Table of Contents
Renal transplant examination
- Perform renal exam (see renal examination notes)
- Look for:
- Aetiology: fingertip capillary glucose monitoring marks (diabetes), flank masses (PKD), butterfly rash (SLE), hearing aid (Alport syndrome), collapsed nasal bridge (granulomatosis with polyangiitis), sternotomy (renovascular disease)
- Previous renal replacement therapy: AV fistula, central line scars, peritoneal dialysis scars
- Graft functionality: active marks in AV fistula, fluid retention, anaemia, uraemia
- Immunosuppression side effects: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression)
Indications
- End stage chronic kidney disease (GFR <15ml/minute)
- Commonest causes
- Diabetes mellitus
- Polycystic kidney disease
- Hypertension
- Autoimmune glomerulonephritis
Contraindications
- Cardiac/pulmonary insufficiency
- Hepatic disease
- Cancer
- Active infection
Procedure
- Pre-operative donor and recipient screening: HLA, cross-match, infection screen (HIV, hepatitis B/C, CMV/EBV, human T-lymphotropic virus, Varicella zoster virus, syphilis, Toxoplasma)
- Additional donor screening: renal ultrasound, blood tests (U&Es, FBC, LFTs, fasting glucose, coagulation screen), urine tests (dipstick, MC&S, protein-creatinine ratio)
- Remove donor kidney (loin scar)
- Anastomose in recipient’s iliac fossa (Rutherford-Morrison scar)
- Renal vein to external iliac vein
- Renal artery to external iliac artery
Complications
- Rejection
- Hyper-acute rejection (immediate): thrombosis and occlusion of graft vessels during surgery
- Acute rejection (weeks to months): deterioration in renal function ± flu-like symptoms and graft tenderness
- Chronic rejection (months to years): gradual deterioration in renal function
- Immunosuppression complications
- Opportunistic infections and sepsis
- EBV-mediated post-transplant lymphoproliferative disorder
- Other
- UTIs
- Renal graft thrombosis
Test your knowledge
How long does a renal graft last?
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What affects this time?
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Which immunosuppressive agents are usually given post-transplant?
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