KIDNEY TRANSPLANTATI

ONBy:

Mohammed Ahmed Rajab

INTRODUCTION

• Kidney transplant provides better long-term survival and improved quality oflife compared to dialysis.

• Patient survival and transplant successhas been progressively improving overthe years.

• Kidney transplant is the treatment ofchoice for End Stage Renal Disease(ESRD) in eligible patients.

History

1902 - The first successful experimental kidney transplants were performed at the Vienna Medical School in Austria with animals.

1909 - The first kidney transplant experiments were performed in humans in France using animal kidneys.

1933 - The first human-to-human kidney transplant was performed.

Unknown to doctors at the time, there were mismatches in donor and recipient blood groups and the donor kidney never functioned.

1940’s - Sir Peter Medawar at the University of London experimented with the immunologic basis of organ rejection.

Early 1950’s - Cortisone-like medications were used to suppress the human body’s self-defense system (immune system), resulting in some kidney transplant success.

THE PERFECT MATCH

1954 - Joseph E. Murray and his colleagues at Peter Bent Brigham Hospital in Boston performed the first truly successful kidney transplant from one twin to another. This was done without any immunosuppressive medication.

INDICATION

• ESRD GFR less than 15ml/L.

• MALIGNANCY.

• HYPERTENSION.

• DIABETES MELLITUS.

• GENETIC DISEASES- polycystic kidney diseases.

• METABOLIC DISORDERS.

• Chronic renal failure (CRF).

CONTRAINDICATIONS

• CARDIAC AND PULMONARY INSUFFICIENCY.

• HEPATIC DISEASES.

• CONCURRENT TOBACCO USE AND MORBID OBESITY

PUTS THE PATIENT AT RISK FOR SURGERY.

• HIV.

BENEFITS AND RISKS

• Benefits:

– Significantly reduced risk of mortality.

• Life expectancy can triple.

– Reduced risk of heart attack, stroke, heart failure.

– Reduced infection-related hospitalization.

– Improved quality of life.

– More likely to stay employed.

BENEFITS AND RISKS

• Risks:

– Acute rejection or failure (less with current meds).

– Anti-rejection medication effects:• Infection.

• Some malignancies, ex/skin cancer.

• Increased risk of diabetes, high blood pressure, high cholesterol.

– Graft loss over time.

• Overall in eligible candidates, the benefits far outweigh the risks.

EARLY TRANSPLANT

• More benefit to early transplant once dialysis started.

• Improved graft survival if transplanted in first 6 months on dialysis and improved patient survival if ≤ 1 year.

• Better long-term graft function the earlier transplant occurs.

PREEMPTIVE TRANSPLANT (TRANSPLANT BEFORE DIALYSIS STARTED)

• MANY benefits including:

– Decreased rejection rates by 25%.

– Improved graft survival long-term.

– Improved patient survival.

– Less delayed graft function.

– Decreased overall hospitalizations.

LIVING DONORS

EVALUATE DONORS ON PHYSICAL, MEDICAL AND PSYCHOLOGICAL

GROUNDS.

ASSURE THE PATIENT THAT THERE WILL BE NO LONG TERM HARM TO

DONOR.

IN SOME CASES MALE LIVING DONOR MAY DEVELOP A HYDROCELE

ON THE SCROTUM ON THE SIDE OF NEPHRECTOMY.

LIVE DONOR PROCEDURE ARE MOSTLY LAPROSCOPIC,HENCE LESS

PAINFULL, LESS SCARRING AND FASTER RECOVERY.

DESEASED DONORS

BRAIN DEAD (BD) DONORS.

DONATION AFTER CARDIAC DEATH.

BRAIN DEAD OR “ BEATING HEART” donors are considered dead

but the pumping heart continues to perfuse the other organs.

DONATION AFTER CARDIAC DEATH are elective donation of organ

by patient himself or the relatives to withdraw life support as they

have slim chances of survival.

COMPATIBILITY

THE PATIENT HAS TO BE ABO COMPATIBLE.

THE RECEPIENT SHOULD SHARE AS MANY AS HLA ANTIGENS

AND MINOR ANTIGENS AS POSSIBLE.

IMMUNOSUPRESSENT DRUGS ARE GIVEN TO PREVENT ANTI

BODY REACTIONS.

PERFORM ANTI BODY TEST ON POTENTIAL RECEPIENT.

POST OPERATION

TIME- 3 HRS APPROX.

DONOR KIDNEY WILL BE PLACED IN THE LOWER ABDOMEN.

ARTERIES,VIENS FROM THE RECIPIENTS BODY IS CONNECTED TO

NEW KIDNEY.

FINAL STEP IIS TO CONNECT THE URETER TO NEW KIDNEY.

NEW KIDNEY STARTS FUNCTIONING IMMEDIATELY, LIVING KIDNEY

TAKE 3-5DAYS AND CADEVERIC KIDNEY TAKE UPTO 7-15 DAYS.

POST OPERATIVE DIET

AVOID GRAPES POMEGRANATE AND GREEN TEA

PRODUCTS.

MONITOR FOR KIDNEY REJECTION.

COMPLICATION

TRANSPLANT RREJECTION.

INFECTION AND SEPSIS.

POST TRANSPLANT LYMPH PROLIFERATIVE DISORDER.

ELECTROLYTE IMBALANCES.

IATRAGENIC SIDE EFFECTS.

PROGNOSIS

KIDNEY TRANSPLANTATION IS A LIFE EXTENDING

PROCEDURE. A PATIENT MAY LIVE UPTO 15 YRS LONGER

WITH A KIDNEY TRANSPLANT THAN IF KEPT ON A DIALYSIS.

PATIENTS WILL HAVE MORE ENERGY, A LES RESTRICTED

DIET, AND FEWER COMPLICATIONS WITH A KIDNEY

TRANSPLANT.

SUMMARYThe best treatment for ESRD is transplant.

Kidney transplant saves lives, improves quality of life,and saves costs.

Living kidney donation is safe and provides betteroutcomes.

Preemptive transplant is best but also advantage toearly transplant once on dialysis.

THANK YOU