THE BEST OPTION FOR RRT
\nOne of the best option of kidney failure management is Kidney transplant<\/p>\n
it offer patients a new life
\nless mortality and morbidity
\nit less cost among the other options.<\/p>\n
In this few pages we If GOD Well will explore this option and will try to cover common ask questions about it
\nPATIENT WELLNESS
\nThe most important issue for kidney transplant is the patient wellness to have kidney transplant and he should know his responsibility and show commitment to obey and follow medical advices to survive transplanted kidney for long time
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\nKIDNEY TRANSPLANT
\nCOMMON ASKED QUESTIONS
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\nWhen renal patient could have kidney transplant?
\nDialysis patients: most kidney transplanted patients have kidney transplant after starting dialysis until available kidney donor
\nPre dialysis: patient who have chronic kidney disease progress to end stage can plan for kidney transplant before they starting dialysis.
\nFor diabetic patients can plan for kidney transplant when GFR (glomerular filtration rate) reach 20 ml per minute, while for undiabetic 15 ml per minute.
\nPre-emptive transplant can improve post-transplant patient and graft survival.
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\nIs me suitable for kidney transplant?
\nAll renal patients less than 75 years old are suitable for kidney transplant if comorbid illness can be treated before the surgery, unfortunately there are some medical conditions cannot be cured
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\nWhat the risk factors affect kidney survival?
\nMajor risk factors that have an impact on the recipient include age, the presence of diabetes mellitus, arteriosclerotic heart disease, chronic pulmonary disorders, and malignancy. Patient compliance
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\nTypes of kidney transplants
\nThere are two general types of kidney transplants
\none from a living donor and another from a deceased donor.
\nA living donor transplant is preferred to the deceased donor because these tend to be better quality kidneys in that the waitlist times tend to be low and graft survival is longer than deceased donor kidneys.
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\nWhat the suitable donor for me?
\nBasically the donor should have blood group compatible with yours.
\nIf blood types are not compatible, the donor still may be able to donate directly to you using treatments that lower your blood antibody levels.
\nIn addition, the donor may consider donating through a paired exchange program which would allow you to get a kidney from another donor who is not a match for their intended recipient.
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\nIs There an Age Cutoff for Kidney Donors?
\nThere is no limit for donor age, theoretically it can be from 6 to 80 years.
\nFor the pediatric they cannot legally give their \u201cinformed consent\u201d proving that they agree to the procedure, and there is some genetic kidney diseases cannot be detected at this age.
\nFor elderly more than 70 may have ageing kidney
\nThe age may not be a barrier to organ donation
\nKIDNEY TRANSPLANT
\nSPECIAL CASES
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\nRelative contraindication
\nDisseminated malignancy
\nExtensive vascular disease
\nHigh risk for perioperative mortality
\nPersistent coagulation abnormality
\nRenal disease with high recurrence rate
\nRefractory noncompliance
\nUrologic abnormalities
\nActive systemic illness
\nOngoing substance abuse
\nUncontrolled psychosis
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\nAge
\nThe very young patient (<5 years) and the elderly recipient do have a poorer patient and graft survival than patients of ages between these two extremes. However, with the improvements in perioperative management and immuno suppressive strategies, advanced age itself is no longer a contraindication
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\nObesity
\nObesity alone is rarely an absolute contraindication to transplantation, yet it is a well-defined risk factor.
\nLower graft survival rates as well as higher postoperative mortalities and complications have been demonstrated in patients with a body mass index (BMI) greater than 30 kg\/m2.
\nThe large body size is also a risk factor for progression and subsequent premature failure, due to the physiologic changes that have been linked to nephron hyperfiltration.
\nweight reduction is important for an obese dialysis patient before proceeding to transplantation.
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\nPrior Kidney Transplantation
\nRenal allograft failure is now one of the most common causes of ESRD, accounting for about 30% of patients awaiting renal transplantation.
\nGraft survival of a second and\/or third kidney transplant has been reported to be inferior to that of the first.
\nEvaluation of a potential recipient for a second or third allograft requires careful attention to the reason for the graft failure.
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\nFactors to be assessed include
\nnoncompliance with immunosuppressive medications
\nloss of the graft in association with recurrent renal disease
\nhigh alloreactivity with high panel-reactive antibody (PRA) titers (PRA).
