aspek bedah pada transplantasi ginjal

KIDNEY KIDNEY TRANSPLANTATIONTRANSPLANTATION

EBEN EZER SIAHAANEBEN EZER SIAHAAN

Dept of surgeryDept of surgeryMedical faculty of Christian unuversity of IndonesiaMedical faculty of Christian unuversity of Indonesia

Kidney transplantation is the pioneer discipline in Kidney transplantation is the pioneer discipline in solid organ transplantation, and the relationship solid organ transplantation, and the relationship

between transplant surgeon and nephrologist has between transplant surgeon and nephrologist has served as a model for multidisciplinary team care.served as a model for multidisciplinary team care.

IntroductionIntroduction

The 1st human renal allograft was The 1st human renal allograft was performed by Voronoy. The recipient is 26 performed by Voronoy. The recipient is 26 years old woman who had attemped years old woman who had attemped suicide by ingesting mercury chloride.suicide by ingesting mercury chloride.

The patient was died 48 hours after the The patient was died 48 hours after the procedure.procedure.

IntroductionIntroduction

The first long term success with The first long term success with human renal allograft in Boston human renal allograft in Boston 19541954

IntroductionIntroduction

Immunosupresion era :Immunosupresion era :-- AzathioprineAzathioprine-- RadiationRadiation-- Corticosteroid + AzathioprineCorticosteroid + Azathioprine

•• 1958 histocompatibility antigen was 1958 histocompatibility antigen was describedescribe

•• 1962 tissue matching to select donor – 1962 tissue matching to select donor – recipient pairsrecipient pairs

Renal failureRenal failure

AcuteAcute

ChronicChronic

Pre RenalPre Renal

RenalRenal

Post RenalPost Renal

DEFINITIONDEFINITION

Permanent renal failure in adult is an Permanent renal failure in adult is an irreversible glomerular filtration rate of less irreversible glomerular filtration rate of less then 10 ml/minute or serum creatinine then 10 ml/minute or serum creatinine level greater then 8 mg/l.level greater then 8 mg/l.

SELECTION AND PREPARATION OF SELECTION AND PREPARATION OF KIDNEY TRANSPLANT RECIPIENTSKIDNEY TRANSPLANT RECIPIENTS

Preliminary screeningPreliminary screening Kidney disease recurrenceKidney disease recurrence InfectionInfection Active malignancyActive malignancy High probability of peri operative morbidity or High probability of peri operative morbidity or

mortalitymortality Non complianceNon compliance Unsuitable condition for technical succes.Unsuitable condition for technical succes.

DONOR SELECTION, PREPARATION DONOR SELECTION, PREPARATION AND SURGERYAND SURGERY

Living donorLiving donor

Deceased donorDeceased donor

KIDNEY PRESERVATIONKIDNEY PRESERVATION

Cold IschemicCold Ischemic

Warm ischemicWarm ischemic

Hypothermic pulsatile Hypothermic pulsatile perfusion.perfusion.

Flushing with an ice Flushing with an ice cold solution.cold solution.

KIDNEY PRESERVATIONKIDNEY PRESERVATION

Kidney preservation ( deceased donor )Kidney preservation ( deceased donor )

RENAL ALLOGRAFT REJECTIONRENAL ALLOGRAFT REJECTION

HistocompatibilityHistocompatibility

Rejection :Rejection :

1. Hyperacute rejection1. Hyperacute rejection

2. Accelerated rejection2. Accelerated rejection

3. Acute rejection3. Acute rejection

4. Chronic rejection4. Chronic rejection

PROBLEMPROBLEM

Early graft dysfucntionEarly graft dysfucntion Vascular complicationsVascular complications Allograft nephrectomyAllograft nephrectomy HematuriaHematuria Fluid collectionFluid collection Obstruction and stonesObstruction and stones UTIUTI VURVUR CancerCancer

SummarySummary

Renal transplant is the best therapy for Renal transplant is the best therapy for most patient ESRD. Morbidity and most patient ESRD. Morbidity and mortality have been significantly reduces mortality have been significantly reduces by attention to pretransplantation by attention to pretransplantation evaluation, donor surgery,kidney evaluation, donor surgery,kidney preservation, recipient selection, recipient preservation, recipient selection, recipient surgery, histocompatibility, surgery, histocompatibility, immunosuppresion and the successful immunosuppresion and the successful management of complication.management of complication.