Renal Transplant

28/04/2013 by admin | Renal
  1. 2000 renal transplants / yr in UK
  2. Specific criteria must be met to be suitable for renal transplant:
    1. o Age <70yo
    2. o Must be HIV negative
    3. o Free of bacterial infection/malignancy
    4. o Have no severe cardiac disease
    5. o Must not have a renal disease that will recur
  3. Transplantation is limited by the availability of organs
  4. Often donated from brainstem dead patients, increasingly being taken from living donors (spouse)
    1. o Short term risks = operation, infection (due to heavy immunosuppression)
    2. o Long term = immunosuppression (=infection, malignancy – skin (x20 risk) and lymphoma (x20-50 risk), CVD/CVA (x20 risk), graft failure/rejection)
  5. Immunosuppression is usually by: prednisolone, azathioprine, mycophenolate, cyclosporin, tacrolimus.
  6. Common infections:
    1. o 0-1 month: post-op chest infections, pneumonia, UTIs, wound infections
    2. o 1-4 months: viral (CMV, VZV), fungal (aspergillus), bacterial (TB, listeria), parasitic (pneumocystis, toxoplasma)
    3. o 3-4 months: Cryptococcus, zoster, CMV retinitis, viral associated malignancy – lymphoma (EBV), Kaposi sarcoma (HHV-8).

 

Drug complications:

  1. Steroids can cause cushingoid features = HTN, tremor.
  1. Cyclosporin can = renal impairment.
  2. Azathioprine and mycophenolate can = neutropenia
  3. Survival of renal transplants at 1, 5, and 10 years is 90%, 70% and 55%
  4. 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.
  5. Obstruction diagnosed with USS
  6. Angiography can be used to show renal blood supply
  7. Pros: increased well being, less complications of CRF, long term survival benefit, pregnancy possible, cheaper
  8. Cons: risks of CVD, 5-10% annual graft failure rate, immunosuppression needed and so infection/malignancy, organ scarcity. 
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