King Abdulaziz University Hospital

Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

Issued Date: Approval Date: Effective Date: Next Review Date:

18 Mar 2024

Department Name / Section Name / Chapter: Number of Pages: 11

Transplant Nephrology Team
Applies to:
Kidney transplantation team and all involved subspecialties for this service

1. PURPOSE:
To facilitate adherence of the outlined procedures for all involved healthcare providers,
minimize deviation and variability of provided care and to minimize healthcare errors.

2. DEFINITIONS:
2.1. Kidney Transplant: A surgery to place a healthy kidney from a living or deceased donor
into end stage renal disease patients.
2.2. End Stage Renal disease: Patients with Glomerular filtration rate less than 15 ml/ min/1.73
m2.
2.3. Kidney Transplant Evaluation Team: Team of the kidney transplant includes but not
limited to the coordinator, transplant neprologist, transplant surgeon, social worker, nurses,
psychologist, transplant pharmacist, Infection Control, Immunologist and Radiologist.
2.4. Cold Ischemia Time: The time during which the donor kidney is not receiving blood flow.
This minimized to reduce ischemic damage.

2.5. Warm Ischemia Time: The period during which the kidney is out of ice without blood
supply during transplantation till perfusion, should be kept as short as possible. This
minimizes the risk of ischemic injury to the organ.

3. POLICY:

3.1. A multidisciplinary team will assess each potential recipient and donor to ensure
suitability for transplantation based on medical, psychosocial, and financial criteria (refer to
attachment # 6.1 Donor Selection Criteria for Kidney Transplantation)

3.2. Transplant decision will be made by a designated transplant team to ensure fairness and
equity.

3.3. Prior to transplantation, both recipients and donors will be provided with detailed
information about the procedure, risk and alternatives.

3.4. Informed consent will be obtained in accordance with legal and ethical standards (refer to
policy: APP-MES -031 Consent)

3.5. Kidney transplant surgeries will be performed by qualified, privileged and experienced
transplant surgeons.
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 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

3.6. Recipients will receive comprehensive post-transplant care, including immunosuppressive

medications, monitoring, and support services (refer to attachment # 6.2: Immunosuppression
Induction Protocol)

3.7. Regular post-transplant follow-up appointments will be scheduled to assess graft function
and recipient’s health.
3.8. Donors will be admitted under transplant surgery team and the recipient under
Nephrology team and initiate the routine process of admission (refer to policy: APP-
MES-041 Admission)

4. PROCEDURE:

SN Procedure Responsible Staff/s

4.1. Living Donor selection

Evaluate potential kidney transplant donors for their
4.1.1 Transplant Nephrologist/
ability to donate. (refer to attachment # 6.1 Donor
Selection Criteria for Kidney Transplantation) Coordinator

4.1.2 Collaborate with King Faisal Specialist Hospital and Transplant Nephrologist/
Research Centre Laboratory (Life Health System)for Coordinator
HLA typing, Panel Reactive Antibodies and
Crossmatch (FLOW crossmatch and Cell Dependent
Cytotoxicity)

4.1.2 Potential transplant candidates will be discussed in Transplant Evaluation

the multidisciplinary team to finalize the decision Team
regarding eligibility.

4.2. Donor evaluation and discussions about the

procedure

4.2.1. Living donors will undergo medical and psychosocial Transplant

evaluations. (refer to attachment # 6.3 Pre- Transplant Nephrologist/Coordinator
Kidney Donor Work -Up)

4.2.2. The Transplant evaluation team will discuss the

following points to the donor:
4.2.2.1 Voluntary Nature - All living donations shall
be made willingly and free of coercion with no Transplant Nephrologist
monetary compensation is involved in the donation.
4.2.2.2 Donation Consent includes benefits and risk of
donation.

