Renal transplantation

Presented by Dilna Berly

Renal transplantation
Renal transplantation is the surgical procedure of placing a healthy
kidney from a donor into a patient whose kidneys have failed.

Note: you will need to take lifelong

medications to make sure the kidney stays
healthy
Why consider a kidney transplant ?
• Main reason is to avoid the need for dialysis
• Eat and drink with fewer restrictions
• Do regular daily activities
• Including travel

Note: People with transplants have a more normal life than those on dialysis. They
live longer, have better health and have more freedom.
Indications for Renal Transplantation
• Chronic Kidney Disease (CKD): A gradual loss of kidney function over
time, which can eventually lead to kidney failure.

• End-Stage Renal Disease (ESRD): The final stage of kidney failure

where the kidneys are functioning at less than 15%.
Contraindications

• Severe vascular disease

• Severe heart disease & lung disease
• Active or recently treated cancer
• Chronic illness that could lead to death within a few years
• Dementia, morbid obesity, current drug or alcohol abuse.
• Inability to remember to take medications
• Transmissible infections like HIV, Hepatitis C & Hepatitis B.
• Some people who have HIV or Hepatitis B & C infections may have
transplant if their disease is well controlled
• Current pregnancy
• Cognitive diseases
• Psychiatric illness
Two types :

Living donor transplantation : living person donates one of their

kidneys to a recipient who needs a transplant.
Living donors can be genetically related (like a family member) or not.

Deceased donor transplantation : kidney comes from a deceased

person who has chosen to donate their organs.
(brain-dead or their heart has stopped beating, but they are not
otherwise "dead")
Living vs. Deceased Donor
Transplantation
Deceased donor transplantation
Pros: No requirement for the donor to be healthy, no need for the donor
to undergo surgery.
Cons: Longer waiting times for a deceased donor kidney, potential for
lower quality kidneys due to longer cold storage times.

Living donor transplantation

Pros: Shorter waiting times, higher success rates, and a better match
between the donor and recipient.
Cons: Donor must be healthy and willing to undergo surgery, potential
risks to the donor during and after the donation.
Pre emptive kidney transplantation

A procedure where a new kidney is transplanted before the recipient’s

kidney fail and they need to start dialysis.
Benefits:-
• Avoiding dialysis
• Improved quality of life
• Longer life expectancy
Maximum age to donate a kidney
• No set max age for donating a kidney
• Living donars - typically ranging from 18 - 65
• Older individuals can donate if they are in good health and pass
necessary medical evaluations
• Even people in their 90s have successfully donated kidneys.
Who pays if you donate a kidney?
It’s illegal to receive monetary compensation for donating.
Donor Evaluation
• There are actually three tests that are done to evaluate donors. They
are blood type, crossmatch, and HLA testing.
• The rules for blood type in transplantation are the same as they are
for blood transfusion.
If your blood type is: You can donate to these blood types:
TYPE O TYPE O, A, B, AB
TYPE A TYPE A, AB
TYPE B TYPE B, AB
TYPE AB TYPE AB
Procedure
• The transplant is performed under
general anesthesia.
• The donor kidney is typically placed in
the lower abdomen, near the iliac blood
vessels (not in the original kidney
position).
• Anastomosis: Surgeons connect the
donor kidney's blood vessels to the
recipient’s iliac artery and vein. The
ureter from the donor kidney is also
connected to the recipient's bladder to
allow urine to pass.
Reason :
• Accessibility : Iliac vessels are relatively easier to reach and expose
during surgery in the iliac fossa ( lower abdomen ) making them
convenient location for anatomosis.
• Easier connection to the bladder
• Minimizing complications: Blood clots or vascular problems that
might arise if the kidney’s blood vessels were connected to other
vessels.
Surgery:

Laparoscopic donor nephrectomy:

