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Renal Transplantation
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Renal Transplantation

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Renal Transplantation

Renal Transplantation

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Renal Transplantation Renal Transplantation Presentation Transcript

  • RENAL TRANSPLANTATION © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
  • HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Autotransplantation wellestablished 2nd century BC: Sushruta pioneered skin grafting for rhinoplasty
  • HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential 1933: Yu Yu Voronoy of the Soviet Union performed the first human-to-human kidney transplant 1954: Joseph E. Murray performed the first successful kidney transplant Donor and recipient identical twins
  • HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
    • Early attempts at
    • immunosuppression
    • Whole-body X-irradiation
    • Nitrogen mustard
    • 6-mercaptopurine
    • 1957 : George Hitchings and
    • Gertrude Elion modify 6-MP to
    • produce azathioprine
    • 1963: Thomas Starzl observed that
    • large doses of corticosteroids can
    • reverse rejection episodes and
    • stabilize allograft function
  • .
    • ESRD on Renal Replacement
    • Therapy (RRT) ie Hemodialysis
    • or Peritoneal Dialysis
    • Chronic Renal Insufficiency
    • approaching the need for RTT-
    • ” pre-emptive” transplant
    • Common causes of ESRD: – HTN
    • – DM
    • – PCKD
    • – IgA Nephropathy
    • – Congenital abnormalities
    • Renal Dysgenesis
    • Obstructive Uropathy
    • – FSGS
    • – Lupus
    Basics of Transplantation © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
  • RENAL BLOOD FLOW © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Cardiac out put Mean Arterial Pressure “ Effective Circulating Volume” Intrarenal Autoregulation Normal RBF/RPF Renal Perfusion Pressure GFR, FF
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential RELATIONSHIP BETWEEN GFR AND S.CREATININE IN ESRD Serum Creatinine (mg/dl) GFR (ml/min per 1.73m 2 ) 1.0 0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 40 60 80 100 120 140 160 180 20 0
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Anatomy of Renal Transplantation
    • Living Kidney Donor (LKD)
    • – Sibling
    • – Parent
    • – Child
    • – Spouse/partner
    • Deceased Donors
    • – Brain Dead
    • – Donation after Cardiac Death (DCD)
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential SOURCES OF KIDNEY
    • Labs:
    • – CBC, CMP, PT/PTT, LFT,
    • Serologies (Hepatitis B and C,
    • HIV, CMV, EBV, HTLV)
    • – ABO x2
    • – HLA’s
    • Chest X-ray
    • Cardiac Clearance
    • – EKG, Echo, Stress, Angio,
    • cardiology consult
    • Cancer screening
    • – Pap, Mammo, PSA,
    • Colonoscopy
    • Dental clearance
    • SW evaluation
    • Surgeon or other transplant
    • physician consultation
    • Other possible
    • tests/consultations
    • – Lower extremity dopplers
    • – Carotid dopplers
    • – CT scans
    • – PFT’s
    • – Cystogram
    • – TB test
    • – Endocrine
    • – Infectious Disease
    • – Hepatology
    • – Psychiatric evaluation
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential EVALUATION PROCESS
    • Histocompatibility
    • Laboratory Tests
    • Blood Typing
    • Tissue Typing
    • Crossmatch Testing
    • Panel Reactive
    • Antibody (PRA)
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential PRE TRANSPLANT EVALUTION
    • Life expectancy
    • Cardiovascular benefits
    • Quality of life
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENEFITS OF TRANSPLANT
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential LIFE EXPECTANCY
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential CARDIOVASCULAR BENEFITS
    • Numerous studies have detailed improved quality of life.
    • Life satisfaction, physical and emotional well-being and ability to return to work higher in transplant recipients.
    • Uremic complications more fully reversed.
    • Fertility returns.
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential QUALITY OF LIFE
    • Clinical signs:
    • Malaise
    • Fever
    • Oliguria
    • Hypertension
    • Graft tenderness
    • Diagnosis hinges on serial
    • creatinine measurements
    • Elevation of 20% over baseline
    • triggers further evaluation
    • Rule out non-immunologic causes
    • Ultrasonography
    • Renal scanning
    • Percutaneous biopsy
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
    • Banff criteria
    • Interpretation of renal biopsy
    • specimens for diagnosing rejection
    • have been greatly facilitated and
    • standardized
    • Based on scores for glomerular,
    • vascular, interstitial, and tubular
    • lesions
    • Has been shown to have clinical
    • relevance when predicting
    • rejection reversal and may prove
    • useful for choosing first-line
    • therapy of rejection episodes
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 1: Moderate interstitial mononuclear inflammation affecting 25-50% of the sampled parenchyma
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 2: Moderate interstitial mononuclear infiltrate involving 26-50% of the renal parenchyma
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 3: severe transmural arteritis and/or transmural fibrinoid change and necrosis of smooth muscle cells
    • Biochemical markers
    • Various markers reported to correlate with rejection
    • ß2-microglobulin1
    • Neopterin2
    • PCR amplification of messenger RNA in urinary sediment3
    • Perforin mRNA
    • Granzyme B mRNA
    • Strong predictive value for acute rejection
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
  • © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential IMMUNOSUPPRESIVE MEDICATION
    • Early complications
      • Surgical complications
      • Delayed or slow graft function
      • Lymphocele
    • Acute rejection
      • Acute cellular rejection
      • Antibody-mediated rejection
    • Infectious complications
      • Cytomegalovirus
      • BK virus
      • Others
    • Malignancy
    • Chronic allograft dysfunction
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential COMMON COMPLICATION OF TRANSPLANTATION
  • OUR NETWORK
    • The transplant programs at HIGH BEAM GLOBAL India partner hospital have earned a number of distinctions in the field, including the #1 ranking in the country in both patient and graft survival for kidney transplant.....
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
    • Liver Transplantation for children and adults with acute and chronic liver failure /cirrhosis
    • Living related Liver transplant and Cadaveric transplant
    • Pediatric hepatology service including transplant and biliary surgery
    • Adult Hepatology and Gastroenterology
    • Renal Transplantation in adults and children including Lap Donor Nephrectomy
    • Complex vascular and peritoneal access procedures
    • Complex Hepatobiliary Surgery...
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential OUR NETWORK FACILITIES
    • Organ transplantation induces a
    • fundamentally abnormal physiologic state
    • Steady improvement has been made in
    • both prevention and treatment of organ
    • rejection
    • The potential for further improvement –
    • both incremental and revolutionary – is
    • great
    © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential CONCLUSION
  • Contact Us © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential High Beam Global 209, Udyog Vihar, Phase – 1, Gurgaon. Phone: +91-124-4824560 Fax: +91-124-4824550 E-mail: [email_address] ; [email_address] Web address: www.medicalfacilitiesinindia.com www.highbeamglobal.com
  • Thank you for considering us © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential