Kidney transplant

common asked questions

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When renal patient could have kidney transplant?
  • Dialysis patients: most kidney transplanted patients have kidney transplant after starting dialysis until available kidney donor
  • Pre dialysis: patient who have chronic kidney disease progress to end stage can plan for kidney transplant before they starting dialysis.
    For diabetic patients can plan for kidney transplant when GFR (glomerular filtration rate) reach 20 ml per minute, while for undiabetic 15 ml per minute.
    Pre-emptive transplant can improve post-transplant patient and graft survival.
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    Is me suitable for kidney transplant?
    All 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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    What the risk factors affect kidney survival?
    Major 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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    Types of kidney transplants
    There are two general types of kidney transplants
    one from a living donor and another from a deceased donor.
    A 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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    What the suitable donor for me?
    Basically the donor should have blood group compatible with yours.
    If blood types are not compatible, the donor still may be able to donate directly to you using treatments that lower your blood antibody levels.
    In 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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    Is There an Age Cutoff for Kidney Donors?
    There is no limit for donor age, theoretically it can be from 6 to 80 years.
    For the pediatric they cannot legally give their “informed consent” proving that they agree to the procedure, and there is some genetic kidney diseases cannot be detected at this age.
    For elderly more than 70 may have ageing kidney
    The age may not be a barrier to organ donation
    Kidney transplant

    Special cases

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    Relative contraindication
  • Disseminated malignancy
  • Extensive vascular disease
  • High risk for perioperative mortality
  • Persistent coagulation abnormality
  • Renal disease with high recurrence rate
  • Refractory noncompliance
  • Urologic abnormalities
  • Active systemic illness
  • Ongoing substance abuse
  • Uncontrolled psychosis
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    The 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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    Obesity alone is rarely an absolute contraindication to transplantation, yet it is a well-defined risk factor.
    Lower 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.
    The 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.
    weight reduction is important for an obese dialysis patient before proceeding to transplantation.
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    Prior Kidney Transplantation
    Renal allograft failure is now one of the most common causes of ESRD, accounting for about 30% of patients awaiting renal transplantation.
    Graft survival of a second and/or third kidney transplant has been reported to be inferior to that of the first.
    Evaluation of a potential recipient for a second or third allograft requires careful attention to the reason for the graft failure.
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    Factors to be assessed include
  • noncompliance with immunosuppressive medications
  • loss of the graft in association with recurrent renal disease
  • high alloreactivity with high panel-reactive antibody (PRA) titers (PRA).
    These 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).
  • Kidney transplant

    Types of kindey donor