high beam global - renal transplantation

8/8/2019 High Beam Global - Renal Transplantation

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RENAL TRANSPLANTATION

High Beam Global, 2010. All Rights Reserved - Privileged and


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HISTORY

High Beam Global, 2010. All Rights Reserved - Privileged andConfidential

Autotransplantation wellestablished2nd century BC: Sushruta pioneered skin grafting forrhinoplasty


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HISTORY


1933: Yu Yu Voronoy of the

Soviet Union performed thefirst human-to-human kidney

transplant

1954: Joseph E. Murray

performed the first successful

kidney transplantDonor and recipient identical

twins


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HISTORY


Early attempts at

immunosuppressionWhole-body X-irradiation Nitrogen mustard 6-mercaptopurine

1957: George Hitchings andGertrude Elion modify 6-MP to

produce azathioprine

1963: Thomas Starzl observed thatlarge doses of corticosteroids can

reverse rejection episodes and

stabilize allograft function


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Basics of Transplantation

.

ESRD on RenalReplacement

Therapy (RRT) ie

Hemodialysisor Peritoneal Dialysis

Chronic RenalInsufficiency

approaching the need

for RTT-pre-emptive transplant

Common causes of ESRD:

HTN

DM

PCKD

IgA Nephropathy

Congenital abnormalities

Renal Dysgenesis

Obstructive Uropathy

FSGS

Lupus

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RENAL BLOOD FLOW


Cardiac

out put

Mean

Arterial

Pressure

Effective Circulating Volume

Intrarenal Autoregulation

Normal

RBF/RPF

Renal

Perfusion

Pressure

GFR, FF


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RELATIONSHIP BETWEEN GFR ANDS.CREATININE IN ESRD

Se

rum

Creatinine

(mg

/dl)

GFR (ml/min per 1.73m2)

1.0

0

2.0

3.0

4.0

5.0

6.0

7.0

8.09.0

40 60 80 100 120 140 160 180200


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Anatomy of RenalTransplantation


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Living Kidney Donor (LKD)

Sibling

Parent

Child

Spouse/partner

Deceased Donors

Brain Dead Donation after Cardiac Death

(DCD) High Beam Global, 2010. All

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SOURCES OF KIDNEY


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Labs:

CBC, CMP, PT/PTT, LFT,

Serologies (Hepatitis B andC,

HIV, CMV, EBV, HTLV)

ABO x2

HLAs

Chest X-ray

Cardiac Clearance

EKG, Echo, Stress, Angio,

cardiology consult

Cancer screening Pap, Mammo, PSA,

Colonoscopy

Dental clearance

SW evaluation

Surgeon or other transplant

physician consultation

Other possible

tests/consultations Lower extremity dopplers

Carotid dopplers CT scans

PFTs

Cystogram

TB test

Endocrine Infectious Disease

Hepatology

Psychiatric evaluation

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Confidential

EVALUATION PROCESS


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Histocompatibility

Laboratory Tests

Blood Typing

Tissue Typing

Crossmatch Testing

Panel Reactive

Antibody (PRA)


Confidential

PRE TRANSPLANT EVALUTION


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Life expectancy

Cardiovascular benefits

Quality of life


Confidential

BENEFITS OF TRANSPLANT


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Confidential

LIFE EXPECTANCY


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Confidential

CARDIOVASCULAR BENEFITS


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Numerous studies have detailed

improved quality of life.

Life satisfaction, physical andemotional well-being and ability to

return to work higher in transplantrecipients.

Uremic complications more fully

reversed. Fertility returns.


Confidential

QUALITY OF LIFE


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Banff criteria Interpretation of renal biopsy

specimens for diagnosing rejection

have been greatly facilitated and

standardized Based on scores for glomerular,

vascular, interstitial, and tubular

lesions

Has been shown to have clinical

relevance when predicting

rejection reversal and may prove

useful for choosing first-line

therapy of rejection episodes

High Beam Global, 2010. All Rights Reserved - Privilegedand Confidential

DIAGNOSIS OF REJECTION


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BENFF CRITERIA

Grade 1: Moderate interstitial mononuclear inflammation affecting 25-

50% of the sampled parenchyma


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BENFF CRITERIA

Grade 2: Moderate interstitial mononuclear infiltrate involving26-50% of the renal parenchyma


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High Beam Global, 2010. All


BENFF CRITERIA

Grade 3: severe transmural arteritis and/or transmural fibrinoid change

and necrosis of smooth muscle cells


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Biochemical markers

Various markers reported tocorrelate with rejection

2-microglobulin1

Neopterin2

PCR amplification ofmessenger RNA inurinary sediment3

Perforin mRNA Granzyme B mRNA

Strong predictive value foracute rejection



DIAGNOSIS OF REJECTION


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IMMUNOSUPPRESIVE MEDICATION

COMMON COMPLICATION OF


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Early complications

Surgical complications Delayed or slow graft function

Lymphocele

Acute rejection

Acute cellular rejection

Antibody-mediated rejection

Infectious complications

Cytomegalovirus

BK virus

Others Malignancy

Chronic allograft dysfunction



COMMON COMPLICATION OFTRANSPLANTATION


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OUR NETWORK

The transplant programs at HIGHBEAM GLOBAL India partner hospitalhave earned a number of distinctions

in the field, including the #1 rankingin the country in both patient andgraft survival for kidney transplant.....




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Liver Transplantation for children and adults with acuteand chronic liver failure /cirrhosis

Living related Liver transplant and Cadaveric transplant

Pediatric hepatology service including transplant andbiliary surgery

Adult Hepatology and Gastroenterology

Renal Transplantation in adults and children including LapDonor Nephrectomy

Complex vascular and peritoneal access procedures

Complex Hepatobiliary Surgery...


OUR NETWORK FACILITIES


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Organ transplantation induces a

fundamentally abnormal physiologic state

Steady improvement has been made in

both prevention and treatment of organ

rejection

The potential for further improvement

both incremental and revolutionary is

great

High Beam Global, 2010. All Rights Reserved - Privileged and Confidential

CONCLUSION


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Contact Us


High Beam Global

209, Udyog Vihar, Phase 1, Gurgaon.

Phone: +91-124-4824560

Fax: +91-124-4824550

E-mail:[email protected]

Web address: www.highbeamglobal.com
http://www.highbeamglobal.com/http://www.highbeamglobal.com/


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Thank you for considering us

Hi h B Gl b l 2010 All Ri ht R d P i il d d

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