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 2n...
HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential 1933: Yu Yu Voronoy of the Soviet Unio...
HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential <ul><li>Early attempts at </li></ul><u...
. <ul><li>ESRD on Renal Replacement  </li></ul><ul><li>Therapy (RRT) ie Hemodialysis </li></ul><ul><li>or Peritoneal Dialy...
RENAL BLOOD FLOW © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Cardiac out put Mean Arterial...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential RELATIONSHIP BETWEEN GFR AND S.CREATININE IN E...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Anatomy of Renal Transplantation
<ul><li>Living Kidney Donor (LKD) </li></ul><ul><li>–  Sibling </li></ul><ul><li>–  Parent </li></ul><ul><li>–  Child </li...
<ul><li>Labs:   </li></ul><ul><li>–  CBC, CMP, PT/PTT, LFT, </li></ul><ul><li>Serologies (Hepatitis B and C, </li></ul><ul...
<ul><li>Histocompatibility </li></ul><ul><li>Laboratory Tests </li></ul><ul><li>Blood Typing </li></ul><ul><li>Tissue Typi...
<ul><li>Life expectancy </li></ul><ul><li>Cardiovascular benefits </li></ul><ul><li>Quality of life </li></ul>© High Beam ...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential LIFE EXPECTANCY
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential CARDIOVASCULAR BENEFITS
<ul><li>Numerous studies have detailed improved quality of life. </li></ul><ul><li>Life satisfaction, physical and emotion...
<ul><li>Clinical signs: </li></ul><ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Oliguria </li></ul><ul><li>Hyp...
<ul><li>Banff criteria </li></ul><ul><li>Interpretation of renal biopsy </li></ul><ul><li>specimens for diagnosing rejecti...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 1: Moderate interstitial ...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 2: Moderate interstitial ...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENFF CRITERIA Grade 3: severe transmural arte...
<ul><li>Biochemical markers </li></ul><ul><li>Various markers reported to correlate  with rejection </li></ul><ul><li>ß2-m...
© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential IMMUNOSUPPRESIVE MEDICATION
<ul><li>Early complications </li></ul><ul><ul><li>Surgical complications </li></ul></ul><ul><ul><li>Delayed or slow graft ...
OUR NETWORK <ul><li>The transplant programs at HIGH BEAM GLOBAL India partner hospital have earned a number of distinction...
<ul><li>Liver Transplantation for children and adults with acute and chronic liver failure /cirrhosis </li></ul><ul><li>Li...
<ul><li>Organ transplantation induces a </li></ul><ul><li>fundamentally abnormal physiologic state </li></ul><ul><li>Stead...
Contact Us © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential High Beam Global  209, Udyog Vihar,...
Thank you for considering us © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
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Renal Transplantation

