This document provides guidance on evaluating and screening potential renal transplant recipients. It discusses:
1. General concepts to consider include referring all end-stage renal disease patients for transplant evaluation once renal replacement therapy is needed within 12 months, and encouraging preemptive kidney transplantation when feasible.
2. The evaluation process involves assessing medical history and conditions, performing initial screening tests, and evaluating any cardiovascular, infectious, or other systemic diseases to identify any absolute contraindications to transplantation or conditions requiring further treatment and monitoring.
3. Cardiovascular disease is a major cause of death for transplant recipients, so candidates undergo cardiac screening and testing based on risk factors to clear them for surgery or identify any need for pre-operative cardiac
Infectious diseases are the second most common cause of death in end-stage renal disease (ESRD) patients. Patients with ESRD are at high risk for several infections, due to exposure to blood products and frequent dialysis. The increased susceptibility to infections among these patients is indicative of a complex and varied state of immunodeficiency manifested by abnormal phagocytosis, T and B lymphocytes abnormalities and impaired response to T cell dependent pathogens such as hepatitis B and influenza viruses. These immunologic abnormalities are complicated by the use of immunosuppressive drugs used to treat and control underlying disease and exacerbated by nutritional deficiency and the dialysis procedure. Though many of these infections can be prevented by appropriate vaccination, the usual schedules of vaccination may be less effective.
The aim of this paper is to review the studies on the use of vaccines in ESRD patients
and summarize the vaccines required in this population.
Infectious diseases are the second most common cause of death in end-stage renal disease (ESRD) patients. Patients with ESRD are at high risk for several infections, due to exposure to blood products and frequent dialysis. The increased susceptibility to infections among these patients is indicative of a complex and varied state of immunodeficiency manifested by abnormal phagocytosis, T and B lymphocytes abnormalities and impaired response to T cell dependent pathogens such as hepatitis B and influenza viruses. These immunologic abnormalities are complicated by the use of immunosuppressive drugs used to treat and control underlying disease and exacerbated by nutritional deficiency and the dialysis procedure. Though many of these infections can be prevented by appropriate vaccination, the usual schedules of vaccination may be less effective.
The aim of this paper is to review the studies on the use of vaccines in ESRD patients
and summarize the vaccines required in this population.
Mayo Clinic Critical Care Grand Rounds (26 Feb 2015)
Pro-Con debate: The use of ultrasound assessment of the Inferior Vena Cava to guide fluid resuscitation: fact or fiction?
Anaesthesia-Critical Care.
Basics of kidney_transplant and donor_recepient evaluationJosephN7
This contains basic information on kidney transplant, benefits of transplant , donor_recepient evaluation, immunosuppressive drugs and risk factors
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Pre-emptive living related renal transplantation is the gold standard therapy for children with end-stage kidney disease
A successful kidney transplant improves quality of life and reduces the mortality risk for the majority of patients when compared with maintenance dialysis
Liver transplantation current status, controversies and mythsAbhishek Yadav
Details the present status, indications, techniques about liver transplantation. Also dispels some common myths surrounding liver transplantation. #liver transplantation # living donor liver transplantation #liver cirrhosis #liver failure#transplantation#live donor#drabhishekyadav.com#liversurgeon#myths#livedonorlivertransplantation#organtransplantation#alcohololiverdisease
2014 06-05 Pretransplant Evaluation for Kidney Transplantation - Pretransplan...Maarten Naesens
Short overview of evidence-based decisions for the pre transplant evaluation of kidney transplant recipients. Pretransplantbilan onderzoeken niertransplantatie UZ Leuven.
explaining the presently available criteria to define futility in liver transplantation and prposing future trends in the definition of futility in liver transplantation
Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver
places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones
and hernia are more common in patients with cirrhosis http://www.jcehapatology.com
Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver
places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones
and hernia are more common in patients with cirrhosis http://www.jcehapatology.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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4. General considerations
§All patients with ERSD should be considered for
kidney transplantation provided no absolute
contraindications exist (Grade A).
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
5. Survival advantage during 1990s
comparing among different age
6th edition Kidney transplantation: principles and practice
6. Role of preemptive KT
6th edition Kidney transplantation: principles and practice
7. Preemptive kidney
transplantation
§The preferred form of RRT and should be encouraged
where feasible (Grade A).
