RENAL TRANSPLANT

1) STEPS INVOLVED IN KIDNEY TRANSPLANTATION

1. Evaluate if you are healthy enough to receive a kidney transplant.

2. Prepare you for the operation.
3. Refer you to the Transplant Department at Beaumont Hospital.
4. You should be listed on the transplant waiting pool.
5. Find a suitable kidney for you.
6. Perform the kidney transplant operation.
7. Help you stay healthy after your kidney transplant.

2) TESTS THAT WILL BE REQUIRED BEFORE TRANSPLANT

** The tests that will be required will depend on a number of factors, including
your age and cause of renal disease.

Blood tests to establish your tissue type, blood group, tests for
Hepatitis B, C and HIV (AIDS test) and other viruses.
Chest x-ray.
ECG.
Cardiac Echo Scan.
Abdominal ultrasound scan.
Dental evaluation (by your own dentist).
Smear test (for women).
Prostate test (for men).
Older patients, patients hoping to receive a second transplant, or
patients with diabetes will also require a coronary angiogram.
You might also require more specialised tests relating to your
bladder or other organ systems, as decided by your nephrologist.

4) POST TRANSPLANT MEDICATION

5) TRANSPLANT COMPLICATIONS

a) Delayed Graft Function Sleepy Kidney

The functioning of your kidney transplant might be delayed, causing a need for
dialysis until the kidney wakes up. Delayed function might last from several days
to several weeks.

b) Wound Problems

c) Dehydration
Symtoms : Thirst, dry skin, dizziness, feeling light-headed, decrease urine output,
dark urine, headache, hunger and weight loss.

d) Infection
Most common : UTI
Bacterial, (S.aureus)
Virus (CMV, HSV 1, HSV 2)
Fungal (most common candida causing oral thrush)

e) Rejection
3 types of rejection:
Hyper acute rejection happens very suddenly, usually during the
transplant surgery or the first few hours after. This form of rejection is,
thankfully, rare due to careful tissue type matching, but is very difficult
to treat.

Acute rejection is the most common kind and develops over a

short period of time, a few days or weeks. The risk is highest during
the first 2 to 3 months, but can also happen a year or more after
transplant.

Chronic rejection is a process that occurs slowly and over a long

period of time. It may begin immediately after the transplant, but the
visible signs of chronic rejection are rarely seen within the first year. It
is not known why it occurs, but the risk of chronic rejection is reduced
when patients continue to take all their medications exactly as
prescribed.

Warning signs of rejection can include:

Flu-like symptoms, such as chills, headache, fatigue, dizziness or vomiting.
High temperature over 38C (You should have a thermometer at
home, as an increase in temperature is an important sign of possible
rejection or infection).
Any signs of fluid retention, such as rapid weight gain or swelling of
the ankles.
Pain or redness over the transplant site.
Reduction in the amount of urine you are producing.
Treating Rejection

Mild to moderate episode of rejection : 3 to 5 day course of Methylprednisolone

(steroid) usually can be treated successfully

Severe episode of rejection : Immunosuppression such as ATG

Antibody mediated rejection : Treated with a course of plasmapheresis.

f) Skin Cancer (BCC, SCC, melanoma)

g) All SE of steroids that you can think off

6) CAUSES OF RISE CREATININE (normal 100-120 micmol/L) Cr level need

to be measured everytime pt come to clinic
A mechanical problem with the flow of urine from the bladder or
kidney.
High Prograf or Cyclosporine level.
Acute Transplant rejection.
Chronic Transplant Rejection.
A viral infection called Polyoma virus.
Recurrence of original disease in the transplanted kidney.
Transplant artery narrowing (stenosis).

7) VACCINATION
VACCINATION AND KIDNEY TRANSPLANT

Routine Vaccinations Travel Vaccinations

Measles, mumps rubella (As appropirate for area your

travelling to)

Haemophylis Typhoid vaccine

Mengococcal vacine Hepatitis A and B

Annual Influenza vaccine Rabies

Pneumococcal vaccine every Diptheria

5 years

Human papiloma virus Yellow Fever

vaccine
(Girls under 16)
Tetanus vaccine Cholera

Inactivated Polio vaccine

(salk)

VACCINATIONS TO AVOID AFTER KIDNEY

TRANSPLANTATION

Measles, mumps and rubella

BCG

Oral Polio

Oral Typhoid

Small Pox, Yellow fever

Chickenpox

8. VASCULAR SUPPLY OF TRANSPLANTED KIDNEY

Donor renal A is anastomosed to either internal or external iliac A.

Donor renal V to External iliac V.
Ureter anastomosed separately to receivers bladder.