\nThese patients may also manifest complications of prior immunosuppressive therapy, and as such should be screened for complications associated with these medications (e.g. infection and malignancy).
\nKIDNEY TRANSPLANT
\nTYPES OF KINDEY DONOR
\nTYPES OF KINDEY DONOR
\nLIVING DONOR
\nA living donor transplant is preferred to the deceased donor because these tend to be better quality kidneys in that the waitlist times tend to be low and graft survival is longer than deceased donor kidneys.<\/p>\n
The half-life of transplanted kidney<\/p>\n
living kidneys around 12\u201314 years
\ndeceased donor is around 9 years.
\nThe longer people wait for transplantation while on dialysis, the more unfavorable their outcomes are after transplant.
\nIdeally, patients would be transplanted before initiating dialysis, referred to as pre-emptive transplant, or as soon as possible after initiating dialysis.
\nPatients can be listed for transplant when their glomerulus filtration rate is below 20 mL\/min\/m2.
\nTYPES OF KINDEY DONOR
\nDECASED DONOR
\nA deceased donor kidney comes from a person who has chosen to be an organ donor and has been declared deceased.
\nLike the living donor, the deceased donor must have blood testing performed to show compatibility with the proposed recipient.
\nThe kidney transplant survival rate for the first year with a deceased donor kidney is 85 to 90 %.
\nThe average functional time period of a deceased donor kidney transplant is between 8-20 years.<\/p>\n
Statistics show that kidney transplants from live donors function longer and the survival rate for live donor kidneys is greater than 95 % for the first year.
\nThe average life of a kidney donated from a perfectly matched (tissue typing identical) sibling is 25 to 30 years
\nthe average life of a kidney donated from a half matched or unrelated donor is 16 years.<\/p>\n
BLOOD GROUP
\nSUITABLE RECIPIENT DONOR AB
\nRecipient blood group\tdonor blood group
\nA\tA and O
\nB\tB and O
\nAB\tA, B, AB and O
\nO\tO
\nKIDNEY TRANSPLANT AND GENDER
\nDONOR-RECIPIENT GENDER<\/p>\n
The most successful transplant based on donor-recipient gender was observed in male donor to male recipient, and then male donor to female recipient.
\nHOW I KNOW WHETHER THE DONOR IS HLA MATCH ?
\nIMMUNE SYSTEM ACTIVATION
\nyou should HLA typing in medical lab for you and for the donor.
\nInput here the results for initial assessment<\/p>\n
the best way is to select donor with immune compatibile with your body.
\nPerson\tClass A\tClass B\tClass DR
\nReciepent
\nDoner
\nHOW TO SELECT COMPATIBILE DONOR ?
\nHUMAN LEUKOCYTE ANTIGEN (HLA)
\nThe main part of immune system is human leukocyte antigen (HLA) system (the major histocompatibility complex [MHC] in humans), it controlled by genes located on chromosome 6.
\nIt encodes cell surface molecules specialized to present antigenic peptides to the T-cell receptor (TCR) on T cells.
\nThe donor with shared HLA matching will be the better. .<\/p>\n
Why HLA matching important ?.
\nHLA matching provides numerous benefits in organ transplantation including better graft function, fewer rejection episodes, longer graft survival, and the possibility of reduced immunosuppression.
\nMismatches are attended by more frequent rejection episodes that require increased immunosuppression that, in turn, can increase the risk of infection and malignancy.
\nHLA mismatches also incur the risk of sensitization, which can reduce the opportunity and increase waiting time for a subsequent transplant.<\/p>\n
HLA MATCHING TEST DONE, WHAT THEN ?
\nPRESENCE OF ANTIBODIES?
\nAFTER DECTING HLA MATHCING, ONE SHOULD SCREEN THE PRESENCE OF ANTIBODIES.
\nComplement Dependent Lymphocytotoxicity (CDC):<\/p>\n
IgG antibodies directed against HLA class I (on both B and T cells) are the most important
\nPRA stands for Panel Reactive Antibodies. In order to determine whether or not a patient already has any specific HLA antibodies
\nWhen PRA positive (there is HLA antibodies), it called the patient is sensitized, and need a procedure called desensitization<\/p>\n
sensitization
\nThe definition of sensitization is variable. One definition defines it as moderately sensitized when PRA is >20% and highly sensitized when the PRA >80%. This is however variable between centres.
