- 2000 renal transplants / yr in UK
- Specific criteria must be met to be suitable for renal transplant:
- o Age <70yo
- o Must be HIV negative
- o Free of bacterial infection/malignancy
- o Have no severe cardiac disease
- o Must not have a renal disease that will recur
- Transplantation is limited by the availability of organs
- Often donated from brainstem dead patients, increasingly being taken from living donors (spouse)
- o Short term risks = operation, infection (due to heavy immunosuppression)
- o Long term = immunosuppression (=infection, malignancy – skin (x20 risk) and lymphoma (x20-50 risk), CVD/CVA (x20 risk), graft failure/rejection)
- Immunosuppression is usually by: prednisolone, azathioprine, mycophenolate, cyclosporin, tacrolimus.
- Common infections:
- o 0-1 month: post-op chest infections, pneumonia, UTIs, wound infections
- o 1-4 months: viral (CMV, VZV), fungal (aspergillus), bacterial (TB, listeria), parasitic (pneumocystis, toxoplasma)
- o 3-4 months: Cryptococcus, zoster, CMV retinitis, viral associated malignancy – lymphoma (EBV), Kaposi sarcoma (HHV-8).
- Steroids can cause cushingoid features = HTN, tremor.
- Cyclosporin can = renal impairment.
- Azathioprine and mycophenolate can = neutropenia
- Survival of renal transplants at 1, 5, and 10 years is 90%, 70% and 55%
- Success of transplant is related to serum creatinine levels. Any sudden increase – Ix for rejection, cyclosporine toxicity, renal vasculature changes, or obstruction to urine flow. Rejection is usually diagnosed with renal biopsy and is treated with high dose methylprednisolone or anti-T-cell antibodies.
- Obstruction diagnosed with USS
- Angiography can be used to show renal blood supply
- Pros: increased well being, less complications of CRF, long term survival benefit, pregnancy possible, cheaper
- Cons: risks of CVD, 5-10% annual graft failure rate, immunosuppression needed and so infection/malignancy, organ scarcity.