Share your insights

Help us by sharing what content you've recieved in your exams


Renal transplant

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 Β± 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?

Oops! This section is restricted to members. Click here to signup!

What affects this time?

Oops! This section is restricted to members. Click here to signup!

Which immunosuppressive agents are usually given post-transplant?

Oops! This section is restricted to members. Click here to signup!

Try an OSCE station

  1. Renal transplant
  2. Lots more stations here!

No comments yet πŸ˜‰

Leave a Reply