Kidney transplantation Flashcards
What is a transplant?
A transplant is when tissue is taken from one person and placed in another, either being taken from someone who has died or from a living donor
What are the 3 main types of transplant?
- Deceased heart beating donations - Brain stem death (DBD)
- Non-heart beating donation (DCD)
- Live donation (Altruistic)
What are the 3 main types of live donation?
- Directed and undirected
- Paired donation
- Financially procured (Illegal in most countries)
What is meant by paired donation?
A patient in need of a kidney has a family member willing to donate but they aren’t a match
A 2nd patient in need of a kidney has a 2nd family member willing to donate but they aren’t a match
If Patient 1 and family member 2 are a match and patient 2 and family member 1 are a match, then they can undergo paired donation, where each family member is “technically” donating to their family member”
What are some requirements for potential donation recipients?
Reasonable life expectancy (>5 years)
Safe to undergo the operation
Passed extensive assessment
What is involved in recipient assessment?
- Immunology - Tissue typing and antibody screening
- Virology - HBV, HVC, HIV, EBV, CMV, VZV, Toxo, Syphilis
- Assess cardiorespiratory risk
- Assess peripheral vessels
- Assess bladder function
- Assess mental state
- Assess any co-morbidities
- Independant assessment
What are some contraindications for donation (In recipient)
- Malignancy (Solid tumour in the last 2-5 years or known untreated malignancy)
- Active infection
- Severe IHD (Not amenable to surgery)
- Severe airways disease
- Active vasculitis
- Severe PVD
- Hostile bladder
What are some assessments required in assessing potential live donors?
- Physical fitness for surgery
- Enough renal function to remain independant with 1
- Anatomically normal kidneys
- Co-morbidities
- Immunological compatibility
- Psychological compatibility
- No coercion
What are the 2 main forms of tissue matching in kidney donation?
- Blood group matching
- HLA type matching
What is involved in HLA matching?
HLA matching is based on both type I and type II matching
This is important as even with immunosuppression, there is better graft survival
What are the 4 stages of kidney allocation?
- Paediatric recipient (any match)
- 0,0,0 mismatch (ideal match)
- 1, 0, 0 or 0, 1, 0 or 1, 1, 0 mismatch (favourable)
- Other match (unfavourable)
What is desensitisation?
- Active removal of blood group or donor specific antibody
- Plasma exchange or B cell antibody (rituximab)
- Monitor antibody levels and transplant when below acceptable threshold
What is involve din the kidney transplant procedure?
- Extra-peritoneal procedure
- Transplant inserted in iliac fossa
- Attached to external iliac artery and vein
- Ureter plumbed into bladder with stent
- 7-10 days in hospital
- Regular clinic followup
- Usually back to full activities and work in 3 months
What are some complications of kidney transplant surgery?
- Bleeding
- Arterial stenosis
- Venous stenosis/kinking
- Ureteric stricture and hydronephrosis
- Wound infection/dehiscence
- Lymphocele
What are some signs of good immediate graft function?
good urine output, falling urea and creatinine
