Categories
Internal Medicine

Organ transplantation


Types

  • Autograft: Self to self
  • Isograft (syngeneic): Genetically identical person to self
  • Allograft: Genetically different person but same species to self
  • Xenograft: Interspecies

Indications

Renal transplant:

  • Adults: M/C indiction: CKD secondary to DM2 (diabetic nephropathy)
    • Combined renal + pancreatic islet transplant
  • Children: M/C indication: Glomerulonephritis

Selection criteria

Maastricht categories of Nonheart‐Beating Donor (NHBD):

  • Category I: Dead on arrival at hospital
    • Cornea & heart valves
  • Category II: Death with Unsuccessful resuscitation
    • Kidney, cornea & heart valves
  • Category III: Awaiting cardiac death
    • Controlled category: Health providers have time to conunsel & obtain consent from patient part
    • All organs can be harvested
  • Category IV: Cardiac arrest while brain dead
    • All organs can be harvested

Expanded donor criteria for renal transplant:

  • Fit & > 60 years age
  • Fit & > 50 years age with ≥ 2 criterias:
    • Death due to stroke
    • H/O HTN
    • Serum creatinine > 1.5 mg/dl

Preparation

Prior to transplant:

  • ABO compatibility

HLA compatibility:

  • Renal transplant: A, B, DR
    • HLA-DR: M/imp for renal transplant
  • Rh-compatibility
  • Donor RFT
  • Donor USG KUB

Renal isotope scan:

  • Methods:
    • DMSA (best for structure/scarring)
    • DTPA (good for function)
    • MAG3 (best for function)
  • Results:
    • Total GFR
    • Differential GFR

Cold ischemia time: Maximum time an organ can be viable outsride human body.

  • Heart: 4 hours (least)
  • Lungs: 6 hours
  • Small intestine: 8 hours
  • Liver: 10-12 hours
  • Kidneys: 24-36 hours (highest)

Procedure

University of Wisconsin (UW) solution:

  • Allopurinol (free radical scavengers)
  • Glutathione (free radical scavengers)
  • Lactobionase (stabilizer)
  • Adenosine (energy)

WHO Critical Pathway for deceased donation:

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WHO Critical Pathway for deceased donation | Dominguez‐Gil B, Haase‐Kromwijk B, Van Leiden H, et al. Current situation of donation after circulatory death in European countries. Transpl Int 2011; 24: 676.
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Cimino, F. M., & Snyder, K. A. (2016). Primary Care of the Solid Organ Transplant Recipient. American family physician, 93(3), 203–210.
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Cimino, F. M., & Snyder, K. A. (2016). Primary Care of the Solid Organ Transplant Recipient. American family physician, 93(3), 203–210.
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Cimino, F. M., & Snyder, K. A. (2016). Primary Care of the Solid Organ Transplant Recipient. American family physician, 93(3), 203–210.

Complications

Graft rejection:

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Annual incidences of early acute rejection, late acute rejection, and delayed graft function. Note that although rejection rates have fallen dramatically, rates of delayed graft function remain unchanged. The latter reflects nonimmunological variables such as ischemia times and use of suboptimal cadaveric donors. | Gjertson DW Impact of delayed graft function and acute rejection on kidney graft survival. Clin Transpl. 2000;467- 480

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