9 renal transplant

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Renal Transplantation Renal Transplantation By By Mohamed Hassouna, MD Mohamed Hassouna, MD Professor of Urology, Professor of Urology, Alexandria University Alexandria University

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Page 1: 9 renal transplant

Renal TransplantationRenal Transplantation

ByByMohamed Hassouna, MDMohamed Hassouna, MD

Professor of Urology, Alexandria Professor of Urology, Alexandria UniversityUniversity

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SELECTION FOR KIDNEY TRANSPLANT SELECTION FOR KIDNEY TRANSPLANT

- Diagnose the - Diagnose the primary diseaseprimary disease and its risk and its risk of recurrence in the kidney graft of recurrence in the kidney graft

- Rule out :- Rule out :-active invasive infection, -active invasive infection, - high probability of operative mortality- high probability of operative mortality

- noncompliance, - noncompliance, - active malignancy, - active malignancy,

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InfectionInfection Dental sepsis, pulmonary infectionDental sepsis, pulmonary infection

UTI should be inactive UTI should be inactive

Tuberculin skin test , TB, CMV, herpes simplex Tuberculin skin test , TB, CMV, herpes simplex virusvirus

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Active MalignancyActive Malignancy

To reduce the risk of cancer To reduce the risk of cancer recurrence, a waiting time of 2 to recurrence, a waiting time of 2 to 5 cancer-free years from the 5 cancer-free years from the time of the last cancer treatmenttime of the last cancer treatment

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Perioperative Morbidity or Perioperative Morbidity or MortalityMortality

- - Heart disease is the main cause of death after renal Heart disease is the main cause of death after renal

Tx Tx

- CVD, peptic ulcer, and pulmonary disease must be - CVD, peptic ulcer, and pulmonary disease must be detecteddetected

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Technical DifficultiesTechnical Difficulties

- to determine the suitability of the to determine the suitability of the Bladder for Ureteric anastomosis Bladder for Ureteric anastomosis

- to determine the necessity for to determine the necessity for pretransplantation nephrectomy:pretransplantation nephrectomy:

Polycystic, Pyonephrosis, Polycystic, Pyonephrosis, uncontrolled UTI, Uncontrolled uncontrolled UTI, Uncontrolled RenoVascular HTNRenoVascular HTN

- significant bladder residual urine- significant bladder residual urine

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DONOR SELECTIONDONOR SELECTION

-Absence of renal disease-Absence of renal disease- Absence of active infectionAbsence of active infection- Absence of transmissible Absence of transmissible

malignancy. malignancy. - Histocompatibility and ABO typingHistocompatibility and ABO typing

the living donor will have the living donor will have nearly nearly normal normal renal function after renal function after nephrectomy. nephrectomy.

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Living DONOR SELECTIONLiving DONOR SELECTION

CT angiographyCT angiography with IV contrast : with IV contrast :

- Satisfactorily excludes stone disease- Satisfactorily excludes stone disease

- Demonstrates renal and vascular - Demonstrates renal and vascular anatomy anatomy

- Defines the urinary collecting system- Defines the urinary collecting system

- With minimal donor morbidity- With minimal donor morbidity

- Reasonable expense- Reasonable expense

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Donor surgery Donor surgery

- Two teams at two close theaters- Two teams at two close theaters

- Warm ischemia time is limited to 30-- Warm ischemia time is limited to 30-40 minutes during surgery.40 minutes during surgery.

- Cut as long as possible renal artery Cut as long as possible renal artery and vein for better anastomosis.and vein for better anastomosis.

- Keep the ureter as long as possible.Keep the ureter as long as possible.

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Simple Cold Storage of KidneysSimple Cold Storage of Kidneys

Cellular energy requirements Cellular energy requirements are significantly reduced by are significantly reduced by hypothermia hypothermia

This is done by surface cooling This is done by surface cooling or flushing with an ice cold or flushing with an ice cold solution followed by cold solution followed by cold storage. storage.

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RECIPIENT OPERATIONRECIPIENT OPERATION

In adults and children In adults and children (more than 20 kg)(more than 20 kg)

the kidney graft is usually the kidney graft is usually placed extraperitoneally in placed extraperitoneally in the iliac fossa by way of a the iliac fossa by way of a Gibson incision Gibson incision

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RECIPIENT OPERATIONRECIPIENT OPERATIONVascular anastomosisVascular anastomosis

In adults:In adults:

Renal A. to Internal iliac A. or External Renal A. to Internal iliac A. or External Iliac A.Iliac A.

Renal V. toRenal V. to External Iliac V. External Iliac V. In children:In children:

Renal A. to aortaRenal A. to aorta

Renal V. to IVCRenal V. to IVC

- Ureteral anastomosis to the bladder- Ureteral anastomosis to the bladder

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Post-operative managementPost-operative management

Immunosuppressent drugs for lifeImmunosuppressent drugs for life Very ExpensiveVery Expensive Any infection is life threateningAny infection is life threatening Only 10% would live for 10 years. Only 10% would live for 10 years.

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Thank you