Table of Contents Renal transplant examinationIndicationsContraindicationsProcedure Complications Test your knowledgeTry an OSCE station 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 scarsGraft functionality: active marks in AV fistula, fluid retention, anaemia, uraemiaImmunosuppression side effects: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression) Renal transplant, AV fistula, PD scarsArteriovenous fistula Indications End stage chronic kidney disease (GFR <15ml/minute)Commonest causesDiabetes mellitusPolycystic kidney diseaseHypertensionAutoimmune glomerulonephritis Contraindications Cardiac/pulmonary insufficiencyHepatic diseaseCancerActive 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 veinRenal artery to external iliac artery Complications RejectionHyper-acute rejection (immediate): thrombosis and occlusion of graft vessels during surgeryAcute rejection (weeks to months): deterioration in renal function ± flu-like symptoms and graft tendernessChronic rejection (months to years): gradual deterioration in renal functionImmunosuppression complicationsOpportunistic infections and sepsisEBV-mediated post-transplant lymphoproliferative disorderOtherUTIsRenal graft thrombosis Test your knowledge How long does a renal graft last? Oops! This section is restricted to members. What affects this time? Oops! This section is restricted to members. Which immunosuppressive agents are usually given post-transplant? Oops! This section is restricted to members. Try an OSCE station Renal transplantLots more stations here!