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 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

4.2.2.3 Encourage the donor to carefully consider the

decision to donate before proceeding and discuss all
questions fully. Transplant Nephrologist

4.3 Recipient evaluation and discussions about the

procedure
Recipient will undergo medical and psychosocial
4.3.1 Transplant
evaluations which includes laboratory and radiological
studies (refer to attachment # 6.4 Kidney Recipient Work - Nephrologist/Coordinator
Up)

Update pre-transplant recipient vaccination based on

4.3.2 Transplant
vaccine record and immunoglobulin titer. (See attached
file) Nephrologist/Coordinator
4.3.2.1 Coordinate with Myclinic (Private clinic) for Infectious Diseases Team
completion of vaccination as per infectious disease
team assessment

4.4 Preoperative Assessment and Preparation

Describe in detail the procedure, implications, risks,
4.4.1
and benefits to the intended donor
Transplant Surgeon
Book for surgery (refer to policy: IPP-OPR-001
4.4.2
Introduction to operating room; Attachment #1 –
Guideline in Scheduling/Booking of patient to OR
Services)

4.4.3 Obtain Informed consent as per hospital Consent policy Transplant Surgeon
(refer to policy : APP-MES-031 Consent) /Designee

4.4.3 Follow process of safe surgical practices for identifying Operating team
correct patient, site and procedure ( refer to policy:
Nurse
APP OPR-040 Preventing Wrong Patient, Wrong Site
and Wrong Surgery/Procedure)

4.4.4 On admission a medical assessment and the following

tests are performed:
4.4.4.1 Final cross-match and blood grouping shall be
available Most Responsible
4.4.4.2 CBC and platelet count Physician (MRP) and
4.4.4.3 PTT and INR Transplant Coordinator
4.4.4.4 Blood group: crossmatch of 2-4 units packed
red cells
4.4.4.5 Electrolytes, Total CO2
4.4.4.6 Urea, creatinine, and uric acid

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Printing or Downloading of any Policy & Procedure is STRICTLY NOT allowed without the Quality Management’s approval.
 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

4.4.4.7 Albumin and total protein

4.4.4.8 AST, ALT, GGT and alkaline phosphatase
4.4.4.9 Transplant immunology (10 cc of clotted blood)
4.4.4.10 Chest X-ray
4.4.4.11 12-lead electrocardiogram
4.4.4.12 Midstream urine for culture and sensitivity
4.4.4.13 Peritoneal fluid cell count and culture (If there
is Peritoneal Dialysis (PD) catheter)
Central Venous Line (CVL), jugular is preferred for
4.4.5 MRP
frequent blood sampling and medications; Keep
tunneled CVL if previously on hemodialysis.
Decision about removal of PD catheter will be made at
4.4.6
the time of the transplant.
The surgical team will follow established protocols for
4.4.7 MRP
preoperative, intraoperative, and postoperative care.

4.4.8 Dialysis requirement:

4.4.8.1 If hemodialysis is required:
4.4.8.1.1 Minimal anticoagulation should be
used, and the line should be capped
with heparin.
4.4.8.1.2 Fluid removal should be minimal unless
fluid overloaded. Discuss with consultant
on call.
4.4.8.2 If Peritoneal Dialysis is required:
4.4.8.2.1 Children should receive their usual
overnight dialysis. Depending on the
time of transplantation and MRP/Designee
biochemistry results, further cycles
may be required.
4.4.8.2.2 When going to theatre, the abdomen
should be empty (No last fill), and the
catheter capped prior to transfer to
theater.
4.4.8.2.3 Fluid removal should be minimal
unless fluid overloaded. Aim is to
leave child at or above their dry
weight i.e. limit the Ultra Filtration
(UF) or allow time to catch up with
I.V. fluids if fluid removal greater
than expected.

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Printing or Downloading of any Policy & Procedure is STRICTLY NOT allowed without the Quality Management’s approval.
 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

TRANSPLANT OPERATION
4.7
Evaluation and assessment shall be performed to
4.7.1 Anesthesiology
patient prior anesthesia induction (refer to policy: IPP-
ANE 705 Pre - Anesthesia Assessment and IPP-ANE
710 Anesthesia Induction)
Donor Procedure:
4.7.3
4.7.3.1 Procedure will start with laparoscopic
nephrectomy of decided marked site
4.7.3.2 Organ Extraction (Living Donor):
4.7.3.2.1 In living donor cases, the surgeon
carefully extracts the kidney while Transplant Surgeon
preserving blood vessels and the ureter.
4.7.3.2.2.The extracted kidney is immediately
placed in a sterile cold preservation
solution to maintain viability.
4.7.3.2.3 Back table for extracted kidney with
immediate flushing of the organ with
preserved cold solution and vascular
ureteral preparation will be carried out.

