PREEMPTIVE TRANSPLANTATION

In certain cases, kidney patient may be offered a kidney from a relative...

 

Preemptive transplant

 

In certain cases, kidney patient may be offered a kidney from a relative

 or he/she may refuse completely the procedures of dialysis, so, he/she advised to start the steps of transplant preparation, it is long journey of laboratory and radiological investigations. So, if he received a kidney with no dialysis, this is pre-preemptive transplant.

 

How can we prepare a patient for kidney transplant?

This is a long story but it is interesting to go through this clinical journey. Two main inlets of preparation should be accomplished:

I.             Patient (recipient) preparation: this stage includes the following:

1)            Full detailed history as regard the original kidney disease and cause of kidney failure(

2)            Blood grouping to determine the best group matching for the patient.

3)            Complete blood picture (CBC), to determine his hemoglobin level (HB) or any evidence of infection (increased leukocytic or neutrophilic count) and other blood diseases.

4)            Blood biochemistry: that includes liver function tests, kidney function tests, lipid profile (total cholesterol, HDL, LDL and triglycerides), calcium and phosphorus level and blood sugar.

5)            Complete urine analysis.

6)            Urine culture and sensitivity in case of presence urinary tract infection.

7)            24 hours urine collection for proteins or albumin/creatinine ratio.

8)            HB A1C: this reads the blood sugar levels evaluation in the last three months before sampling.

9)            Clinical evaluation that includes: blood pressure monitoring, other vital signs e.g., pulse, temperature and respiratory rate. A general and local examination should be passed through various body organs.

10)         Virology testing: Hepatitis B, Hepatitis C, AIDS, cytomegalovirus, PK virus and other common viruses.

11)         Respiratory function tests.

12)         Electrocardiogram (ECG).

13)         DSA (donor sensitive antibodies) testing.

14)         Radiological examination: that include the following:

•     Plain x-ray chest.
• ·                     Echocardiogram.
• ·                     Abdomino-pelvic ultrasound and kidney dimensions.
• ·                     Bone mineral density.
• ·                     Ascending cystourethrogram.
• ·                     Stress thallium study
• ·                     Doppler study to arterial and venous of both upper and lower limbs.
•  Cardiac catheterization if indicated in cardiac patients.

:II.            Donor preparation: that include the following

1.      Blood grouping to determine the best group matching for the patient
2.     Complete blood picture (CBC), to determine his hemoglobin level (HB) or any evidence of infection (increased leukocytic or neutrophilic count) and other blood diseases.
3.     Blood biochemistry: that includes liver function tests, kidney function tests, lipid profile (total cholesterol, HDL, LDL and triglycerides), calcium and phosphorus level and blood sugar.
4.     Complete urine analysis.
5.     24 hours urine collection for proteins or albumin/creatinine ratio.
6.    HB A1C: this reads the blood sugar levels evaluation in the last three months before sampling.
7.     Clinical evaluation that includes: blood pressure monitoring, other vital signs e.g., pulse, temperature and respiratory rate. A general and local examination should be passed through various body organs.
8.    Virology testing: Hepatitis B, Hepatitis C, AIDS, cytomegalovirus, PK virus and other common viruses.
9.     Electrocardiogram (ECG).
10. Radiological examination: that include the following:

• ·                     Plain x-ray chest.
• ·                     Echocardiogram.
• ·                     Abdomino-pelvic ultrasound and kidney dimensions.

1. -       After the primary preparation of both of the donor and recipient have been accomplished, first cross matching will be proceeded and another one will be performed just before surgery.
2. -       “Tissue typing” is a fundamental test will be performed to determine the patient with a high risk of rejection.