAS SO DESPERATE TO GET MY MOTHER BACK TO NORMAL, ONE DAY MY UNCLE WHO LIVES IN LONDON UNITED KINGDOM TOLD ME ABOUT DR OLIHA ,WHO HELPED HIM GET RID OF HERPES /GENITAL WART WITH HERBAL MEDICINE AND HIS HERBAL SOAP ,I WAS SO SHOCKED WHEN HE TOLD ME ABOUT THIS ,ALTHOUGH I NEVER BELIEVE IN HERB BUT, I KEEP TO BELIEVE BECAUSE MY UNCLE CAN’T TELL ME LIES WHEN IT COMES TO HEALTH CONDITION I CONTACTED DR OLIHA VIA HIS EMAIL; OLIHA.MIRALEMEDICINE@GMAIL.COM , YOU CAN TALK TO HIM VIA CALL OR WHATSAPP MESSENGER ON +2349038382931 , HE REPLIED AND ASK ME TO SEND MY HOME ADDRESS AND MY MOTHER’S DETAIL AND THEN I PURCHASED THE HERBAL MEDICINE,SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE USED IT FOR 2 WEEKS, AND 4 DAYS OF USAGE THE WARTS FELL OFF, MY MOTHER I NOW TOTALLY CURED AND MY MOTHER IS LIVING FREE AND HAPPY AGAIN.

  24. Avatar MICHELLE HUFF says:

    The doctors said Herpes virus do not have medical cure because the virus is capable of hiding within the human cells, it remains protected from your immune system. Herpes isn’t a special virus – your immune system has the tools to fight it back. But because it is able to lay dormant in protected cells, your immune system is unable to remove it from your body,But with strong reactive herbal medication is capable of getting rid of the virus gradually and totally from your body without damaging any of your cells,natural herbs kills the virus totally not just reducing the out break. Get natural herbs cure Email DR.

Leave a Reply

Your email address will not be published. Required fields are marked *

Consultation