High Beam Global - Renal Transplantation | Kidney Transplantation | Chronic Kidney Disease

RENAL TRANSPLANTATION

© High Beam Global, 2010. All Rights Reserved - Privileged and

HISTORY

Autotransplantation wellestablished
2nd century BC: Sushruta pioneered skin grafting for rhinoplasty

© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential

Privileged and . All Rights Reserved . 2010. Murray performed the first successful kidney transplant Donor and recipient identical twins © High Beam Global.HISTORY 1933: Yu Yu Voronoy of the Soviet Union performed the first human-to-human kidney transplant 1954: Joseph E.

2010. All Rights Reserved .Privileged and .HISTORY Early attempts at immunosuppression •Whole-body X-irradiation • Nitrogen mustard • 6-mercaptopurine 1957: George Hitchings and Gertrude Elion modify 6-MP to produce azathioprine 1963: Thomas Starzl observed that large doses of corticosteroids can reverse rejection episodes and stabilize allograft function © High Beam Global.

Basics of Transplantation Common causes of ESRD: . 2010. All Rights Reserved Privileged and Confidential . • ESRD on Renal Replacement Therapy (RRT) ie Hemodialysis or Peritoneal Dialysis Chronic Renal Insufficiency approaching the need for RTT”pre-emptive” transplant – HTN – DM – PCKD – IgA Nephropathy – Congenital abnormalities Renal Dysgenesis Obstructive Uropathy – FSGS – Lupus • • © High Beam Global.

RENAL BLOOD FLOW Cardiac out put Mean Arterial Pressure “Effective Circulating Volume” Intrarenal Autoregulation Normal RBF/RPF Renal Perfusion Pressure GFR.Privileged and Confidential . All Rights Reserved . FF © High Beam Global. 2010.

All Rights Reserved .0 0 0 20 40 60 80 100 120 140 160 180 GFR (ml/min per 1.0 6.Privileged and Confidential .0 5.0 3.0 8.CREATININE IN ESRD 9.RELATIONSHIP BETWEEN GFR AND S.0 n nt aer C m r e S i i u )l d g m / ( 4.0 2.0 7. 2010.0 1.73m2) © High Beam Global.

All Rights Reserved .Anatomy of Renal Transplantation © High Beam Global. 2010.Privileged and Confidential .

Privileged and Confidential . 2010.SOURCES OF KIDNEY Living Kidney Donor (LKD) • – Sibling • – Parent • – Child • – Spouse/partner Deceased Donors • – Brain Dead • – Donation after Cardiac Death (DCD) © High Beam Global. All Rights Reserved .

Stress. EBV. PSA. HIV. All Rights Reserved . cardiology consult Cancer screening – Pap. Colonoscopy Dental clearance SW evaluation • • Surgeon or other transplant physician consultation Other possible tests/consultations • • • • • • • • • • – – – – – – – – – – Lower extremity dopplers Carotid dopplers CT scans PFT’s Cystogram TB test Endocrine Infectious Disease Hepatology Psychiatric evaluation © High Beam Global. HTLV) – ABO x2 – HLA’s Chest X-ray Cardiac Clearance – EKG.Privileged and Confidential . Serologies (Hepatitis B and C. CMP.EVALUATION PROCESS Labs: • • • • • • • • • • • • • • – CBC. Angio. PT/PTT. LFT. 2010. Mammo. Echo. CMV.

Privileged and Confidential .PRE TRANSPLANT EVALUTION • • • • • • • Histocompatibility Laboratory Tests Blood Typing Tissue Typing Crossmatch Testing Panel Reactive Antibody (PRA) © High Beam Global. 2010. All Rights Reserved .

All Rights Reserved .BENEFITS OF TRANSPLANT • Life expectancy • Cardiovascular benefits • Quality of life © High Beam Global. 2010.Privileged and Confidential .

2010.Privileged and Confidential . All Rights Reserved .LIFE EXPECTANCY © High Beam Global.

Privileged and Confidential . 2010. All Rights Reserved .CARDIOVASCULAR BENEFITS © High Beam Global.