The surgeon usually makes 2 or 3 small incisions in the abdomen.
Very small incisions are used as portals to insert the fibre optic surgical
instruments.
A slightly larger incision is used to remove the donor kidney(4-5cm)
The equipment includes a small knife, clamps and a special camera
called laparoscope that is used to view the internal organs and guide
the surgeons through the procedure.
In open nephrectomy, a 5-7 inch (13-18cm) incision is made on the
side of the chest and upper abdomen.
Pediatric kidney transplantation
• Most common causes of pediatric kidney failure are birth defects and
genetic conditions
• All donors older than 36 - weeks of gestation with evidence of urine
production after birth and a normal or normalized serum creatinine
were considered for donation.
• Most pediatric kidney transplant recipients are teenagers, but surgery
can be done on children as young as a year old and as small as 22
pounds.
• Babies below those benchmarks considered for transplants case by
case, or they may receive dialysis until they grow a bit more
• Congenital abnormalities of the kidneys are sometimes discovered in
utero, so doctors can know even before a baby is born that he or she may need
a transplant
• Bilateral Renal agenesis: Absence of both kidneys.
• Hypoplasia: Underdevelopment of the kidneys.
• Dysplasia: Abnormal development of kidney tissue.
• Ectopic kidneys: Kidneys located in an abnormal position.
• Fused kidneys: Kidneys joined together.
• Polycystic kidney disease: Presence of fluid-filled cysts in the kidneys.
• Obstructive kidney disease: Blockages in the urinary tract that prevent
proper urine flow.
• Vesicoureteral reflux: Backflow of urine from the bladder into the ureters.
• Other times those issues are not detected early, and children begin to
develop symptoms of kidney disease over months or years.
Symptoms include :
>Fatigue
>Short stature
>Not developed as expected for a child’s age
>High blood pressure
• Can an infant recieve an adult kidney ?
A child older than 2 yrs of age can get an adult kidney if the kidney
fits in their body.
• Can a kidney transplant recipient have a baby ?
It is usually recommended to wait atleast 1 yr after their
transplant.
• Can you donate a kidney after having a baby ?
Recommend not donating for 1 yr after having a baby.
 After Kidney Transplantation
• Lifelong Medication → ↓Risk of rejection
• Usual regime →Tacrolimus → Tremor
Mycophenolate
Prednisolone→cushings syndrome
Others → Cyclosporine → Gum Hypertrophy
Sirolimus
Azathioprine
Complications : 2 types
Immediate complications & Late complications
Relating to transplant
As with any surgery :
• Bleeding
• Immediate post operative risk of infection,especially a bladder
infection
• Pain or numbness along the inner thigh that usually goes away
without treatment
• Transplant rejection
• Transplant failure
Related to immunosuppresants
• Infections
• Ischaemic heart disease
• Skin cancer
• Pneumocystis jirovecii pneumonia (PCP)
 Success rate of kidney
transplantation
• At the end of 1 yr after transplantation more than 93 - 95 % of kidney
transplants survive
How many years kidney will survive?
There is no clear cut answer to that question in related to that
person.
On an average 50% of KT fail at the end of 10 -12 yrs.
• Recovery time after kidney transplant
On avg, about 6 weeks.
Different for everyone, coz it depends on overall health and other
factors
During Preservation
• Kidneys are stored in hypothermic state
• Kidneys can typically survive outside the body for 24-36 hrs
• Livers,intestines & pancrea only last on average for about 12-18 hrs.
• Heart and lungs - shortest preservation time (6 hrs)
Diet
Kidney transplant recipients are discouraged from consuming
grapefruit, pomegranate and green tea products.
These food products are known to interact with the transplant
medications, specifically tacrolimus, cyclosporin and sirolimus.
 History
• 1902: First animal kidney transplant.
• 1954: First successful human kidney transplant (identical twins).
• 1960s: Immunosuppressive drugs introduced.
• 1980s: Organ preservation and cyclosporine revolutionize transplants.
• 1990s–2000s: Better matching and organ preservation techniques,
increased use of living donors.
• Present: Advances in organ bioengineering, immunology, and
transplantation technologies.
Recent Advances in Renal Transplantation
1. New Immunosuppressive Drugs: Newer drugs have fewer side
effects and better control over rejection.
2. Organ Preservation Techniques: Improved methods such as machine
perfusion allow kidneys to be preserved and transported for longer
periods.
3. Xenotransplantation: Using animal organs (particularly from pigs) for
transplantation into humans is being researched as a solution to the
organ shortage.