Evaluation of kidney donor sudan 2017

1. Evaluation of kidney Donor
Dr. Osama El-shahat
Consultant nephrologist
Head of nephrology department
New Mansoura general hospital (international)
ISN educational ambassador

2. Better out come
Shorter waiting time
Elective planning and optimization of the
recipient health status
Realistic chance for pre-emptive kidney
transplantation
Rational for living donation

3.  Education, counseling and consenting
 Psychological evaluation
 Medical screening process
 Identification of transmissible infections
 Evaluation of renal anatomy
Donor evaluation process

4.  Complications
 Blood grouping and HLA
 Medical evaluation steps
 Stress of the right to withdraw at any time
 Follow up
 Informed consent
 ILDA
Education, counseling and
consenting
Erratum in: Am J Transplant. 2015 May;15(5):1447

5.  Psychiatrist, psychologist or social worker
 For :
 Psychological evaluation and identification of active
mental health problems
 Social assessment including high risk behavior
 Assessment of consenting ability
Psychological evaluation

6. History of physical examination
Laboratory testing
Identification of transmissible infection
Evaluating renal anatomy and function
Medical screening process

7. 2014
Medical screening process

8. 2014

9. 2014

10. 2014

11. 2014

12. 2014

13. 2014

14. Immunological work up
•MHC class I molecules
•HLA A, B, C
•found on all nucleated cells
•MHC class II molecules
•HLA DP, DQ, DR
•Expressed on antigen presenting cells (and inducible)
•Nomenclature
• according to the techniques “ serological or DNA
sequencing “

15.  Absolute
 <18 year-old
 Active substance abuse
 Impaired ability ta make a decision
 Hypertension
 DM
 Morbid obesity
 Renal disease
 Renal stones
 Inherited renal disease
 Infections
 Cancer
 Cardiovascular disease
 Significant size discrepancy
Contraindication for donation

16.  Relative
 Age > 65
 Controlled Hypertension
 Impaired glucose tolerance
 Obesity
 Borderline line renal function
 Microscopic hematuria
 Single renal stone
Contraindication

17. Types of Donors

18.  Genetically Related
 Emotionally Related
 Altruistic Donors
 Organ Exchangers
 Vendors
Types of Live Donors

19. Organ Exchangers
Nephrology Self-Assessment Program - Vol 10, No 6, November 2011

20. Iranian Model
Clin J Am Soc Nephrol 1: 1136–1145, 2006

21. Contraindications

22. Contraindications
Clin J Am Soc Nephrol February, 2012
Types of Donors

23. Evaluation

24. Live Kidney Donor: Evaluation
Checklist
2015

25. Live Kidney Donor:
Evaluation Checklist
2015

26. Guidelines

27. American Journal of Transplantation April 2015; 15: 914–922

28. Special Situations

29. Ethical Issues
Transplantation Reviews 28 (2014) 134–139
Case Vignette #4 – Case of the older recipient and young spousal donor

30. Kidney International (2015) 87, 31–45;
Living Donor
Eligibility

31. Kidney International (2015) 87, 31–45;
Living Donor
Eligibility

32. HCV
Nat. Rev. Nephrol. 11, 172–182 (March 2015); published online 3 February 2015;

33. Schistosomiasis:
Mansoura Experience

34. Clin Transplant 2014: 28: 419–422
Smoking

35. 30
 Hereditary nephritis: 25/30
 Isolated C3 deposited disease: 3/30
 IgA nephropathy: 1/30
 IgM nephropathy: 1/30
Hematuria:
Mansoura Experience

36. An asymptomatic potential donor with history of a single
stone may be suitable for kidney donation if:
1. No hypercalciuria, hyperuricemia or metabolic acidosis.
2. No cystinuria or hyperoxaluria.
3. No urinary tract infection.
4. No multiple stones or nephrocalcinosis are evident on CT scan
Live Donor:
Urinary Stones

37. MDT
Transplant
Nephrologist
Transplant
Surgeon
Pathology
Lab
Radiologist
Immunology Lab
System

38. Donor Radiological
assessment

39. DONOR RADIOLOGICAL ASSESSMENT

41. US Chest x ray

42. Spiral CT CTA

43. How to Assess The
Split Function?
Clin Transplant 2016; 30: 1028–1035

44. Renogram

45. Relative (split) function
ROI’s
Renogram

46. Renogram curves

47. IVU
 Kidney film 3 min.
 A KUB radiograph is obtained to assess temporal
symmetry and opacification.
 Compression? (Contraindications ).

