Kidney Transplantation: Patient Pathway

By Mehreen Mehmood

Introduction:• Kidney Transplant: taking a kidney from

another person (Donor), and placing it into the patient (Recipient)

• Donor can be either a • Living Donor • or a Cadaveric Donor

• NHSBT: April 2011-March 2012, 674 Cadaveric, and 1,009 Live Donor Transplants

Who is eligible for Renal Transplantation?

Chronic Kidney Disease (CKD) Stage 4 or 5 (where

eGFR<25%)

GP Referral to Nephrologist for assessment

End-Stage Renal DiseaseeGFR<15%

Conservative Care Dialysis Kidney Transplant

In developed countries, Kidney damage associated with:

Diabetes Old age Hypertension Obesity Cardiovascular

disease (CVD)

Staging CKD:1: >75%2: 50-75%3: 25-50%4: 12.5-25%5: <12.5%

Assessment and Options• Live Donor Seminar: Patient Information• Tests: ECHO, Myocardial Perfusion scan, Blood

group• Surgical Clinic:

1) Thorough history (past medical problems, medications, social history)2) Examination: abdominal palpation, pulses in legs3) Discussion: Patient expectations, surgery, hospital stay, common complications, reasons for long term kidney failure, risk to life, other options

• Donor Coordinator: paperwork, contact details

Dialysis:

Haemodialysis:-Ward 301 at QEHB-Satellite Units or Home

Peritoneal Dialysis:-Old QE-Home

AV Fistula created

Pre-Surgery:Live Donor:•Tests on both recipient and donor completed while on Ward 305: ECHO etc.•Surgery•NB: Kidney should be transplanted within 3-4 hours

Cadaveric:Phone call can come at any time!Recipient must come to hospital (Ward 305) straight awayIf no up to date imaging, get tests done: ECG, X Ray, ECHOSurgeryNB: Kidney can be stored for up to 24 hours

Surgery:• 2-3 hours surgery each:• To remove a kidney: Assisted Laparoscopic• To insert a kidney: Laparotomy

Immediate Post-Op Care:• Patient taken back to Ward 305 (or to

Critical care if not enough beds)• Regular Blood Tests: Creatinine should

be decreasing, any sign of infection or rejection

• Is recipient urinating well?• Essentially: Is new kidney functioning? • Patient can be kept for 1-2 weeks

Post-op Outpatients Care:Surgical Clinic:

Meet the SurgeonFor 3 months after transplantAcute ComplicationsMedication review: immunosuppression drugs (Tacrolimus)Regular blood tests to monitor kidney function: Creatinine

Medical Clinic:

Meet the NephrologistFollowed up for the rest of their life. Every 3 months, on averageChronic ComplicationsMedication reviewRegular blood tests to monitor kidney function: CreatinineWellbeing (Holistic care)

Summary:GP Nephrologist

Basic Tests

Discussion

Surgical Assessment Clinic

In depth discussion

More tests: ECG, X-ray,

ECHO, Myocardial perfusion

scan

Dialysis Transplantation

Cadaveric

Live Donor

Join List(Donor

Coordinator)

MatchingWard 305:

Tests, Monitoring

Peritoneal: at home or

CAPD

Haemodialysis: Satellite unit or

ward 301

Surgery

Ward 305 or Critical

Care

Discharge

Outpatients Surgical Clinic

Outpatients Medical Clinic

References• Organ Donation. How To Become A Donor. www.organdonation.nhs.uk/ukt/how_to_become_a_donor/ (accessed 25

November 2012).• Organ Donation. Queen Elizabeth Hospital (Centre Specific Report). www.organdonation.nhs.uk:8001/ukt/statistics/centre-

specific_reports/pdf/Birmingham.pdf (accessed 25 November 2012).

• NHS University Hospitals Birmingham . Patient Information Leaflets and Factsheets. www.uhb.nhs.uk/patient-information-leaflets.htm (accessed 25 November 2012).

• Patient UK. Chronic Kidney Disease (Chronic Renal Failure). www.patient.co.uk/doctor/chronic-kidney-disease-chronic-renal-failure (accessed 25 November 2012).

• Patient UK. Renal Replacement Therapy and Transplantation. www.patient.co.uk/doctor/renal-replacement-therapy-and-transplantation (accessed 25 November 2012).

• NHS National Institute for Health and Clinical Excellence (NICE). Quick Reference Guide: Chronic kidney disease: Early identification and management of chronic kidney disease in adults in primary and secondary care . Issued September 2008. www.nice.org.uk/nicemedia/live/12069/42119/42119.pdf (accessed 25 November 2012).

• NHS National Institute for Health and Clinical Excellence (NICE). Chronic kidney disease: Early identification and management of chronic kidney disease in adults in primary and secondary care. Issued September 2008. www.nice.org.uk/nicemedia/live/12069/42117/42117.pdf (accessed 25 November 2012).

Questions?