\nWHAT HAPPEN IF I HAVE ANTIBODIES ?
\nDESENSITIZATION
\nIt is not easy to become sensitized to human HLA antigens. Most people waiting for a transplant (around 80%) are not sensitized. Patients can become sensitized to HLA antigens because of:<\/p>\n
Pregnancies. About 30-50% of women with three or more pregnancies will develop HLA antibodies. In some women the antibodies could be present for just a short time (weeks to months), while in others they may persist for many years.
\nBlood transfusions. About 50% of patients who receive multiple transfusions will develop antibodies. Today, most patients who require blood transfusions receive filtered blood, which decreases the chances for a patient to become sensitized.
\nPrevious transplant. About 90% of patients develop HLA antibodies within two weeks of a failed graft. However, by the time the patient is relisted (some will have “lost” their antibodies.
\nViral\/bacterial infections. There are some reports that patients with virus infections develop HLA antibodies, although this is relatively rare.
\nDESENSITIZATION PROTOCOLS OF KIDNEY TRANSPLANT RECIPIENTS
\nDESENSITIZATION PROTOCOLS
\nRemoval of anti-HLA antibodies
\nPlasmapheresis
\nImmunoadsorption
\nIdeS
\nDepletion of antibody-producing cells
\nNa\u00efve and memory B cells: rituximab (anti-CD20)
\nPlasma cells: bortezomib (proteosomal inhibitor)
\nInhibition of antibody and complement-system cascade
\nIVIg
\nComplement inhibitors
\nEculizumab (C5a inhibitor)
\nC1 inhibitor
\nInhibition of cytokines and inflammation
\nIVIg
\nTocilizumab (anti\u2013IL-6 receptor blocker)<\/p>\n
Abbreviations: IdeS, immunoglobulin G-degrading enzyme of Streptococcus pyogenes; IL-6, interleukin 6; IVIg, intravenous immune globulin.
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\nPLASMAPHERESIS AND IMMUNOADSORPTION
\nAIMED REMOVING ALLOANTIBODIES
\nPP removes all plasma proteins including Ig.
\nIA includes a sepharose-bound staphylococcal protein A column with a high affinity for binding IgG and developed to remove IgG antibodies.
\nThe advantages of IA over PP include specificity, a greater amount of antibody removal, and the elimination of the need to replace large volumes of plasma.
\nOne 3- to 4-hour treatment course with IA results in a 15% to 20% reduction and three to six courses of treatment result in 90% reduction in plasma IgG levels.
\nHowever, anti- HLA antibody titers rebound and return to baseline levels within a few weeks after the completion of PP or IA.
\nMost of the IA columns manufactured in USA and Japan are not approved by the FDA
\nINHIBITION OF ANTIBODY PRODUCTION & COMPLEMENT INHIBITORS
\nINHIBITING ANTIBODY PRODUCTION
\nRituximab (Anti-CD 20):
\noff label use in desensitization protocol\/treatment of AMR as a single dose of 375mg\/m\u00b2.
\nPlasma cells and pro-B cells do not have surface CD-20 decreasing the efficacy.
\nB-cell recovery takes 6-12 months.
\nBortezomib (Proteasomal Inhibitor):
\nInduces apoptosis of plasma cells.
\nGiven in dosage of 1.3 mg\/m\u00b2 and repeated on days 4, 8, and 11 intravenously over 3 to 5 seconds.
\nEculizumab:
\nIt is a monoclonal antibody against C5.
\nBinds to C5 protein with high affinity, thereby inhibiting its cleavage to C5a and C5b and preventing generation of the terminal complement complex C5b-9.<\/p>\n","protected":false},"excerpt":{"rendered":"
THE BEST OPTION FOR RRT One of the best option of kidney failure management is Kidney transplant it offer patients a new life less mortality and morbidity it less cost among the other options. In this few pages we If GOD Well will explore this option and will try to cover common ask questions about […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1274","post","type-post","status-publish","format-standard","hentry","category-med"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/1274","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/comments?post=1274"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/1274\/revisions"}],"predecessor-version":[{"id":1275,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/1274\/revisions\/1275"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/media?parent=1274"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/categories?post=1274"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/tags?post=1274"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}