§Not proceed unless GFR < 20 mL/minute and
evidence of progressive and irreversible deterioration
in renal function over previous 6–12 months.
§Exceptions may be made for patients receiving
combined organ transplants where a kidney transplant
is combined with a non-renal organ
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
9. Time for referral
§Potential transplant recipients should be referred for
evaluation by a transplant program once renal
replacement therapy is expected to be required within
the next 12 months (Grade C).
§Patients already requiring dialysis support should be
referred for transplant evaluation as soon as their
medical condition stabilizes (Grade C).
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
11. Patient Education and Consent
§ Patient education is core of process
§ Transplant evaluation implies not only the medical
assessment of potential recipient by the transplantation
team but also the assessment by the patients of
transplant option and its relevance to their well-being.
12. Absolute contraindications
§ Active infections
§ Active malignancy.
§ Active substance abuse
§ Reversible renal failure
§ Uncontrolled psychiatric disease.
§ Documented active and ongoing treatment nonadherence.
§A significantly shortened life expectancy < 1 yr
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
13. Age and functional capacity
§Advanced age per se is not a contraindication to
kidney transplantation (Grade B).
§Very young age and small size should not prevent early
referral for transplant evaluation (Grade B).
§Cognitive or neurodevelopmental delay is not an
absolute contraindication to renal transplantation in
children (Grade B).
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
15. Initial evaluation
§ History and Physical Examination
§ Determine cause of underlying renal disease
§ Estimation of urine output
§ Result of kidney biopsy if available
§ Family history (ADPKD, Alport syndrome)
§ Potentially recurring renal diseases after transplantation
§ Symptoms of cardiac disease
§ Risk factors for CAD (DM , smoking, DLP, dyslipidemia, premature
death in family)
§ History of claudication
§ Hx possible exposure to tuberculosis and other infection, previous
treatment
16. Initial evaluation
§Evidence of CHF, carotid artery disease, and PVD
§Presence of femoral bruits and poor peripheral pulses (may further pelvic
vasculature with either a Doppler US or MRA )
17. Initial screening studies
§ ABO group, CBC, BUN, Cr, electrolytes, calcium, phosphorous, albumin, LFTs
prothrombin time, partial thromboplastin time, iPTH, and HbA1c (for diabetic
patients).
§ Pregnancy test for fertile women.
§ Serology for varicella, measles, mumps, and rubella viruses. If a potential
recipient is found to be nonimmune to these common childhood diseases
(vaccinated prior to KT)
§ Serologic testing for HIV, hepatitis B virus (HBsAg, HBsAb, HBcAb) and HCV
§ Human leukocyte antigen (HLA) typing , panel reactive antibody (PRA)
§ Urinalysis and urine culture
§ Drug screen.
18. Initial screening studies —
§CXR to exclude tuberculosis/effusion/mass
§ECG
§All men : testicular examination.
§Male >50 years à PSA and DRE (Ealier if strong family history)
§Breast examination and Papanicolaou smear.
§Women > 40 years: mammogram
§Mammography; the age for mammography should be lowered to 35 years if
there is a history of breast cancer in the premenopausal years in a first-degree
relative.
§ All patients >50 years: screening colonoscopy
§ Patients who have Hx of Barrett’s esophagus should have EGD
§ Abdominal and pelvic ultrasounds
19. Systemic conditions
§Severe hyperparathyroidism : parathyroidectomy prior to transplantation
§Primary oxalosis should be evaluated for combined kidney-liver transplantation.
§Systemic amyloidosis, esp cardiac involvement, may not be candidates for renal
transplant due to high mortality
§anti-GBM disease should be considered for KT if circulating anti-GBM antibody
is undetectable and they have quiescent disease (off cytotoxic agents) for at
least 6 months post-treatment
§SLE should be considered for renal transplantation if they have clinically
quiescent disease for at least 6 months off cytotoxic agents
§Renal transplant candidates with vasculitis (Wegener’s granulomatosis,
microscopic polyangiitis, pauci-immune necrotizing glomerulonephritis, Henoch-
Schonlein purpura) should be considered for renal transplantation if they have
quiescent disease for at least 12 months off cytotoxic agents
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
20. Specific conditions
§ Cardiovascular disease (CAD, heart failure)
§ Infection
§ Gastrointestinal disease
§ Cerebrovascular disease
§ Peripheral vascular disease
§ Pulmonary disease
§ Malignancy
§ Patients with a history of cancer
§ Abnormal lower urinary tract
§ Hematologic disorders
§ Obesity
§ Psychosocial issues
§ Frailty
21. Cardiovascular disease
§ Leading cause of death after KT
§ Major cause of morbidity and mortality in patients on
waiting list
Kasiske BL, Maclean JR, Snyder J. J Am Soc Nephrol 2006; 17:900.
