Renal Transplant

Renal transplant is where a kidney is transplanted into the patient with end stage renal failure. It typically adds 10 years to life compared with just using dialysis.

Donor Matching

Patients and donor kidneys are matched based on the human leukocyte antigen (HLA) type A, B and C on chromosome 6. They don’t have to fully match. Recipients can receive treatment to desensitise them to the donor HLA when there is a living donor. The less they match, the more likely the transplant is to fail.

 

Procedure

The patient’s own kidneys are left in place. The donor kidney’s blood vessels are connected (anastomosed) with the patient’s pelvic vessels, usually the external iliac vessels. The donor kidney’s ureter is anastomosed directly with the patient’s bladder. The donor kidney is placed anterior in the abdomen and can usually be palpated in the iliac fossa area. They typically use a “hockey stick incision” and there will be a “hockey stick scar”.

 

Post Renal Transplant

The new kidney will start functioning immediately.

Patients will require life long immunosuppression to reduce the risk of transplant rejection. The usual immunosuppressant regime is:

  • Tacrolimus
  • Mycophenolate
  • Prednisolone

Other possible immunosuppressants:

  • Cyclosporine
  • Sirolimus
  • Azathioprine

 

Complications

Complications relating to the transplant:

  • Transplant rejection (hyperacute, acute and chronic)
  • Transplant failure
  • Electrolyte imbalances

Complications related to immunosuppressants:

  • Ischaemic heart disease
  • Type 2 diabetes (steroids)
  • Infections are more likely and more severe
  • Unusual infections can occur (PCP, CMV, PJP and TB)
  • Non-Hodgkin lymphoma
  • Skin cancer (particularly squamous cell carcinoma)

 

Last updated April 2019
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