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Renal Transplantation

  1. 1. RENAL TRANSPLANTATION © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
  2. 2. HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Autotransplantation wellestablished 2nd century BC: Sushruta pioneered skin grafting for rhinoplasty
  3. 3. 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
  4. 4. HISTORY © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential <ul><li>Early attempts at </li></ul><ul><li>immunosuppression </li></ul><ul><li>Whole-body X-irradiation </li></ul><ul><li>Nitrogen mustard </li></ul><ul><li>6-mercaptopurine </li></ul><ul><li>1957 : George Hitchings and </li></ul><ul><li>Gertrude Elion modify 6-MP to </li></ul><ul><li>produce azathioprine </li></ul><ul><li>1963: Thomas Starzl observed that </li></ul><ul><li>large doses of corticosteroids can </li></ul><ul><li>reverse rejection episodes and </li></ul><ul><li>stabilize allograft function </li></ul>
  5. 5. . <ul><li>ESRD on Renal Replacement </li></ul><ul><li>Therapy (RRT) ie Hemodialysis </li></ul><ul><li>or Peritoneal Dialysis </li></ul><ul><li>Chronic Renal Insufficiency </li></ul><ul><li>approaching the need for RTT- </li></ul><ul><li>” pre-emptive” transplant </li></ul><ul><li>Common causes of ESRD: – HTN </li></ul><ul><li>– DM </li></ul><ul><li>– PCKD </li></ul><ul><li>– IgA Nephropathy </li></ul><ul><li>– Congenital abnormalities </li></ul><ul><li>Renal Dysgenesis </li></ul><ul><li>Obstructive Uropathy </li></ul><ul><li>– FSGS </li></ul><ul><li>– Lupus </li></ul>Basics of Transplantation © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
  6. 6. 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
  7. 7. © 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
  8. 8. © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential Anatomy of Renal Transplantation
  9. 9. <ul><li>Living Kidney Donor (LKD) </li></ul><ul><li>– Sibling </li></ul><ul><li>– Parent </li></ul><ul><li>– Child </li></ul><ul><li>– Spouse/partner </li></ul><ul><li>Deceased Donors </li></ul><ul><li>– Brain Dead </li></ul><ul><li>– Donation after Cardiac Death (DCD) </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential SOURCES OF KIDNEY
  10. 10. <ul><li>Labs: </li></ul><ul><li>– CBC, CMP, PT/PTT, LFT, </li></ul><ul><li>Serologies (Hepatitis B and C, </li></ul><ul><li>HIV, CMV, EBV, HTLV) </li></ul><ul><li>– ABO x2 </li></ul><ul><li>– HLA’s </li></ul><ul><li>Chest X-ray </li></ul><ul><li>Cardiac Clearance </li></ul><ul><li>– EKG, Echo, Stress, Angio, </li></ul><ul><li>cardiology consult </li></ul><ul><li>Cancer screening </li></ul><ul><li>– Pap, Mammo, PSA, </li></ul><ul><li>Colonoscopy </li></ul><ul><li>Dental clearance </li></ul><ul><li>SW evaluation </li></ul><ul><li>Surgeon or other transplant </li></ul><ul><li>physician consultation </li></ul><ul><li>Other possible </li></ul><ul><li>tests/consultations </li></ul><ul><li>– Lower extremity dopplers </li></ul><ul><li>– Carotid dopplers </li></ul><ul><li>– CT scans </li></ul><ul><li>– PFT’s </li></ul><ul><li>– Cystogram </li></ul><ul><li>– TB test </li></ul><ul><li>– Endocrine </li></ul><ul><li>– Infectious Disease </li></ul><ul><li>– Hepatology </li></ul><ul><li>– Psychiatric evaluation </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential EVALUATION PROCESS
  11. 11. <ul><li>Histocompatibility </li></ul><ul><li>Laboratory Tests </li></ul><ul><li>Blood Typing </li></ul><ul><li>Tissue Typing </li></ul><ul><li>Crossmatch Testing </li></ul><ul><li>Panel Reactive </li></ul><ul><li>Antibody (PRA) </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential PRE TRANSPLANT EVALUTION
  12. 12. <ul><li>Life expectancy </li></ul><ul><li>Cardiovascular benefits </li></ul><ul><li>Quality of life </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential BENEFITS OF TRANSPLANT
  13. 13. © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential LIFE EXPECTANCY
  14. 14. © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential CARDIOVASCULAR BENEFITS
  15. 15. <ul><li>Numerous studies have detailed improved quality of life. </li></ul><ul><li>Life satisfaction, physical and emotional well-being and ability to return to work higher in transplant recipients. </li></ul><ul><li>Uremic complications more fully reversed. </li></ul><ul><li>Fertility returns. </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential QUALITY OF LIFE
  16. 16. <ul><li>Clinical signs: </li></ul><ul><li>Malaise </li></ul><ul><li>Fever </li></ul><ul><li>Oliguria </li></ul><ul><li>Hypertension </li></ul><ul><li>Graft tenderness </li></ul><ul><li>Diagnosis hinges on serial </li></ul><ul><li>creatinine measurements </li></ul><ul><li>Elevation of 20% over baseline </li></ul><ul><li>triggers further evaluation </li></ul><ul><li>Rule out non-immunologic causes </li></ul><ul><li>Ultrasonography </li></ul><ul><li>Renal scanning </li></ul><ul><li>Percutaneous biopsy </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
  17. 17. <ul><li>Banff criteria </li></ul><ul><li>Interpretation of renal biopsy </li></ul><ul><li>specimens for diagnosing rejection </li></ul><ul><li>have been greatly facilitated and </li></ul><ul><li>standardized </li></ul><ul><li>Based on scores for glomerular, </li></ul><ul><li>vascular, interstitial, and tubular </li></ul><ul><li>lesions </li></ul><ul><li>Has been shown to have clinical </li></ul><ul><li>relevance when predicting </li></ul><ul><li>rejection reversal and may prove </li></ul><ul><li>useful for choosing first-line </li></ul><ul><li>therapy of rejection episodes </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
  18. 18. © 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
  19. 19. © 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
  20. 20. © 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
  21. 21. <ul><li>Biochemical markers </li></ul><ul><li>Various markers reported to correlate with rejection </li></ul><ul><li>ß2-microglobulin1 </li></ul><ul><li>Neopterin2 </li></ul><ul><li>PCR amplification of messenger RNA in urinary sediment3 </li></ul><ul><li>Perforin mRNA </li></ul><ul><li>Granzyme B mRNA </li></ul><ul><li>Strong predictive value for acute rejection </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential DIAGNOSIS OF REJECTION
  22. 22. © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential IMMUNOSUPPRESIVE MEDICATION
  23. 23. <ul><li>Early complications </li></ul><ul><ul><li>Surgical complications </li></ul></ul><ul><ul><li>Delayed or slow graft function </li></ul></ul><ul><ul><li>Lymphocele </li></ul></ul><ul><li>Acute rejection </li></ul><ul><ul><li>Acute cellular rejection </li></ul></ul><ul><ul><li>Antibody-mediated rejection </li></ul></ul><ul><li>Infectious complications </li></ul><ul><ul><li>Cytomegalovirus </li></ul></ul><ul><ul><li>BK virus </li></ul></ul><ul><ul><li>Others </li></ul></ul><ul><li>Malignancy </li></ul><ul><li>Chronic allograft dysfunction </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential COMMON COMPLICATION OF TRANSPLANTATION
  24. 24. OUR NETWORK <ul><li>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..... </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential
  25. 25. <ul><li>Liver Transplantation for children and adults with acute and chronic liver failure /cirrhosis </li></ul><ul><li>Living related Liver transplant and Cadaveric transplant </li></ul><ul><li>Pediatric hepatology service including transplant and biliary surgery </li></ul><ul><li>Adult Hepatology and Gastroenterology </li></ul><ul><li>Renal Transplantation in adults and children including Lap Donor Nephrectomy </li></ul><ul><li>Complex vascular and peritoneal access procedures </li></ul><ul><li>Complex Hepatobiliary Surgery... </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential OUR NETWORK FACILITIES
  26. 26. <ul><li>Organ transplantation induces a </li></ul><ul><li>fundamentally abnormal physiologic state </li></ul><ul><li>Steady improvement has been made in </li></ul><ul><li>both prevention and treatment of organ </li></ul><ul><li>rejection </li></ul><ul><li>The potential for further improvement – </li></ul><ul><li>both incremental and revolutionary – is </li></ul><ul><li>great </li></ul>© High Beam Global, 2010. All Rights Reserved - Privileged and Confidential CONCLUSION
  27. 27. 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
  28. 28. Thank you for considering us © High Beam Global, 2010. All Rights Reserved - Privileged and Confidential

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