Some notes on renal transplants

I’m yet to work in a place that sees lots of renal transplant patients, hence the set of notes! If you have any thoughts or tips please let me know in the comments.

THE TRANSPLANT

  • commonest transplant
  • anastamosed to common iliac artery and vein in the pelvis. the ureter is plumbed into the bladder
  • allows ease of access for palpation and biopsy
  • kidney will be matched for HLA and MHC to minimise rejection but this is never guaranteed
  • immune suppression is induced prior to surgery and maintained long term. The drugs involved are usually different

PROGNOSIS

  • graft survival 95% for matched, living donor.
  • about 90% for cadaveric donors

EARLY COMPLICATIONS

  • vascular
  • renal artery thrombosis
    • high BP
    • low urine Na
    • needs surgical intervention
  • renal vein thrombosis (
    • pain
    • fever
    • high BP
    • proteinuria
    • needs anticoagulation
  • Infection – up to 20% following surgery
  • ureteric obstrction
    • get an ultrasound – really important
  • acute rejection
    • pain
    • fever
    • high BP
    • needs a biopsy to confirm

LATER COMPLICATIONS

  • new renal disease
  • chronic rejection
    • slow rise in creat
    • no real treatment
  • infection
  • common and often odd
  • they still get common or garden UTIs but there are lots of weird and wonderful infections in transplant patients that don’t present as you might expect.
  • of note the commonest presentation of meningitis is simply headache so low threshold for sticking a needle in their back.

VACCINES

  • dead vaccines and immunoglobulin fine
  • live or attenuated vaccines (MMR, polio, BCG etc) are contraindicated

MEDICATIONS THEY’RE ON

  • this is where it gets tricky. I’m not going to give lots of details as the important message is – look it up
  • the medications all increase cancer risk
  • esp lymphoma, cervical and skin cancer

 

About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

Speak Your Mind

*