Recipient Procedure:
4.7.4 Transplant surgeon
Once organ (donated kidney) is about to be extracted,
the recipient will be pushed and prepared for transplant
in another room to reduce ischemia time.

4.8 Immunosuppression Initiation

Immunosuppressive medications, including calcineurin Transplant Nephrology/
4.8.1
inhibitors, antiproliferative agents, and corticosteroids, MRP/Designee
are initiated. (refer to attachment # 6.2: Pharmacy
Immunosuppression Induction Protocol)

Immunosuppressive therapy is based on the transplant

4.8.2 Transplant Nephrology/
recipient’s immunological risk and donor factors.
(refer to attachment # 6.2: Immunosuppression MRP/Designee
Induction Protocol)

4.9 Post operative care

4.9.1 Recipients are transferred to PICU/SICU: MRP

4.9.1.1.Observe for any complications and function of Anesthesiologist
graft.
Nurse

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Printing or Downloading of any Policy & Procedure is STRICTLY NOT allowed without the Quality Management’s approval.
 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

4.9.1.2.Conduct continuous assessment of vital signs,

kidney function, until full recovery.
(refer to policy: IPP-ANE-002 Patient Care in Post
Anesthesia Care Unit (PACU) & IPP-NUR-079
Transfer and Transportation of Patients).
Donors are transferred to SIMCU for observation MRP/Nurse
4.9.2

4.9.3 Recipient will be monitored on daily basis on following

items:
4.9.3.1. Clinical Examination includes but not limited
to:
4.9.3.1.1. Urine output hourly and weight is
monitored daily.
4.9.3.1.2. Daily lab investigations include serum
creatinine (SCr), and calcineurin
inhibitor (CNI) blood concentrations
with results recorded in the patient’s
chart.
4.9.3.2. Nutrition: The patient starts with a clear fluid
diet, then proceeds to full fluids and then MRP
advances to a solid diet as quickly as patient Nurse
tolerated.
4.9.3.3. Foley Catheter: During the transplant
operation, an indwelling Foley catheter is
inserted into all patients. The catheter
normally stays in place for a minimum of
three to five days and the decision of the
removal will be made by the transplant.

4.9.3.4. Wound Care: The patient's incision is

managed according to infection control policy
(refer policy APP-IPC-047 Surgical Site
Infection)

Patient will be closely monitored for potential

4.9.4 Transplant Surgeon
complications, such as bleeding, infection, or vascular
issues. Nurse
4.9.5.1. Interventional procedures or surgical revisions
4.9.5 Transplant Surgeon
may be performed if complications arise.
Radiology
4.9.5.2.An urgent Renal Graft ultrasound will be
requested accordingly.
For follow up of post-transplant patient (refer to
4.9.6 Transplant
attachment # 6.5: Post Kidney Transplant Follow up
Protocol) Nephrologist/Coordinator

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 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

Long-Term Immunosuppression Regimen: Patients will Transplant

remain on immunosuppression for the life of their
4.9.6 transplanted kidney. (refer to attachment # 6.2: Nephrologist/Specialist
Immunosuppression Induction Protocol)
Antimicrobials: Recipient will be on antimicrobial
4.9.7 Transplant
regimen. (refer to attachment # 6.6: Infectious Disease
Protocol for Kidney Transplantation) Nephrologist/Specialist

4.10 Graft Rejection

The diagnosis of rejection is usually based on
4.10.1 Transplant
combination of serum creatinine, Donor Specific
Antibodies (DSAs) and kidney biopsy determined in Nephrologist/Specialist
case by case.

4.11 Donor Follow up

4.11.1.1 Living donors undergo a thorough
4.11.1 Adult Transplant
postoperative assessment to ensure their well-
being. Nephrologist/Specilaist

4.11.1.2 Long-term follow-up may include monitoring

kidney function, blood pressure, and overall
health.

