Renal Transplantation

21.5.07

History
• In 01/02, Emerich Ullmann reported first case of renal autotransplantation performed in neck of dog.
• In same year, presented first xenotransplantation of kidney (goat with dog's).

First successful human kidney transplantation: Boston (1954) - identical twins.

Treatment options for ESRF
DIALYSIS
(long term)

Peritoneal Haemodialysis

TRANSPLANTATION

Cadaveric Live donor

What life is like on dialysis
• Poor quality of life.
• Usually unable to work.
• Little/no holidays.
• Feel ill most of time.

Transplantation optimum renal replacement therapy for most patients.

Cadaveric donor operation - donor selection criteria
• 2-75 years.
• No infection.
• No DM.
• No cancer except primary brain tumours.
• No HIV.

Donor selection - UK code
• Brainstem death.
• Preconditions: irreversible coma.
• Exclusions.

Imaging renal anatomy: angiogram.

Matching of kidney
• ABO.
• HLA.
• Lymphocytotoxic crossmatch.

Surgical complications
• Renal artery thrombosis.
• Renal vein thrombosis.
• Urine leak and ureteric stenosis.
• Lymphocele.

Long-term complications
• Infection.
• Cancer.
• Drug side-effects.
• Rejection.
• Graft loss.

Side-effects of immunosuppression
• Drug-specific.
• Total burden of immunosuppression.
• Additional chronic renal failure.
• Progression of primary disease.

Predictors of long-term graft function
• Factors impacting on graft survival (HLA match, donor type etc).
• Factor impacting on patient survival.