KIDNEY

TRANSPLANTATION

Mahesh Raj Sigdel

August 1st, 2019
What is transplantation?
Place of Kidney transplantation in the
management of ESKD patients

1. Quality of life
2. Longevity
3. Cost
Basic understanding:

The anti rejection medicines have to be taken for life

and the patient needs to be on life long follow up
When do you plan / suggest kidney
transplantation?

CKD 5

Pre-emptive kidney transplantation

Transplant Terminology
Landmarks in
Kidney
Transplantation

Concept of Brain Death

Issues / challenges in transplantation

1. Technical: organ harvesting, storage,

perfusion, implantation/grafting, reperfusion
2. Immunological
3. Legal
4. Ethical: organ sharing, wait list management
5. Issues of availability of donor organs
The evolution of the immune response after kidney transplantation. CTL, cytotoxic T cell; IFN, interferon; MHC, major histocompatibility complex; TCR,
T-cell receptor; TNF, tumor necrosis factor.
Landmarks in immunosuppression
1. Total-body irradiation - sublethal irradiation
2. Steroids
3. Azathioprine (Imuran)
4. Antithymocyte globulin
5. Cyclosporine
6. Tacrolimus (Prograf)
7. Mycophenolate mofetil
Who are the kidney donors?
1. Live
2. Deceased
Recipient work up
Any contraindication eg active infection or malignancy

Psychological stability

Compliance / adherence issues

Function of the urinary tract

Vaccination
Donor work up
Legal issues

 Functioning of different organ systems

Presence of diabetes

Perioperative and the long-term risk to the donor especially risk of kidney
disease later

Donor vessels
Transplant work up in progress
Legal clearance
Clearance from different departments
Cross matching negative
Appropriateness of the donor anatomy
Induction immunosuppression for the recipient
Transplant procedure
Continued immunosuppression for the recipient
Long term follow up of the donor and the recipient
Donor follow up

Overall health

Kidney function
Typical drugs a kidney transplant recipient
is on:
Prednisolone
Tacrolimus
Mycophenolate mofetil
Drugs for infection prophylaxis, in the period
early after transplantation: cotrimoxazole,
valganciclovir
Others
Renal allograft recipient follow up
General health
Renal graft function
Adherence
Rejection
Immunosuppression drug levels
Use of any medicine that could affect the immunosuppressant
drug level
Infection
malignancy
AKI in the renal transplant recipient
(renal allograft recipient)
All the causes of AKI in the population

The specific dominant causes depend on the timing after transplantation

Priority considerations:
Immunosuppressant drug toxicity
Rejection (adherence to the prescription)
Infection
Obstruction
Thank
you !!!