kidney transplant presentation

8/13/2019 Kidney Transplant Presentation

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also known as chronic renal disease

a progressive loss in renal function over a period of

months or years

Common causes:

1. Diabetes Mellitus

2. Hypertension

3. Glomerulonephritis

Chronic Kidney Disease


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Stage 1- has kidney damage with a glomerular filtrationrate at a normal or high level greater than 90

ml/min.Symptoms: no symptoms to indicate the kidneys are

damaged.

Stage 2- kidney damage with a mild decrease in theirGFR of 60-89 ml/min

Symptoms: Blood or protein in the urine

Stages of Chronic

Kidney Disease


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Stage 3- has kidney damage with a moderate decreasein the GFR of 30-59 ml/min

Symptoms: Fatigue, change in urination, kidney painand sleep problems

Stage 4: has advanced kidney damage with a severe

decrease in the GFR to 15-30 ml/min.

Symptoms: Nausea, taste change, uremic breath, loss ofappetite, difficulty in concentrating, nerve problems

Stages of Chronic

Kidney Disease


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Stage 5- End Stage Renal Disease (ESRD)

-GFR of 15 ml/min or less. At this advanced stage

of kidney diseaseSymptoms: Loss of appetite, nausea or vomiting,

headaches, being tired, being unable to concentrate,itching, making little or no urine, swelling, especially

around the eyes and anklesmuscle cramps, tingling in hands or feet, changes in skincolor, increased skin pigmentation

Stages of Chronic

Kidney Disease


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1. Hemodialysis-requires that an accessbe created to

get the blood from the body to the dialyzer

(artificial kidney) so it can be cleaned and then goback into the body.

Dialysis
http://www.davita.com/kidney-disease/vocabulary/vascular-access/e/5512http://www.davita.com/kidney-disease/vocabulary/vascular-access/e/5512


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2. Peritoneal dialysis- a catheter access is placed in the

abdomen. PD is performed by running dialysate

solution through the catheter into the peritoneum andthen removing the solution after a time and replacing itwith new dialysate.

Dialysis
http://www.davita.com/treatment-options/home-peritoneal-dialysis/what-is-peritoneal-disease-/preparing-for-peritoneal-dialysis-catheter-surgery/t/6152http://www.davita.com/treatment-options/home-peritoneal-dialysis/what-is-peritoneal-disease-/preparing-for-peritoneal-dialysis-catheter-surgery/t/6152http://www.davita.com/treatment-options/home-peritoneal-dialysis/what-is-peritoneal-disease-/preparing-for-peritoneal-dialysis-catheter-surgery/t/6152http://www.davita.com/treatment-options/home-peritoneal-dialysis/what-is-peritoneal-disease-/preparing-for-peritoneal-dialysis-catheter-surgery/t/6152


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replacement of nonworking kidneys with a healthykidney from another person (the donor). The healthy

kidney takes over the functions of the nonworkingkidneys.

a person can live normally with only one kidney aslong as it functions properly.

Kidney Transplant


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1. The Living Donor

Sometimes family members, including brothers,

sisters, parents, children (18 years or older), uncles, aunts,cousins, or a spouse or close friend may wish to donate akidney. That person is called a "living donor."

The donor must be in excellent health, well informed

about transplantation, and able to give informedconsent. Any healthy person can donate a kidney safely.

Kidney Donor

Classification


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2. Deceased Donor

A deceased donor kidney comes from a person

who has suffered brain death. The UniformAnatomical Gift Act allows everyone to consent toorgan donation for transplantation at the time of deathand allows families to provide such permission as

well. After permission for donation is granted, thekidneys are removed and stored until a recipient hasbeen selected.

Kidney Donor

Classification


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1. Open incision- standard for the removal ofthe donated kidney. It involves a 5-7 inchincision on the side, division of muscle andremoval of the tip of the twelfth rib. Theoperation typically lasts 3 hours and the

recovery in the hospital averages 4-5 dayswith time out of work of 6-8 weeks.

Nephrectomy


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2. Laparoscopic- performed under general anesthesia, usesvery small incisions, a thin scope with a camera to view insideof the body, and wand-like instruments to remove the

kidney.Pros:

Decreased need for strong pain medications Shorter recovery time in the hospitalQuicker return to normal activitiesVery low complication rate The operation takes 2-3 hours. Recovery time in the

hospital is typically 1-3 days. Donors often are able toreturn to work as soon as 2-3 weeks after the procedure.

