renal transplantation from living and deceased donor

Question 1

renal transplantation is

Answer 1

the most common form of organ transplantation

Question 2

matching donor to recipient

Answer 2

• ABO compatibility: Donor & recipient must be ABO compatible.
• Hyper-acute rejection occurs in ABO incompatible patients.
• HLA typing:
• A favorable match is < 1 mis-match for HLA-A, HLA-B & no mismatches for HLA-DR.

• Children are given priority.

Question 3

Technique of transplantation:

Answer 3

The kidney is placed, non-anatomically, into the iliac fossa using an extra peritoneal approach.
• The renal vessels are anastomosed to external iliac vessels.
• The ureter is anastomosed to urinary bladder.
• The ureter is occasionally stented.
• Preoperative native nephrectomy is only occasionally needed for continued / recurrent urinary infection, tuberculosis of the kidney / massive polycystic kidney disease.

Question 4

post op care

Answer 4

Early management is to maintain a balance between adequate renal perfusion & blood pressure control.
• Graft function is monitored by urea, creatinine & creatinine clearance.
• Oliguria / polyuria are common early after transplantation, indications of ischemic injury prior to organ harvest / prolonged, cold ischemic time.
• Biopsy to confirm rejection is done percutaneously.

Question 5

complications

Answer 5

• Infection.
• Rejection.
• Renal vein / artery thrombosis may result in kidney loss.
• Ureteric stenosis: treated by ureteroplasty with stenting / surgery.
• Urinary leak requires urgent surgical repair.
• Lymphocele (collection of lymphatic fluid) is managed by percutaneous drainage / Marsupialization into the peritoneum.
There is a better survival rate, after transplant from living donor.