rinal transplantation نقل الكلوي.pptx

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1. Renal Transplantation By Mohammed Hamza Abd Zaid Mohamed Abd Al Khaleq

2. Definition "Renal transplantation is the surgical implantation of a human kidney from a compatible donor in a recipient

3. Indication End Stage Renal Disease (ESRD ) means irreversible loss of kidney function, requiring dialysis or transplantation for survival. Chronic Kidney Disease (CKD): Severe, irreversible kidney damage, usually with a glomerular filtration rate (GFR) less than 15 ml/min, often requiring permanent dialysis Serum creatinine level of greater than 8mg/dl.

4. Recipient Selection It is mainly done in end stage of kidney disease ARI. GFR below 15. Certain patients, particularly those with cardiovascular disease and diabetes mellitus, are considered high risk and must be carefully evaluated and then monitored closely after the transplantation It significantly improves both the quality of life and physiological function.

5. Contd... This approach is most advantageous for patient with diabetes, who have a much higher mortality. rate on dialysis than non diabetics Willing family members are evaluated for physical and mental health and screened for ABO blood group, tissue specific antigen, and human leukocyte antigen histocompatibility. A surgical procedure may be required before transplantation based on the result of recipient evaluation

6. Donor Sources Kidneys for transplantation may be obtained from Compatible blood type deceased (cadaver) donors. Blood relatives. Living donors (spouses, distant cousins ). Altruistic living donors who are known (friends) and unknown to the recipient.

7. Live Donor Extensive Donor is in good health and have no history of disease that would place them at risk for developing kidney failure or operative complications. Psychosocial and financial evaluations Cross matching

8. Contraindications: • Recent malignancy. • Active or chronic infection. • Severe irreversible extrarenal disease (e.g., inoperable cardiac disease, chronic lung disease, severe peripheral vascular disease). • Active autoimmune disease (e.g., HIV, hepatitis B and C). • Morbid obesity (BMI greater than 35). • Current substance abuse. • Inability to give informed consent or history of nonadherence to treatment regimens.

9. Preoperative Management (Pre-transplant): Evaluation : A complete physical examination is performed to detect any conditions that might cause complications. Tissue typing, blood typing, and antibody screening are essential to determine compatibility. Renal angiography may be used preoperatively to evaluate renal blood flow.

10. Infection Control The patient must be free of infection (e.g., gingival disease, dental caries) because postoperative medications will suppress the immune response, increasing the risk of infection.

11. Dialysis Hemodialysis is often performed the day before the scheduled transplantation to optimize the patient's physical status.

12. Procedure 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. A "hockey stick" incision is typically used, and there will be a "hockey stick" scar.

13. The Renal Transplant The new kidney will function immediately. Basiliximab is a monoclonal antibody targeting the interleukin-2 receptor on T-cells. Two doses are given after surgery to prevent acute rejection

14. Complications Complications relating to the transplant: Transplant rejection ( hyperacute , acute or chronic) Transplant failure Electrolyte imbalances

15. Complications Related To Immunosuppressants Ischaemic heart disease Type 2 diabetes (steroids) Infections are more likely, more severe and may involve unusual pathogens Non-Hodgkin lymphoma Skin cancer (particularly squamous cell carcinoma)

16. Nursing Care - Monitor vital signs, kidney function and lab results. - Prevent infection through hygiene, avoiding crowds, and wound care. - Manage medications by ensuring adherence and educating about side effects. - Care for surgical wounds with cleanliness and regular dressing changes. - Support nutrition with a low-sodium, balanced diet and adequate fluids. - Encourage moderate physical activity and rest. - Provide emotional support and counseling

17. Patient and family education: - Importance of medication adherence and timing. - Recognizing signs of infection, rejection, and complications. - Dietary restrictions and hydration guidance. - Wound care and hygiene practices. - Lifestyle changes and necessity of regular follow-up.