Download - 9 renal transplant
![Page 1: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/1.jpg)
Renal TransplantationRenal Transplantation
ByByMohamed Hassouna, MDMohamed Hassouna, MD
Professor of Urology, Alexandria Professor of Urology, Alexandria UniversityUniversity
![Page 2: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/2.jpg)
SELECTION FOR KIDNEY TRANSPLANT SELECTION FOR KIDNEY TRANSPLANT
- Diagnose the - Diagnose the primary diseaseprimary disease and its risk and its risk of recurrence in the kidney graft of recurrence in the kidney graft
- Rule out :- Rule out :-active invasive infection, -active invasive infection, - high probability of operative mortality- high probability of operative mortality
- noncompliance, - noncompliance, - active malignancy, - active malignancy,
![Page 3: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/3.jpg)
InfectionInfection Dental sepsis, pulmonary infectionDental sepsis, pulmonary infection
UTI should be inactive UTI should be inactive
Tuberculin skin test , TB, CMV, herpes simplex Tuberculin skin test , TB, CMV, herpes simplex virusvirus
![Page 4: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/4.jpg)
Active MalignancyActive Malignancy
To reduce the risk of cancer To reduce the risk of cancer recurrence, a waiting time of 2 to recurrence, a waiting time of 2 to 5 cancer-free years from the 5 cancer-free years from the time of the last cancer treatmenttime of the last cancer treatment
![Page 5: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/5.jpg)
Perioperative Morbidity or Perioperative Morbidity or MortalityMortality
- - Heart disease is the main cause of death after renal Heart disease is the main cause of death after renal
Tx Tx
- CVD, peptic ulcer, and pulmonary disease must be - CVD, peptic ulcer, and pulmonary disease must be detecteddetected
![Page 6: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/6.jpg)
Technical DifficultiesTechnical Difficulties
- to determine the suitability of the to determine the suitability of the Bladder for Ureteric anastomosis Bladder for Ureteric anastomosis
- to determine the necessity for to determine the necessity for pretransplantation nephrectomy:pretransplantation nephrectomy:
Polycystic, Pyonephrosis, Polycystic, Pyonephrosis, uncontrolled UTI, Uncontrolled uncontrolled UTI, Uncontrolled RenoVascular HTNRenoVascular HTN
- significant bladder residual urine- significant bladder residual urine
![Page 7: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/7.jpg)
DONOR SELECTIONDONOR SELECTION
-Absence of renal disease-Absence of renal disease- Absence of active infectionAbsence of active infection- Absence of transmissible Absence of transmissible
malignancy. malignancy. - Histocompatibility and ABO typingHistocompatibility and ABO typing
the living donor will have the living donor will have nearly nearly normal normal renal function after renal function after nephrectomy. nephrectomy.
![Page 8: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/8.jpg)
Living DONOR SELECTIONLiving DONOR SELECTION
CT angiographyCT angiography with IV contrast : with IV contrast :
- Satisfactorily excludes stone disease- Satisfactorily excludes stone disease
- Demonstrates renal and vascular - Demonstrates renal and vascular anatomy anatomy
- Defines the urinary collecting system- Defines the urinary collecting system
- With minimal donor morbidity- With minimal donor morbidity
- Reasonable expense- Reasonable expense
![Page 9: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/9.jpg)
Donor surgery Donor surgery
- Two teams at two close theaters- Two teams at two close theaters
- Warm ischemia time is limited to 30-- Warm ischemia time is limited to 30-40 minutes during surgery.40 minutes during surgery.
- Cut as long as possible renal artery Cut as long as possible renal artery and vein for better anastomosis.and vein for better anastomosis.
- Keep the ureter as long as possible.Keep the ureter as long as possible.
![Page 10: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/10.jpg)
![Page 11: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/11.jpg)
Simple Cold Storage of KidneysSimple Cold Storage of Kidneys
Cellular energy requirements Cellular energy requirements are significantly reduced by are significantly reduced by hypothermia hypothermia
This is done by surface cooling This is done by surface cooling or flushing with an ice cold or flushing with an ice cold solution followed by cold solution followed by cold storage. storage.
![Page 12: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/12.jpg)
RECIPIENT OPERATIONRECIPIENT OPERATION
In adults and children In adults and children (more than 20 kg)(more than 20 kg)
the kidney graft is usually the kidney graft is usually placed extraperitoneally in placed extraperitoneally in the iliac fossa by way of a the iliac fossa by way of a Gibson incision Gibson incision
![Page 13: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/13.jpg)
![Page 14: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/14.jpg)
RECIPIENT OPERATIONRECIPIENT OPERATIONVascular anastomosisVascular anastomosis
In adults:In adults:
Renal A. to Internal iliac A. or External Renal A. to Internal iliac A. or External Iliac A.Iliac A.
Renal V. toRenal V. to External Iliac V. External Iliac V. In children:In children:
Renal A. to aortaRenal A. to aorta
Renal V. to IVCRenal V. to IVC
- Ureteral anastomosis to the bladder- Ureteral anastomosis to the bladder
![Page 15: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/15.jpg)
![Page 16: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/16.jpg)
![Page 17: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/17.jpg)
Post-operative managementPost-operative management
Immunosuppressent drugs for lifeImmunosuppressent drugs for life Very ExpensiveVery Expensive Any infection is life threateningAny infection is life threatening Only 10% would live for 10 years. Only 10% would live for 10 years.
![Page 18: 9 renal transplant](https://reader033.vdocuments.us/reader033/viewer/2022061117/546638b6af79596f338b501e/html5/thumbnails/18.jpg)
Thank you