2. INTRODUCTION:
– Kidney transplantation is the preferred means of
renal transplant therapy in the pediatric age group
– Transplantation offers the opportunity for a
relatively normal life
3. RENAL TRANSPLANT:
– Renal/ kidney transplant is the organ transplant of
a kidney into a patient with end stage renal disease
7. COMPATABILITY:
– The patient has to be ABO compatible
– The recipient should share as many as HLA
antigens and minor antigens as possible
– Immuno-suppressant drugs are given to prevent
antibody reaction
– Perform antibody test on potential recipient
8. LIVING DONOR:
– Evaluate donors on physical, medical and
psychological grounds
– Assure the patient that there will be no long terms
harm to donor
– In some cases male living donor may develop a
hydrocele on the scrotum on the side of the
nephrectomy
9. – Live donor procedure are mostly laparoscopic,
hence less painful , less scaring and faster
recovery
12. – Auto immune condition( lupus, good pastures
syndrome)
– Chronic renal failure
13. CONTRA INDICATION:
– Cardiac and pulmonary insufficiency
– Hepatic disease
– Substance abuse
– HIV
– Concurrent tobacco use
– Morbid obesity
14. PRE OPERATIVE
PERIOD:
– TEAM comprises;
– Urologist, nephrologist, nurses, transplant co
Ordinator, renal transplant educator, clinical
dietician and physiotherapist
15.
16. MANAGEMENT:
OVERALL GOAL:
– To promote maximum renal function
– To maintain fluids and electrolyte balance within safe
biochemical limits
– To treat systemic complication
– To promote active and normal life as long as possible
17. DIET:
Protein: 0.8- 1g/kg/day
Sodium: since renal regulation of Na reabsorption
is impaired, its dietary intake needs to be
individualized
Potassium: should be avoided
19. Calcium and phosphorus: given in the form of
calcium carbonate or acetate, diary products should
be avoided
Water: restriction in case of fluid overload, excessive
use of diuretics, restriction of salt and gastroenteritis
may lead to dehydration that should be corrected
20. CONTROLLING
HYPERTENSION:
– Decreased fluid intake
– Sodium restriction
– Administration of hydralazine. Beta blockers(
atenolol, propanalol), ca channel antagonist(
nifedipine, amlodipine)
– If not treated , angiotensin converting enzymes
inhibitors( enalapril), clonidine or prazosin
21. MANAGING
ANEMIA:
– Parental administration of recombinant human
erythropoietin is the treatment of choice for anemia
of CRF
– Iron & folic acid supplementation
– Red cell packed transfusion( Hb< 6g/dl) slowly since
it can aggravate hypertension and lead to heart failure
23. MAINTAIN GROWTH:
– Treatment of osteodystrophy is important
– Administration of recombinant human growth
hormone improves growth velocity in children
with CRF
24. DENTAL CARE:
– Dental defects are common in children(
hypoplasia, hypo mineralization, tooth
discoloration and alteration in size and shape of
teeth
– Therefore regular care of teeth is vital
25. POST OPERATIVE
PERIOD:
– The main focus is on achieving graft function and early
mobilization without the difficulties of rejection, infection,
fluid overload and technical mishap
– Fluid replacement
– Hemodynamic monitoring
– Urine output
– Care of Vascular and ureteric drain
26. – Vital signs
– Central venous pressure( to ensure appropriate
renal function)
– Antibiotic and immunosuppressive therapy
– Ventilatory support( increase in intra abdominal
pressure causes respiratory difficulties in case of
transplant of adult kidney to the child)
27. DRUGS:
– Tab. Mycofenolate mofelate( 40mg/kg/day in 2 divided dose) or
tab. Mycophenolate sodium(30mg/kg/day in 2 divided dose)
– Tab. Tacrolimus( 0.15mg/kg/day in 2 divided dose)
– Azathioprine( 1.5- 2mg/kg/day 3 days prior to transplantation)
– Inj. Dexamethasone( 0.3mg/kg)
– In. Emeset
– Tab. Prednisolone(start 0.4 mg/kg/day & continue 10mg once
daily)
