Renal Transplant

• A renal transplant is where a kidney is transplanted into a patient with end-stage renal failure.
• A renal transplant typically adds ten years to life compared to just using dialysis and significantly improves quality of life.
• Patient and donor kidneys are matched based on the human leukocyte antigen (HLA) type A, B and C on chromosome 6.
• The closer the match between the patient and donor kidneys, the less likely there is organ rejection and the better the outcomes.
• Recipients can receive treatment to desensitise them to the donor HLA in preparation for a transplant from a living donor.
• During a renal transplant, the patient’s kidneys are left in place.
• The donor kidney blood vessels are connected (anastomosed) with the pelvic vessels, usually the external iliac vessels.
• The ureter of the donor kidney is anastomosed directly with the bladder.
• The donor kidney is placed anteriorly in the abdomen and can usually be palpated in the iliac fossa area.
• Basiliximab is a monoclonal antibody targeting the interleukin-2 receptor on T-cells
• There are various options and combinations of: Tacrolimus Mycophenolate Ciclosporin Azathioprine Prednisolone
• Tuberculosis (TB)
• Steroids cause features of Cushing’s syndrome
• Complications relating to the transplant: Transplant rejection (hyperacute, acute or chronic)
• When examining a patient with a renal transplant, you can look particularly clever by looking for the side effects of particular immunosuppressant medications
• A “ hockey stick ” incision is typically used, and there will be a “ hockey stick ” scar
• Infections are more likely, more severe and may involve unusual pathogens
• Patients require life-long immunosuppression to reduce the risk of transplant rejection
• Tacrolimus causes a tremor
• Immunosuppressants cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal)
• After The Renal Transplant The new kidney will function immediately
• Complications related to immunosuppressants: Ischaemic heart disease
• Type 2 diabetes (steroids)
• Unusual infections can occur secondary to immunosuppressant medication, such as: Pneumocystis jiroveci pneumonia (PCP/PJP)
• Cytomegalovirus (CMV)
• Skin cancer (particularly squamous cell carcinoma)
• Cyclosporine causes gum hypertrophy
• Non-Hodgkin lymphoma
• Two doses are given after surgery to prevent acute rejection