Renal transplantation involves selecting recipients by diagnosing their primary kidney disease, ruling out active infections or malignancies, and assessing operative risks. Suitable living donors undergo evaluation with CT angiography and surgery to remove a kidney, with efforts to minimize warm ischemia time and preserve vessel length. The donated kidney is preserved through simple cold storage before transplantation via vascular anastomosis and ureter reimplantation during the recipient's operation. Lifelong immunosuppression is required post-operatively to prevent rejection, while infection risk remains.

1. Renal TransplantationRenal Transplantation
ByBy
Mohamed Hassouna, MDMohamed Hassouna, MD
Professor of Urology, AlexandriaProfessor of Urology, Alexandria
UniversityUniversity

2. SELECTION FOR KIDNEY TRANSPLANTSELECTION FOR KIDNEY TRANSPLANT
- Diagnose the- Diagnose the primary diseaseprimary disease and its risk ofand its risk of
recurrence in the kidney graftrecurrence in the kidney graft
- Rule out :- Rule out :
-active invasive infection,-active invasive infection,
- high probability of operative mortality- high probability of operative mortality
- noncompliance,- noncompliance,
- active malignancy,- active malignancy,

3. InfectionInfection
 Dental sepsis, pulmonary infectionDental sepsis, pulmonary infection
 UTI should be inactiveUTI should be inactive
 Tuberculin skin test , TB, CMV, herpes simplex virusTuberculin skin test , TB, CMV, herpes simplex virus

4. Active MalignancyActive Malignancy
 To reduce the risk of cancerTo reduce the risk of cancer
recurrence, a waiting time of 2 to 5recurrence, a waiting time of 2 to 5
cancer-free years from the time of thecancer-free years from the time of the
last cancer treatmentlast cancer treatment

5. Perioperative Morbidity or MortalityPerioperative Morbidity or Mortality
-- Heart disease is the main cause of death after renal TxHeart disease is the main cause of death after renal Tx
- CVD, peptic ulcer, and pulmonary disease must be detected- CVD, peptic ulcer, and pulmonary disease must be detected

6. Technical DifficultiesTechnical Difficulties
- to determine the suitability of the Bladderto determine the suitability of the Bladder
for Ureteric anastomosisfor Ureteric anastomosis
- to determine the necessity forto determine the necessity for
pretransplantation nephrectomy:pretransplantation nephrectomy:
Polycystic, Pyonephrosis, uncontrolledPolycystic, Pyonephrosis, uncontrolled
UTI, Uncontrolled RenoVascular HTNUTI, Uncontrolled RenoVascular HTN
- significant bladder residual urine- significant bladder residual urine

7. DONOR SELECTIONDONOR SELECTION
-Absence of renal disease-Absence of renal disease
- Absence of active infectionAbsence of active infection
- Absence of transmissible malignancy.Absence of transmissible malignancy.
- Histocompatibility and ABO typingHistocompatibility and ABO typing
the living donor will havethe living donor will have nearly normalnearly normal
renal function after nephrectomy.renal function after nephrectomy.

8. Living DONOR SELECTIONLiving DONOR SELECTION
CT angiographyCT angiography with IV contrast :with IV contrast :
- Satisfactorily excludes stone disease- Satisfactorily excludes stone disease
- Demonstrates renal and vascular anatomy- Demonstrates renal and vascular anatomy
- Defines the urinary collecting system- Defines the urinary collecting system
- With minimal donor morbidity- With minimal donor morbidity
- Reasonable expense- Reasonable expense

9. Donor surgeryDonor surgery
- Two teams at two close theaters- Two teams at two close theaters
- Warm ischemia time is limited to 30-40- Warm ischemia time is limited to 30-40
minutes during surgery.minutes during surgery.
- Cut as long as possible renal artery andCut as long as possible renal artery and
vein for better anastomosis.vein for better anastomosis.
- Keep the ureter as long as possible.Keep the ureter as long as possible.

11. Simple Cold Storage of KidneysSimple Cold Storage of Kidneys
 Cellular energy requirements areCellular energy requirements are
significantly reduced bysignificantly reduced by
hypothermiahypothermia
This is done by surface cooling orThis is done by surface cooling or
flushing with an ice cold solutionflushing with an ice cold solution
followed by cold storage.followed by cold storage.

12. RECIPIENT OPERATIONRECIPIENT OPERATION
 In adults and children (moreIn adults and children (more
than 20 kg)than 20 kg)
 the kidney graft is usuallythe kidney graft is usually
placed extraperitoneally in theplaced extraperitoneally in the
iliac fossa by way of a Gibsoniliac fossa by way of a Gibson
incisionincision

14. RECIPIENT OPERATIONRECIPIENT OPERATION
Vascular anastomosisVascular anastomosis
 In adults:In adults:
Renal A. to Internal iliac A. or External Iliac A.Renal A. to Internal iliac A. or External Iliac A.
Renal V. toRenal V. to External Iliac V.External Iliac V.
 In children:In children:
Renal A. to aortaRenal A. to aorta
Renal V. to IVCRenal V. to IVC
- Ureteral anastomosis to the bladder- Ureteral anastomosis to the bladder

17. Post-operative managementPost-operative management
 Immunosuppressent drugs for lifeImmunosuppressent drugs for life
 Very ExpensiveVery Expensive
 Any infection is life threateningAny infection is life threatening
 Only 10% would live for 10 years.Only 10% would live for 10 years.

18. Thank you