52. Safety of using HCV ab +ve PCR –ve kidney
donors to HCV –ve recipients

55. Safety of using HCV ab +ve PCR –ve
kidney donors to HCV –ve
recipients
 Between 1993 and 2013  23 HCVab+/PCR- donors
 6 recipients were +ve
 17 recipients were -ve
 Mainly children
 Age of recipients ranges from 10 to 43 years (only 3
recipients above 30)
 All donors were parents except 5 “ 2 brothers, 2
uncles and one unrelated”

58.  It is diethylene triamine pentaacetic acid ( 99mTc-DTPA)
isotopic clearance.
 Compared with inulin clearance & correlation was 0.97
 So, it is reliable in measurement of GFR.
 Among all radionuclidic methods 99mTc-DTPA shows the
best results .
Radioisotopes
Rehling et al., Clin Sci 1985; 66:613-619
Fotopoulos (Abstract). Hell J Nucl Med 2006; 9:133-140

59.  Abimereki et al., 2014 reported that Compared with
matched healthy nondonors, kidney donors had an
increased risk of ESRD over a median of 7.6 years
 These findings may help inform discussions with
persons considering live kidney donation.
 Their finding has urged us to do that study to see what
will happen to kidney function after kidney donation
Risk of ESRD Following Live Kidney
Donation

61.  It is diethylene triamine pentaacetic acid ( 99mTc-DTPA)
isotopic clearance.
 Compared with inulin clearance & correlation was 0.97
 So, it is reliable in measurement of GFR.
 Among all radionuclidic methods 99mTc-DTPA shows the
best results .
Radioisotopes
Rehling et al., Clin Sci 1985; 66:613-619
Fotopoulos (Abstract). Hell J Nucl Med 2006; 9:133-140

62.  Creatinine Clearance = UxV/Px
 Cockcroft-Gault : eGFR (ml/min) = (140 – age) x body weight
/ (72 x SCr) (x 0.85 for women)
 Walser eGFR (ml/min/3m2)=7.57x(SCr x 0.0884)-1 -0.103 x
age+0.096 x weight-6.66 for man
 =6.05 x (SCr x 0.0884)-1 -0.080 x age + 0.080 x weight – 4.81
for woman

GFR estimation
Clausen, Med. Montsschr 1953: 7:652-7
Cockcroft AW , Gault MH: Nephron 1976; 16:31-4.
Walser et al., Kidney Int 1993; 44 (5):1145-1148.

63. DonorRecipient
A or OA
B or OB
AllAB
OO
Transplantation 2004;78: 1693–1696)
Living Donor
ABO/Rh Matching

64. Preparation

65.  Identification of HLA Antibodies
Cell based assay
CDC
Flowcytometry
Solid phase assay
ELIZA
Flowcytometry
Luminex
Immunological work up

66. Antiglobulin-Enhanced Technique
•More sensitive
•Can detect non-complement
binding antibodies
•Can detect antibodies present
in small amounts

67. Laser
Cells
Flow chamber
Laser activated
fluorochromes
emit light in red
or green
spectrum
Flow Crossmatch
Donor cells are
incubated with
recipient serum
and then
fluorochrome-
coated antihuman
antibodies

68. Panel Reactive Antibodies
Donor non specific
Donor specific
Different limit across centers
PRA

69. Why Do Patients Make Anti-HLA
Antibodies?
Antibodies occur due to exposure to:
-- Blood product
-- Pregnancies
-- Transplants
-- idiopathic

70.  Identification of transmissible infection
 HCV, HBV, HIV and CMV
 TB
 Rapid plasma reagin
 Strongleloids, Trypanosoma cruzi and West
Nile virus
Identification of transmissible
infection

71. 1- Re-transplant patient
 Cause of the first graft loss
 Duration of the first transplant
 Nephrectomy
 Malignancy, cardiovascular risk
Specific situations

72. Techniques for Detecting
Anti HLA Antibodies
•Cytotoxic—the classic
•Solid Phase—the present

73. Cells vs. Beads for PRA and antibody
specificity determination
 Cells have multiple HLA antigens
 Use of donor cells determines if a patient has
antibodies to donor antigens (OK for the
crossmatch)
 But cells do not allow identification of specific
antigens to which a patient has antibodies
 Beads have only HLA and their use can determine PRA and
identify antibodies to specific antigens

74. Laser
Beads
Flow chamber
Laser activated
fluorochromes
emit light
The intensity of
light indicates
the PRA
Flow PRA Determination
HLA antigen coated
beads are incubated
with patient serum
and then with a
fluorochrome tagged
anti human antibody

75. 40
50
60
70
80
90
100
0 1 2 3 4
NDSA (152)
DSA (66)
no antibodies (550)
89%
Years after testing
%Graftsurvival
p < 0.0001
p < 0.0001 70%
51%
Lachmann, Terasaki, et al. Clinical Transplants 2006, p. 189
Impact of DSA on Graft Survival
Patients were tested once,
post transplantation in
2002, and followed for 4
years

76. HLA Antibody Identification
•Using Luminex Single Antigen Beads
•Beads have HLA molecules of a single specificity
•Can identify unacceptable donor antigens
•Can identify acceptable donor antigens

77. B7
A2
Laser
Beads
Flow chamber
Laser activated
fluorochromes
emit light and
beads emit
intrinsic colors
identifying which
antigens are
bound
HLA antigen Specificity
Determination
Single HLA antigen
coated beads are
incubated with patient
serum and then with a
fluorochrome tagged
anti human antibody