Kidney transplantation provides better long-term survival and quality of life than dialysis for patients with end-stage renal disease. While the first successful kidney transplants were between twins in 1954, transplantation techniques and anti-rejection drugs have improved outcomes over decades. Living donors are preferred as they offer reduced rejection rates and improved graft survival, though deceased donors also help many patients. Preemptive transplantation before dialysis starts provides the best results, but early transplantation once on dialysis also benefits patients.

1. KIDNEY
TRANSPLANTATI
ON
By:
Mohammed Ahmed Rajab

2. INTRODUCTION
• Kidney transplant provides better long-
term survival and improved quality of
life compared to dialysis.
• Patient survival and transplant success
has been progressively improving over
the years.
• Kidney transplant is the treatment of
choice for End Stage Renal Disease
(ESRD) in eligible patients.

3. History
1902 - The first successful experimental kidney transplants were
performed at the Vienna Medical School in Austria with animals.
1909 - The first kidney transplant experiments were performed in
humans in France using animal kidneys.
1933 - The first human-to-human kidney transplant was performed.
Unknown to doctors at the time, there were mismatches in donor
and recipient blood groups and the donor kidney never functioned.
1940’s - Sir Peter Medawar at the University of London experimented
with the immunologic basis of organ rejection.
Early 1950’s - Cortisone-like medications were used to suppress the
human body’s self-defense system (immune system), resulting in
some kidney transplant success.

4. THE PERFECT MATCH
1954 - Joseph E. Murray and
his colleagues at Peter Bent
Brigham Hospital in Boston
performed the first truly
successful kidney transplant
from one twin to another. This
was done without any
immunosuppressive
medication.

6. INDICATION
• ESRD GFR less than 15ml/L.
• MALIGNANCY.
• HYPERTENSION.
• DIABETES MELLITUS.
• GENETIC DISEASES- polycystic kidney diseases.
• METABOLIC DISORDERS.
• Chronic renal failure (CRF).

7. CONTRAINDICATIONS
• CARDIAC AND PULMONARY INSUFFICIENCY.
• HEPATIC DISEASES.
• CONCURRENT TOBACCO USE AND MORBID OBESITY
PUTS THE PATIENT AT RISK FOR SURGERY.
• HIV.

8. BENEFITS AND RISKS
• Benefits:
– Significantly reduced risk of mortality.
• Life expectancy can triple.
– Reduced risk of heart attack, stroke, heart failure.
– Reduced infection-related hospitalization.
– Improved quality of life.
– More likely to stay employed.

9. BENEFITS AND RISKS
• Risks:
– Acute rejection or failure (less with current meds).
– Anti-rejection medication effects:
• Infection.
• Some malignancies, ex/skin cancer.
• Increased risk of diabetes, high blood pressure, high cholesterol.
– Graft loss over time.
• Overall in eligible candidates, the benefits far outweigh the
risks.

10. EARLY TRANSPLANT
• More benefit to early transplant once dialysis started.
• Improved graft survival if transplanted in first 6 months on
dialysis and improved patient survival if ≤ 1 year.
• Better long-term graft function the earlier transplant
occurs.

11. PREEMPTIVE TRANSPLANT (TRANSPLANT
BEFORE DIALYSIS STARTED)
• MANY benefits including:
– Decreased rejection rates by 25%.
– Improved graft survival long-term.
– Improved patient survival.
– Less delayed graft function.
– Decreased overall hospitalizations.

12. LIVING DONORS
 EVALUATE DONORS ON PHYSICAL, MEDICAL AND PSYCHOLOGICAL
GROUNDS.
 ASSURE THE PATIENT THAT THERE WILL BE NO LONG TERM HARM TO
DONOR.
 IN SOME CASES MALE LIVING DONOR MAY DEVELOP A HYDROCELE
ON THE SCROTUM ON THE SIDE OF NEPHRECTOMY.
 LIVE DONOR PROCEDURE ARE MOSTLY LAPROSCOPIC,HENCE LESS
PAINFULL, LESS SCARRING AND FASTER RECOVERY.

13. DESEASED DONORS
 BRAIN DEAD (BD) DONORS.
 DONATION AFTER CARDIAC DEATH.
BRAIN DEAD OR “ BEATING HEART” donors are considered dead
but the pumping heart continues to perfuse the other organs.
DONATION AFTER CARDIAC DEATH are elective donation of organ
by patient himself or the relatives to withdraw life support as they
have slim chances of survival.

14. COMPATIBILITY
 THE PATIENT HAS TO BE ABO COMPATIBLE.
 THE RECEPIENT SHOULD SHARE AS MANY AS HLA ANTIGENS
AND MINOR ANTIGENS AS POSSIBLE.
 IMMUNOSUPRESSENT DRUGS ARE GIVEN TO PREVENT ANTI
BODY REACTIONS.
 PERFORM ANTI BODY TEST ON POTENTIAL RECEPIENT.

15. POST OPERATION
 TIME- 3 HRS APPROX.
 DONOR KIDNEY WILL BE PLACED IN THE LOWER ABDOMEN.
 ARTERIES,VIENS FROM THE RECIPIENTS BODY IS CONNECTED TO
NEW KIDNEY.
 FINAL STEP IIS TO CONNECT THE URETER TO NEW KIDNEY.
 NEW KIDNEY STARTS FUNCTIONING IMMEDIATELY, LIVING KIDNEY
TAKE 3-5DAYS AND CADEVERIC KIDNEY TAKE UPTO 7-15 DAYS.

16. POST OPERATIVE DIET
 AVOID GRAPES POMEGRANATE AND GREEN TEA
PRODUCTS.
 MONITOR FOR KIDNEY REJECTION.

17. COMPLICATION
 TRANSPLANT RREJECTION.
 INFECTION AND SEPSIS.
 POST TRANSPLANT LYMPH PROLIFERATIVE DISORDER.
 ELECTROLYTE IMBALANCES.
 IATRAGENIC SIDE EFFECTS.

18. PROGNOSIS
KIDNEY TRANSPLANTATION IS A LIFE EXTENDING
PROCEDURE. A PATIENT MAY LIVE UPTO 15 YRS LONGER
WITH A KIDNEY TRANSPLANT THAN IF KEPT ON A DIALYSIS.
PATIENTS WILL HAVE MORE ENERGY, A LES RESTRICTED
DIET, AND FEWER COMPLICATIONS WITH A KIDNEY
TRANSPLANT.

19. SUMMARY
The best treatment for ESRD is transplant.
Kidney transplant saves lives, improves quality of life,
and saves costs.
Living kidney donation is safe and provides better
outcomes.
Preemptive transplant is best but also advantage to
early transplant once on dialysis.

20. THANK YOU