Aspek Bedah Pada Transplantasi Ginjal

KIDNEY TRANSPLANTATION EBEN EZER SIAHAAN Dept of surgery Medical faculty of Christian unuversity of Indonesia

Kidney transplantation is the pioneer discipline in solid organ transplantation, and the relationship between transplant surgeon and nephrologist has served as a model for multidisciplinary team care.

Introduction  The

1st human renal allograft was performed by Voronoy. The recipient is 26 years old woman who had attemped suicide by ingesting mercury chloride. The patient was died 48 hours after the procedure.

Introduction

The

first long term success with human renal allograft in Boston 1954

Introduction  Immunosupresion

era :

- Azathioprine - Radiation - Corticosteroid + Azathioprine • 1958 histocompatibility antigen was describe • 1962 tissue matching to select donor – recipient pairs

Renal failure  Pre

Renal

 Acute  Renal  Chronic

 Post

Renal

DEFINITION  Permanent

renal failure in adult is an irreversible glomerular filtration rate of less then 10 ml/minute or serum creatinine level greater then 8 mg/l.

SELECTION AND PREPARATION OF KIDNEY TRANSPLANT RECIPIENTS  Preliminary

screening  Kidney disease recurrence  Infection  Active malignancy  High probability of peri operative morbidity or mortality  Non compliance  Unsuitable condition for technical succes.

DONOR SELECTION, PREPARATION AND SURGERY  Living

donor

 Deceased

donor

KIDNEY PRESERVATION  Cold

Ischemic  Hypothermic

pulsatile

perfusion.  Warm

ischemic  Flushing

with an ice cold solution.

KIDNEY PRESERVATION

Kidney preservation ( deceased donor )

RENAL ALLOGRAFT REJECTION  Histocompatibility  Rejection

: 1. Hyperacute rejection 2. Accelerated rejection 3. Acute rejection 4. Chronic rejection

PROBLEM  Early

graft dysfucntion  Vascular complications  Allograft nephrectomy  Hematuria  Fluid collection  Obstruction and stones  UTI  VUR  Cancer

Summary  Renal

transplant is the best therapy for most patient ESRD. Morbidity and mortality have been significantly reduces by attention to pretransplantation evaluation, donor surgery,kidney preservation, recipient selection, recipient surgery, histocompatibility, immunosuppresion and the successful management of complication.