22. CVD Relative contraindications to KT:
§ Progressive symptoms of angina or severe CAD that
not amenable to angioplasty or bypass surgery
§ History of MI within 3-6 months
§ Severe ischemic cardiomyopathy (LVEF <30%)
Kasiske BL, Malik MA, Herzog CA. Risk-stratified screening for ischemic heart disease in kidney transplant candidates.
Transplantation 2015; 80:815.
23. Cardiac evaluation
§ALL patients with
§Angina or
§Reduced LVEF or
§T1DM with DN as a cause of ESRD or
§Positive noninvasive stress test
§Refer for cardiology evaluation and angiography
K/DOQI Workgroup. K/DOQI clinical practice guidelines for CVD in dialysis pts. Am J Kidney Dis 2005; 45:S1.
24. Cardiac evaluation
§In patients without previous criteria with
§ Age >60 years
§ Diabetes mellitus
§ Hypertension
§ Dyslipidemia
§ Peripheral vascular disease
§ Previous history of CHD (such as myocardial infarction)
§ Left ventricular hypertrophy
§ Family history of heart disease
§ Dialysis vintage greater than one year
§ Prolonged duration of CKD
§ History of smoking
§ History of radiation therapy (either whole body or chest irradiation)
K/DOQI Workgroup. K/DOQI clinical practice guidelines for CVD in dialysis pts. Am J Kidney Dis 2005; 45:S1.
NEED 3 criteria
25. Cardiac evaluation
§Patients with ≥3 clinical risk factors or diabetes, or PAD
§Screening with noninvasive test, such as
a dobutamine stress echocardiogram or myocardial
perfusion study
§Dobutamine stress echocardiogram and thallium myocardial
perfusion scan both have moderate sensitivity and specificity
among kidney transplant candidates
§Pts with negative noninvasive stress test who have diabetes
or previous hx of CHD à repeat noninvasive test annually
§If LVEF ≤40 % , PAD , or ≥2 traditional risk factors, we
repeat noninvasive testing every 2 years
K/DOQI Workgroup. K/DOQI clinical practice guidelines for CVD in dialysis pts. Am J Kidney Dis 2005; 45:S1.
26. Decision tree pre-transplant
cardiovascular screening
European Renal Best Practice Guideline on kidney donor and recipient evaluation and
perioperative care, Nephrol Dial Transplant (2015) 30: 1790–1797
27.
28. Infection
§ Patient should be free of all untreated, active infection
before transplantation.
§Dental infections should be treated prior KT
§Peritonitis, tunnel infections and vascular access-
related infections should be fully treated before
transplantation
29. Tuberculosis
§ Obtaining clinical history regarding risk factors,
duration and type of prior tuberculous therapy
§ Review of recent chest X ray
§ It is less clear whether prophylaxis reduces the
incidence of reactivation of tuberculosis.
§However most centres currently require pre- or post-
transplant prophylaxis in patients with a positive test in
the absence of prior treatment, provided there are no
contraindications to therapy
30.
31. Screening solid organ transplant
candidates for latent tuberculosis
Ferguson TW et al Transplantation. 2015;99(5):1084.
32. Indication for latent TB treament
§ Initial or boosted TST with induration ≥5 mm or a
positive IGRA
§History of untreated latent TB
§Receiving an organ from a donor known to have
untreated latent TB
§recent close and prolonged contact with an individual
with active TB
§Chest radiographic evidence suggestive of previous TB
(apical fibronodular lesions, calcified solitary nodule,
calcified lymph nodes, or pleural thickening)
Ferguson TW et al Transplantation. 2015;99(5):1084.