Nephrectomy


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Nephrectomy

LaparoscopicOpen Incision


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Blood Type Testing

The first test establishes the blood type. . The recipient

and donor should have either the same blood type orcompatible ones, unless they are participating in a specialprogram that allow donation across blood types. The listbelow shows compatible types: If the recipient blood type is A Donor blood type must be A

or O

If the recipient blood type is B Donor blood type must be Bor O

If the recipient blood type is O Donor blood type must be O If the recipient blood type is AB Donor blood type can be A,

B, AB, or O

Transplant Evaluation

Process


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Tissue Typing The second test, which is a blood test for human leukocyte

antigens (HLA), is called tissue typing. Antigens are markersfound on many cells of the body that distinguish eachindividual as unique. These markers are inherited from theparents. Both recipients and any potential donors have tissuetyping performed during the evaluation process.

To receive a kidney where recipient's markers and the donor'smarkers all are the same is a "perfect match" kidney. Perfectmatch transplants have the best chance of working for manyyears. Most perfect match kidney transplants come fromsiblings.


Process


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Crossmatching Throughout life, the body makes substances called antibodies that

act to destroy foreign materials. Individuals may make antibodieseach time there is an infection, with pregnancy, have a bloodtransfusion, or undergo a kidney transplant. If there are antibodiesto the donor kidney, the body may destroy the kidney. For thisreason, when a donor kidney is available, a test called a crossmatchis done to ensure the recipient does not have pre-formed antibodiesto the donor .

The crossmatch is done by mixing the recipient's blood with cellsfrom the donor. If the crossmatch is positive, it means that there areantibodies against the donor. The recipient should not receive thisparticular kidney unless a special treatment is done beforetransplantation to reduce the antibody levels. If the crossmatch isnegative, it means the recipient does not have antibodies to the

donor and that they are eligible to receive this kidney.


Process


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Serology

Testing is also done for viruses, such as HIV (humanimmunodeficiency virus), hepatitis, and CMV(cytomegalovirus) to select the proper preventivemedications after transplant. These viruses are checked

in any potential donor to help prevent spreadingdisease to the recipient.


Process


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Pre-transplant PeriodTime that a patient is on the deceased donor waiting list or prior to thecompletion of the evaluation of a potential living donor. The recipientundergoes testing to ensure the safety of the operation and the ability totolerate the anti-rejection medication necessary after transplantation.

The type of tests varies by age, gender, cause of renal disease, and other

concomitant medical conditions. These may include, but are not limited to: General Health Maintenance: general metabolic laboratory tests,

coagulation studies, complete blood count, colonoscopy, pap smear andmammogram (women) and prostate (men)

Cardiovascular Evaluation: electrocardiogram, stress test,

echocardiogram, cardiac catheterization Pulmonary Evaluation: chest x-ray, spirometry

Phases of Transplant


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Transplant Surgery The transplant surgery is performed under general

anesthesia. The operation usually takes 2-4 hours. Thistype of operation is a heterotopic transplant meaning thekidney is placed in a different location than the existingkidneys.

The kidney transplant is placed in the front (anterior)part of the lower abdomen, in the pelvis.



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Transplant Surgery (cont.)

The artery that carries blood to the kidney and the veinthat carries blood away is surgically connected to theartery and vein already existing in the pelvis of therecipient. The ureter, or tube, that carries urine from

the kidney is connected to the bladder. Recovery in thehospital is usually 3-7 days.



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Post Transplant Period The post transplant period requires close monitoring of

the kidney function, early signs of rejection, adjustmentsof the various medications, and vigilance for theincreased incidence of immunosuppression-related effectssuch as infections and cancer.

Just as the body fights off bacteria and viruses (germs)that cause illness, it also can fight off the transplantedorgan because it is a "foreign object." When the bodyfights off the transplanted kidney, rejection occurs.


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also known as immunosuppressive agents,help to prevent and treat rejection. They are

necessary for the "lifetime" of thetransplant. If these medications are stopped,rejection may occur and the kidney

transplant will fail.

Anti-Rejection

Medications

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Anti-inflammatory Medication

Anti-proliferative Medications

Cytokine Inhibitors

Antilymphocyte Medications

Anti-RejectionMedications

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