1 Page Notes : Renal Transplant

RENAL TRANSPLANT (done under GA & operation last for about 2-3 hours) Placed in the iliac fossa region and can give up to 50% function of 2 normal kidneys. Donor ureter placed on recipients bladder and blood vessels joined to the ones supplying the leg. (external iliac artery) Source : cadaver (90%), heart-beating donor, non heart-beating donor and live donors (10%) including genetically unrelated donors. Prognosis – 1 yr survival rate of 80% - 90%, after 5 yrs (70%), after 10 yrs (50%). Success affected by : ABO compatibility, matching donor and recipient for HLA type, preoperative blood transfusion, adequate immunosuppressive Rx, ‘centre effect’. Intended benefits – Freedom from dialysis, dietary and fluid restriction, correct anaemia and infertility. Risk / Complication (1) Technical – Occlusion/ stenosis of anastomoses, defects, urinary leaks. (2) Rejection – Rx with high-dose corticosteroids  anti-lymphocyte Ab or plasma exchange. (3) Infection - opportunistic ( CMV, Pneumocystis jirovecii). (4) Skin malignancy - (50% white people develop it 15 years post-transplant) (5) Post-transplant HPT, diabetes (6) Recurrence of disease that caused renal failure – Eg; Goodpasture’s syndrome, 1y oxalosis. (7) Die – 3% _______________________________________________ In UK, over 1,500 are performed every year average waiting time on list is 2 years. Details of tissue type and blood group are kept at UK Transplant Support Service Authority (UKTSSA). Transplant goes ahead if cross-match with donor is negative. Paid live non-related donor transplant is illegal. Combined renal & pancreas transplant considered in certain Type I DM. What are the contraindications? Absolute • Active malignancy - a period of at least 2 years to complete remission is recommended for most tumours prior to transplantation. • Active vasculitis or anti-GBM disease, with positive serology – at least 1 year of remission is recommended prior to transplantation • Severe IHD • Severe occlusive aorto-iliac vascular disease. Relative • Age – while practice varies, transplants are not routinely offered to very young children (<1 year) or older (>75 years) • High risk of disease recurrence in the transplant kidney • Disease of lower urinary tract – in patients impaired bladder function, an ileal conduit may be considered • Significant comorbidity Management after transplantation • Immunosuppressive therapy. Corticosteroids  high-dose methylprednisolone for acute rejection  side effects Azathioprine  prevents cell-mediated rejection  bone marrow depression, hepatotoxicity. Cyclosporin  prevents activation of T-lymphocytes  nephrotoxicity, rash, tremor, diabetes. Tacrolimus  greater neuro & nephrotoxicty, abnormal GLU metabolism & cardiomyopathy.

Mycophenolate mofetil Antilymphocyte and antithymocyte globulin. • Medication to prevent complications of the above. • Medication for high BP or high cholesterol Further reading if you have time: http://www.kidney.org.uk ©Minci Yazumin 2007