• Fertility returns. All Rights Reserved .Privileged and Confidential . © High Beam Global. 2010. • Uremic complications more fully reversed.QUALITY OF LIFE • Numerous studies have detailed improved quality of life. physical and emotional well-being and ability to return to work higher in transplant recipients. • Life satisfaction.

2010.DIAGNOSIS OF REJECTION Clinical signs: • Malaise • Fever • Oliguria • Hypertension • Graft tenderness Diagnosis hinges on serial creatinine measurements • Elevation of 20% over baseline • triggers further evaluation • Rule out non-immunologic causes • Ultrasonography • Renal scanning • Percutaneous biopsy © High Beam Global. All Rights Reserved .Privileged and Confidential .

interstitial. vascular. 2010.DIAGNOSIS OF REJECTION Banff criteria • Interpretation of renal biopsy specimens for diagnosing rejection have been greatly facilitated and standardized • Based on scores for glomerular. All Rights Reserved .Privileged and Confidential . and tubular lesions • Has been shown to have clinical relevance when predicting rejection reversal and may prove useful for choosing first-line therapy of rejection episodes © High Beam Global.

2010.Privileged and Confidential .BENFF CRITERIA Grade 1: Moderate interstitial mononuclear inflammation affecting 2550% of the sampled parenchyma © High Beam Global. All Rights Reserved .

All Rights Reserved .BENFF CRITERIA Grade 2: Moderate interstitial mononuclear infiltrate involving 26-50% of the renal parenchyma © High Beam Global. 2010.Privileged and Confidential .

BENFF CRITERIA Grade 3: severe transmural arteritis and/or transmural fibrinoid change and necrosis of smooth muscle cells © High Beam Global. 2010.Privileged and Confidential . All Rights Reserved .

All Rights Reserved .Privileged and Confidential .DIAGNOSIS OF REJECTION Biochemical markers • Various markers reported to correlate with rejection ß2-microglobulin1 Neopterin2 PCR amplification of messenger RNA in urinary sediment3 • • • Perforin mRNA Granzyme B mRNA Strong predictive value for acute rejection © High Beam Global. 2010.

Privileged and Confidential . All Rights Reserved . 2010.IMMUNOSUPPRESIVE MEDICATION © High Beam Global.

All Rights Reserved .COMMON COMPLICATION OF TRANSPLANTATION  Early complications  Surgical complications  Delayed or slow graft function  Lymphocele Acute rejection  Acute cellular rejection  Antibody-mediated rejection Infectious complications  Cytomegalovirus  BK virus  Others Malignancy Chronic allograft dysfunction © High Beam Global. 2010.Privileged and Confidential     .

...Privileged and Confidential .OUR NETWORK • The transplant programs at HIGH BEAM GLOBAL India partner hospital have earned a number of distinctions in the field. © High Beam Global. 2010. including the #1 ranking in the country in both patient and graft survival for kidney transplant.. All Rights Reserved .

© High Beam Global. All Rights Reserved .. 2010.OUR NETWORK FACILITIES • Liver Transplantation for children and adults with acute and chronic liver failure /cirrhosis • Living related Liver transplant and Cadaveric transplant • Pediatric hepatology service including transplant and biliary surgery • Adult Hepatology and Gastroenterology • Renal Transplantation in adults and children including Lap Donor Nephrectomy • Complex vascular and peritoneal access procedures • Complex Hepatobiliary Surgery..Privileged and Confidential .

Privileged and Confidential . 2010. All Rights Reserved .CONCLUSION • Organ transplantation induces a fundamentally abnormal physiologic state • Steady improvement has been made in both prevention and treatment of organ rejection • The potential for further improvement – both incremental and revolutionary – is great © High Beam Global.

Gurgaon.Contact Us High Beam Global 209. All Rights Reserved .highbeamglobal. Phase – 1.com Web address: www.Privileged and . Udyog Vihar.chauhan@highbeamglobal. Phone: +91-124-4824560 Fax: +91-124-4824550 E-mail:Tejasvee. 2010.com © High Beam Global.

Thank you for considering us © High Beam Global.Privileged and . 2010. All Rights Reserved .

Sign up to vote on this title
UsefulNot useful