Contents
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:
Complications
Graft rejection:
