Renal transplant

Key points

Common aetiologies of end stage renal failure (ESRF):

Posterior urethral valves: 1/4 progress to ESRF in childhood

Reflux nephropathy: No reduction in rate for 40 years

Investigations pre-transplant:

ABO match

HLA A, B, DR

Prothrombosis

Virology

MRA/CTA for vascular anatomy

Bladder studies

Cadaveric grafts 13y expectancy

Live donor 15-20y expectancy

Induction medications:

Methylprednisolone

Tacrolimus - Continues as maintenance

Basiliximab

Mycophenalate Mofetil

Complications:

Acute thrombosis - presents with sudden anuria

Flush catheter, urgent USS. Needs urgent theatre for thrombectomy but graft loss in 1 hour, likely needs removing

Graft rejection

Hyperacute: Within minutes of transplant; rare due to improved cross-matching. Requires immediate graft removal

Accelerated: T-cell mediated, within days - long-term prognosis is poor.

Acute Cellular: Within 1-12 weeks

Chronic: Gradual increase in creatinine and proteinuria, hypertension - needs biopsy

References:

Patient.co.uk Renal replacement therapy and transplantation Last updated by Dr Colin Tidy, MRCGP 18 Feb 2022