Renal Transplant

A renal transplant is where a kidney is transplanted into a patient with end-stage renal failure. It typically adds 10 years to life compared with just using dialysis and also significantly improves quality of life.

 

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 match fully, but the closer the match, the less likely there is to be organ rejection and the better the outcomes. Recipients can receive treatment to desensitise them to the donor HLA when there is a living donor.

 

Procedure

The patient’s own 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.

 

After The Renal Transplant

The new kidney will start functioning immediately.

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

  • Tacrolimus
  • Mycophenolate
  • Prednisolone

 

Other possible immunosuppressants:

  • Cyclosporine
  • Sirolimus
  • Azathioprine

 

TOM TIP: When examining a patient with a renal transplant, you can look particularly clever by looking for the side effects of particular immunosuppressant medications. 

  • Immunosuppressants often cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal)
  • Tacrolimus causes a tremor
  • Cyclosporine causes gum hypertrophy
  • Steroids cause features of Cushing’s syndrome

 

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, more severe and may involve unusual pathogens
  • Non-Hodgkin lymphoma
  • Skin cancer (particularly squamous cell carcinoma)

 

Unusual infections can occur secondary to immunosuppressant medication, such as:

  • Pneumocystis jiroveci pneumonia (PCP/PJP)
  • Cytomegalovirus (CMV)
  • Tuberculosis (TB)

 

Last updated May 2021
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