5. DISTRIBUTION:

5.1. All Policies and Procedures shall be available and accessible electronically via:

5.1.1. Hospital’s Intranet (Internal Hospital Website)

5.1.2. Share Folder Link in the Personal Desktop Screen
5.1.3. KAAUH SharePoint, KAUKSA SharePoint
5.1.4. Google Drive (Cloud Storage)
5.1.5. Virtual Private Network (VPN)

5.2. In case of System Downtime:

5.2.1. System Downtime (Shifaa Hyperlink): http://shifaa.kau.edu.sa/kauh/policy.html

5.2.2. Quick Response Code (QR code):

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Printing or Downloading of any Policy & Procedure is STRICTLY NOT allowed without the Quality Management’s approval.
 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

6. ATTACHMENTS:

6.1. Donor Selection Criteria for Kidney Transplantation

6.2. Immunosuppression Induction Protocol
6.3. Pre- Transplant Kidney Donor Work up
6.4. Kidney Recipient Work up
6.5. Post Kidney Transplant Follow up Protocol
6.6. Infectious Disease Protocol for kidney Transplantation
6.7. Kidney Rejection Management Protocol

7. REFERENCES:

7.1. The Hospital for Sick Children Renal Transplant Protocol

7.2. Clinical Guidelines for Renal Transplantation, King Faisal Specialist Hospital and Research
Center
7.3. Clinical Guidelines for Kidney Transplantation 2018 Vancouver, Canada
7.4. KDIGO Guideline for Kidney Transplant Recipients 2009 & 2018
7.5. The Banff 2013 & 2017 Working Classification of Renal Allograft Pathology
7.6. Panel Reactive Antibody Test (PRA) In Renal Transplantation Hajeer AH, Saudi J Kidney
DisTransplant 2006;17(1):1-4
7.7. Management of Kidney Transplant Recipients by General Nephrologists: Core Curriculum
2019. Santhi Voora and Deborah B. Adey. Am J Kidney Dis.73(6):866-879. Published
Online April 11, 2019.
7.8. Chronic allograft nephropathy, Jeffery et al. Pediatric Nephrol (2009) 24:1465–1471

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Printing or Downloading of any Policy & Procedure is STRICTLY NOT allowed without the Quality Management’s approval.
 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

8. APPROVAL BLOCK

Name Signature Date

Dr. Abdulaziz Bahassan

Pediatric Transplant Nephrologist

Name Signature Date
Dr. Abrar Nawawi
Prepared By
Consultant, HBP Surgery and Transplant Surgery
Signature Date
Name
Ms. Ghaidaa Thabit

Renal Transplant Coordinator

Name: Signature Date
Dr. Reem Alhameedi
Reviewed By Consultant Nurse, Deputy Nursing Director,
Dialysis and medical Ancillary Service
Name Signature Date
Prof. Jameela Kari
Reviewed By
Division Head, Pediatric Nephrologist
Name: Signature Date
Prof. Osama Safdar
Reviewed By
Pediatric Transplant Nephrologist
Name Signature Date
Dr. Abdulsalam Alsulami
Reviewed By
Consultant, Pediatric Infectious diseases
Name Signature Date
Dr. Faten Basnawi
Reviewed By
Consultant, Pediatric Infectious diseases
Date
Name
Signature
Dr. Ahmad Abduljabar
Reviewed By
Chairman of Radiology Department
Name Signature Date
Reviewed By Prof. Abdulaziz Boker

Chairman, Anesthesia and Critical Care

Department

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 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

Name Signature Date

Dr. Meshari Al-Aifan
Reviewed and
Endorsed By Chairman of Pediatrics Department
Name Signature Date
Reviewed and Dr. Ghadah Abdulla
Endorsed By Director of Nursing
Name Signature Date
Reviewed and Prof. Tariq A. Madani
Endorsed By
Chairman, Infectious Disease Unit
Name Signature Date
Reviewed and Prof. Abdulaziz Boker
Endorsed By
Medical Director
Name Signature Date
Mr. Hussam Albaz
Reviewed By
Director, Quality Management
Name Signature Date
Dr. Amre S. Hamdi
Approved By
Vice Dean University Hospital Director

9. ACCREDITATION COMPLIANCE:

Accreditation Body AC CBAHI

Meets the standards /measurable elements of ✓ ✓

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 King Abdulaziz University Hospital
Jeddah, Saudi Arabia

Policy Title: Policy Code: Version No.:

Kidney Transplantation IPP -PED-002 (1)

10. POLICY HISTORY:

Revision No. Code No. Date Remarks

Version No. (1) IPP-PED-002 New Policy

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