33. Regimen of Latent TB
treatment
§ Oral isoniazid 5 mg/kg (maximum dose 300 mg) daily
§For 9 month
§ Oral pyridoxine (B6) 25-50 mg daily should be used
§ Alternative regimens :
§rifampin 600 mg PO daily for four months
§isoniazid plus rifapentine for 12 weeks
Blumberg HM,. JAMA 2005; 293:2776.
34. Strongyloides
§ Hyperinfestation syndrome (hemorrhagic
enterocolitis, pneumonia, gram-negative or mixed
bacteremia, or meningitis) may emerge
§Empirical pretransplantation therapy of
Strongyloidesseropositive recipients (ivermectin)
prevents such infections
35. HIV infection
§HIV per se in not a contra-indication for kidney transplantation.
(1C)
§Wait-listing HIV patients only if
§ 1) they are compliant with treatment, particularly HAART
therapy
§ 2) their CD4+ T cell counts are > 200/µL and have been stable
during the previous 3 months
§ 3) HIV RNA was undetectable during the previous 3 months
§ 4) no opportunistic infections occurred during the previous 6
months
§ 5) they show no signs compatible with progressive multifocal
leukoencephalopathy, chronic intestinal cryptosporidiosis, or
lymphoma. (1C)
ERBP GUIDELINE ON KIDNEY DONOR AND RECIPIENT EVALUATION AND PERIOPERATIVE CARE
37. Guidelines for Vaccinating Dialysis Patients and Patients with Chronic Kidney Disease summarized from Center of disease control 2012
38. HBV Vaccination
§Dose : double standard dosage in a 4 dose schedule for
hemodialysis patients and other immunocompromised
adults (age ≥20 years) patients administered in 1 or 2
injections
§Serologic testing performed 1-2 months after
administration of the last dose of the vaccine series by
using a method that allows determination of a
protective level of anti-HBs (e.g., >10 mIU/mL)
§Persons found to have anti-HBs levels of < 10 mIU/mL
repeat 4 double dose vaccination and serologic test
Guidelines for Vaccinating Dialysis Patients and Patients with Chronic Kidney Disease summarized from Center of disease control 2012
40. Malignancy screening
§Screening kidney transplant candidates for cancer
recommendations that apply to the general population
§Screening kidney cancer by ultrasound
§Screening urothelial cancer by urinary cytology and
cystoscopy
§HCV and HBV-infected screening presence of HCC
according to the EASL-EORTC Clinical Practice Guideline
on the management of hepatocellularcarcinoma
§Current or previous cancer be discussed with an oncologist
and considered on a case-by-case basis.
2015 European Renal Best Practice Guideline on kidney donorand recipient evaluation and perioperative care
41. Breast Cancer: mammography
§Sensitivity 56-95%
§Lower in younger, dense breasts, HRT
§Specificity 94-97%
§More false positives (less specific) in younger women
§Abnormal mammogram & chance of cancer:
§40-49: 2-4% PPV
§50-59: 5-9%
§60+: 7-19%
2013 U.S. Preventive Services Task Force Recommendation Statement
42. Breast Cancer
§The USPSTF recommends screening mammography, with or
without clinical breast examination (CBE), every 1-2 years for
women aged 40 and older.
B recommendation
2013 U.S. Preventive Services Task Force Recommendation Statement
43. Cervical Cancer
§The USPSTF strongly recommends screening for cervical
cancer in women who have been sexually active and have a
cervix.
A recommendation
2013 U.S. Preventive Services Task Force Recommendation Statement
44. Cervical Cancer
§The USPSTF recommends against routinely screening women
older than age 65 for cervical cancer if they have had adequate
recent screening with normal Pap smears and are not
otherwise at high risk for cervical cancer .
D recommendation
2013 U.S. Preventive Services Task Force Recommendation Statement
45. Colorectal Cancer - DRE
§Little evidence
§Sensitivity much less than multiple test cards
§False negatives – no stool in vault
§False positives – rectal trauma
§Therefore, not recommended as a tool for colorectal cancer
screening
2012 U.S. Preventive Services Task Force Recommendation Statement
46. Colorectal Cancer - FOBT
§sensitivity 26 - 92%, specificity 90-99%
§Annual screening has detected 49% of incident cancers
§FOBT: 33% reduction in mortality over controls
§inexpensive
2012 U.S. Preventive Services Task Force Recommendation Statement
47. Colorectal Cancer
§The USPSTF strongly recommends that clinicians screen men
and women 50 years of age or older for colorectal cancer.
