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is the preferred
treatment for patients
with end-stage renal
disease. It offers
better quality of life
and confers greater
longevity than long-
term dialysis.
Common Causes of End-Stage Renal Disease
• Diabetes mellitus
• High blood pressure
• Glomerulonephritis
• Polycystic Kidney Disease
• Severe anatomical problems of the
urinary tract
Contraindications
• If there are antibodies to the donor kidney, the body may destroy
the kidney. For this reason, when a donor kidney is available, a
test called a crossmatch is done to ensure the recipient does not
have pre-formed antibodies to the donor .
• The crossmatch is done by mixing the recipient's blood with
cells from the donor. If the crossmatch is positive, it means that
there are antibodies against the donor.
• Crossmatches are performed several times during preparation for
a living donor transplant, and a final crossmatch is performed
within 48 hours before this type of transplant.
Serology
Testing is also done for viruses, such as HIV (human
immunodeficiency virus), hepatitis, and CMV (cytomegalovirus)
EBV, Hep.B,C to select the proper preventive medications after
transplant. These viruses are checked in any potential donor to
help prevent spreading disease to the recipient.
Pre-transplant Period
This period refers to the time that a patient is on the deceased
donor waiting list or prior to the completion of the evaluation of
a potential living donor.
The recipient undergoes testing to ensure the safety of the
operation and the ability to tolerate 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 and mammogram (women) and prostate (men)
• Cardiovascular Evaluation: electrocardiogram, stress test,
echocardiogram, cardiac catheterization
• Pulmonary Evaluation: chest x-ray, spirometry
Potential Reasons of Excluding Transplant
Recipient
• Uncorrectable cardiovascular disease
• History of metastatic cancer or ongoing chemotherapy
• Active systemic infections
• Uncontrollable psychiatric illness
• Current substance abuse
• Current neurological impairment with significant
cognitive impairment and no surrogate decision maker
Transplant Surgery
• The transplant surgery is performed under general anesthesia.
• The operation usually takes 2-4 hours.
• This type of operation is a heterotopic transplant meaning the
kidney is placed in a different location than the existing kidneys.
• The original kidneys are not usually removed unless they are
causing severe problems such as uncontrollable high blood
pressure, frequent kidney infections, or are greatly enlarged.
• The renal artery of the new kidney, previously branching from
the abdominal aorta in the donor, is often connected to
the external iliac artery in the recipient.
• The renal vein of the new kidney, previously draining to
the inferior vena cava in the donor, is often connected to
the external iliac vein in the recipient.
• The donor ureter is anastomosed with the recipient bladder.
• Recovery in the hospital is usually 3-7 days.
• Complications can occur with any surgery.
Post operative period