Kidney Transplantation

simple presentation about kidney transplantation

1. KIDNEY TRANSPLANTATION By: Mohammed Ahmed Rajab

2. Introduction Kidney transplant provides better long-term survival and improved quality of life compared to dialysis. Patient survival and transplant success has been progressively improving over the years. Kidney transplant is the treatment of choice for End Stage Renal Disease (ESRD) in eligible patients.

3. History 1902 - The first successful experimental kidney transplants were performed at the Vienna Medical School in Austria with animals. 1909 - The first kidney transplant experiments were performed in humans in France using animal kidneys. 1933 - The first human-to-human kidney transplant was performed. Unknown to doctors at the time, there were mismatches in donor and recipient blood groups and the donor kidney never functioned. 1940’s - Sir Peter Medawar at the University of London experimented with the immunologic basis of organ rejection. Early 1950’s - Cortisone-like medications were used to suppress the human body’s self-defense system (immune system), resulting in some kidney transplant success .

4. The Perfect Match 1954 - Joseph E. Murray and his colleagues at Peter Bent Brigham Hospital in Boston performed the first truly successful kidney transplant from one twin to another.  This was done without any immunosuppressive medication .

5. INDICATION ESRD GFR less than 15ml/L. MALIGNANCY. HYPERTENSION. DIABETES MELLITUS. GENETIC DISEASES- polycystic kidney diseases. METABOLIC DISORDERS. Chronic renal failure (CRF ).

6. CONTRAINDICATIONS CARDIAC AND PULMONARY INSUFFICIENCY. HEPATIC DISEASES. CONCURRENT TOBACCO USE AND MORBID OBESITY PUTS THE PATIENT AT RISK FOR SURGERY. HIV .

7. Benefits and risks Benefits: Significantly reduced risk of mortality. Life expectancy can triple. Reduced risk of heart attack, stroke, heart failure. Reduced infection-related hospitalization. Improved quality of life. More likely to stay employed .

8. Benefits and risks Risks: Acute rejection or failure (less with current meds). Anti-rejection medication effects: Infection. Some malignancies, ex/skin cancer. Increased risk of diabetes, high blood pressure, high cholesterol. Graft loss over time. Overall in eligible candidates, the benefits far outweigh the risks.

9. Early transplant More benefit to early transplant once dialysis started. Improved graft survival if transplanted in first 6 months on dialysis and improved patient survival if ≤ 1 year. Better long-term graft function the earlier transplant occurs.

10. Preemptive transplant (transplant before dialysis started) MANY benefits including: Decreased rejection rates by 25 %. Improved graft survival long-term. Improved patient survival. Less delayed graft function. Decreased overall hospitalizations.

11. LIVING DONORS EVALUATE DONORS ON PHYSICAL , MEDICAL AND PSYCHOLOGICAL GROUNDS. ASSURE THE PATIENT THAT THERE WILL BE NO LONG TERM HARM TO DONOR. IN SOME CASES MALE LIVING DONOR MAY DEVELOP A HYDROCELE ON THE SCROTUM ON THE SIDE OF NEPHRECTOMY. LIVE DONOR PROCEDURE ARE MOSTLY LAPROSCOPIC,HENCE LESS PAINFULL , LESS SCARRING AND FASTER RECOVERY.

12. DESEASED DONORS BRAIN DEAD (BD) DONORS. DONATION AFTER CARDIAC DEATH. BRAIN DEAD OR “ BEATING HEART” donors are considered dead but the pumping heart continues to perfuse the other organs. DONATION AFTER CARDIAC DEATH are elective donation of organ by patient himself or the relatives to withdraw life support as they have slim chances of survival.

13. COMPATIBILITY THE PATIENT HAS TO BE ABO COMPATIBLE. THE RECEPIENT SHOULD SHARE AS MANY AS HLA ANTIGENS AND MINOR ANTIGENS AS POSSIBLE. IMMUNOSUPRESSENT DRUGS ARE GIVEN TO PREVENT ANTI BODY REACTIONS. PERFORM ANTI BODY TEST ON POTENTIAL RECEPIENT.

14. POST OPERATION TIME- 3 HRS APPROX. DONOR KIDNEY WILL BE PLACED IN THE LOWER ABDOMEN. ARTERIES,VIENS FROM THE RECIPIENTS BODY IS CONNECTED TO NEW KIDNEY. FINAL STEP IIS TO CONNECT THE URETER TO NEW KIDNEY. NEW KIDNEY STARTS FUNCTIONING IMMEDIATELY, LIVING KIDNEY TAKE 3-5DAYS AND CADEVERIC KIDNEY TAKE UPTO 7-15 DAYS.

15. POST OPERATIVE DIET AVOID GRAPES POMEGRANATE AND GREEN TEA PRODUCTS. MONITOR FOR KIDNEY REJECTION.

16. COMPLICATION TRANSPLANT RREJECTION. INFECTION AND SEPSIS. POST TRANSPLANT LYMPH PROLIFERATIVE DISORDER. ELECTROLYTE IMBALANCES. IATRAGENIC SIDE EFFECTS.

17. PROGNOSIS KIDNEY TRANSPLANTATION IS A LIFE EXTENDING PROCEDURE. A PATIENT MAY LIVE UPTO 15 YRS LONGER WITH A KIDNEY TRANSPLANT THAN IF KEPT ON A DIALYSIS. PATIENTS WILL HAVE MORE ENERGY, A LES RESTRICTED DIET, AND FEWER COMPLICATIONS WITH A KIDNEY TRANSPLANT.

18. Summary The best treatment for ESRD is transplant. Kidney transplant saves lives, improves quality of life, and saves costs. Living kidney donation is safe and provides better outcomes. Preemptive transplant is best but also advantage to early transplant once on dialysis.

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