A recommendation
2012 U.S. Preventive Services Task Force Recommendation Statement
48. Colorectal Cancer
§Other considerations:
§ Family history of colon cancer <60: test earlier
§ “The choice of screening strategy should be based on
patient preferences, medical contraindications, patient
adherence, and resources for testing and followup.”
(USPSTF)
§ Timing (American Cancer Society)
§ FOBT: yearly
§ Sigmoid: every 5 years
§ DCBE: every 5 years
§ Colonoscopy: every 10 years
§ (One-in-a-lifetime after age 55)
2012 U.S. Preventive Services Task Force Recommendation Statement
49. Prostate Cancer
§The U.S. Preventive Services Task Force (USPSTF) concludes
that the evidence is insufficient to recommend for or against
routine screening for prostate cancer using prostate specific
antigen (PSA) testing or digital rectal examination (DRE).
“I” recommendation
2012 U.S. Preventive Services Task Force Recommendation Statement
50. Lung cancer
§The USPSTF recommends annual screening for lung
cancer with low-dose computed tomography (LDCT)
in adults aged 55 to 80 years who have a 30 pack-year
smoking history and currently smoke or have quit
within the past 15 years.
§Screening should be discontinued once a person has
not smoked for 15 years or develops a health problem
that substantially limits life expectancy or the ability or
willingness to have curative lung surgery.
2012 U.S. Preventive Services Task Force Recommendation Statement
54. Risks of Recurrence of Renal Disease after
Transplantation and Risks of Graft Loss as a
Result of Recurrence,
6th edition Kidney transplantation: principles and practice
55. Stroke
§ Older patients with risk factors such as (history of
TIA , HT, cigarette smoking, and DLP should be
carefully examined for carotid stenosis)
§ Perform a screening MRA in all transplant candidates
with ADPKD who have a history of headaches or a
family history of aneurysm
§If aneurysms >7-10 mm à neurosurgical evaluation
prior to transplant
56. Peripheral vascular disease
§ Increased risk of amputation , allograft ischemia,
significant morbidity, and poor patient survival
§ Femoral, pedal pulses should be assessed esp. diabetes,
CVD or history of PAD
§Severe bilateral iliac or lower-extremity arterial disease
or large abdominal aneurysms that are
contraindications to transplantation
§Options to assess vasculature include Doppler vascular
studies ,Abdominal radiograph and/or noncontrast CT
for iliac calcification to guide ptimal allograft placement
57. Pulmonary disease
§Following clinical features should not be candidates for kidney transplantation
§ Home oxygen therapy requirement.
§ Uncontrolled asthma.
§ Severe cor pulmonale or uncorrectable moderate to severe pulmonary
hypertension.
§ Severe chronic obstructive
pulmonary disease/pulmonary fibrosis/restrictive disease.
§ This is defined by best FEV1 <25 percent predictive value,
§ PO2 room air <60 mmHg with exercise desaturation SaO2 <90 percent,
§ more than four lower respiratory tract infections in the last 12 months,
§ In addition to the above contraindications, candidates with uncorrectable
moderate to severe pulmonary hypertension may not be eligible for
kidney transplant.
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
58. Obesity
§ Defined by a BMI >30 kg/m2 are at increased risk for
adverse outcomes including delayed graft function,
surgical complications including poor wound healing
and infection and NODAT
§Weight loss prior to KT is often recommended,
although there are no data that demonstrate a benefit
of this intervention
2005 Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
60. Abnormal urogenital tract
§ESRD is caused by either a congenital or acquired
malformation (neurogenic bladder) should be corrected
before transplantation
§Avoid ureteral implantation in a fibrotic, thickened bladder
wall (e.g. following a urethral valve) because of the high risk
of surgical complications and/or graft loss
§In low-compliance bladders, pharmacological therapy (e.g.
parasympathicolysis), with or without intermittent self-
catheterisation
§If these methods fail, bladder augmentation is
recommended
Guidelines on Renal Transplantation, European Association of Urology 2014