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1. RENAL PRE-TRANSPLANT MEET
Dr Manoj Aryal/Dr Nirmal Rasaily
DM Nephrology Resident/MCh Urology Resident
NAMS
(2081-01-09)

2. DESCRIPTIONS
DESCRIPTION RECIPIENT DONOR
NAME Lal Bahadur Tamang Bishnu Maya Tamang
AGE 45yrs 38yrs
SEX Male Female
RELATION HUSBAND WIFE
BLOOD GR/TYP O positive A positive
ADDRESS Ramechhap,Gokulganga Rural
Municipality
Ramechhap,Gokulganga
Rural Municipality
Height 5 feet 6 inches 5 feet 5 inches
Weight 57 kg 60 kg
BMI 20.2kg/m2 22kg/m2

3. VIRAL MARKER
DESCRIPTION RECIPIENT DONOR
HIV I / II (2081/01/03)
Non-Reactive Non-Reactive
HBs Ag (2081/01/03) Non-Reactive Non-Reactive
Anti HCV(2081/01/03) Non-Reactive Non-Reactive
CMV IgG Positive Positive
CMV IgM Negative Negative

4. RECIPIENT CLINICAL DETAILS
 HISTORY/ PRIMARY DISEASE: CKD WITH HTN
 DIALYSIS STATUS : HD via Left Radio cephalic AV Fistula
 Under MHD since 12 months (Sunday/Tuesday/Friday)

5. RECIPIENT INVESTIGATION
HEMATOLOGY(2081/01/08)
HB 7.3
TLC 3,910
DC Neutrophils 64%
Lymphocytes 22%
Monocytes 12.3%
PLT 152000
PT/INR 12.6/0.90
BT 2
CT 6

6. RECIPIENT INVESTIGATION
BIOCHEMISTRY
RBS(2081/01/03) 118 Total Bilirubin 1.1
FBS (2080/11/04) 95 Direct Bilirubin 0.4
HBA1C (2080/11/04) 5.4% SGPT 51
UREA 47 SGOT 29
CREATININE 4.7 ALK.PHOS 58
NA + 135 T. PROTEIN 7.2
K + 3.5 S. ALBUMIN 4.0
CALCIUM 10.5 IPTH (2080/03/29) 281
PHOSPHORUS 3.6

7. RECIPIENT INVESTIGATION
TFT(2081/01/03)
•FT3/FT4
3.15/1.05
•TSH
1.47

8. RECIPIENT INVESTIGATION(2081/01/03)
URINE ANALYSIS ALBUMIN 2+
SUGAR Nil
RBC Nil
WBC NIL
CAST Nil
URINE CULTURE (2080/12/18) No Growth
BLOOD CULTURE(2080/12/18) No Growth

9. RECIPIENT INVESTIGATION
 ECG :NSR
 USG: Rt 7.2 cm , Left 7.6 cm; B/l small echogenic kidneys
with loss of CMD.
 ECHO: (2080/10/17) LVEF 60%,DILATED LA,LV,MOD
MR,MOD TR ,MODERATE PAH WITH PASP
68mmHg,LVDD-I,ECCENTRIC LVH.
 CXR –PA: (2081/01/02) NORMAL STUDY
 SPIROMETRY(2080/10/26):Normal Spirometry.

10. • UGI ENDOSCOPY done on 2080/12/21 showed
Gastrodudenal Ulcers Forest III ,H pylori eradication
was done .
• Colonoscopy done on 2081/01/05 showed Normal
Study except External Hemorrhoids.

11. • Stress ECG Test Patient Exercised for 8’01’’
with workload of 9.3 METS on Bruce Protocol.
Exercise terminated due to 100% THR
achieved. Good Effort Tolerance.
• No significant ST-T changes during exercise
and recovery as compared to Baseline ECG.

12. • Stress Echo revealed Baseline LVEF 40% and
Peak LVEF 50%.Good contractile reserve.NO
RWMA.
• Test is Negative for Exercise Induced
Reversible Myocardial Ischemia.

13. TREATMENT CARDEX
S.N MEDICATION DOSE ROUTE DIRECTIONS
1 TAB AMLODIPINE 10 MG PO OD
2 TAB PRAZOPRESS-
XL
5 MG PO BD
3 TAB METOP-XR 25MG PO OD
4 TAB FEBU 40MG PO OD
5 TAB IFOL-XT 1 TAB PO OD
6 TAB REDUPHOS 400 MG PO BD
7 TAB CALVIT 500MCG PO BD
8 INJ EPOFIT 4000U S/C Once week

14. Recipient Systemic Evaluation Clearance
 Chest Evaluation: Done and Cleared
 Cardiac Evaluation: Done and Cleared
 ENT Evaluation : Done and Cleared
 Dental Evaluation : Done and Cleared
 UROLOGY: Done and Cleared
 PSYCHIATRY No active intervention required
 PAC : To be reviewed

15. DONOR EVALUATION
• No Known Comorbidity.
• Has Two children Female:25 yrs,Male:26 yrs. both
via Normal Vaginal Delivery.
• Has CU-T in situ.

16. DONOR INVESTIGATION
HEMATOLOGY(2081/01/03)
HB 12.9gm%
TLC 8,010
DC Neutrophils 71%
Lymphocytes 23%
Monocytes 04%
Eosinophils 02%
PLT 266000
PT/INR 14/1.0
APTT 29.0 sec
BT 1 mins
CT 6 mins

17. DONOR INVESTIGATION
BIOCHEMISTRY(2081/01/03)
RBS 75 HbA1C 5%
UREA 26 Total Bilirubin 0.5
CREATININE 0.6 Direct Bilirubin 0.2
NA + 136 SGPT 15
K + 3.6 SGOT 20
CALCIUM 8 ALK.PHOS 45
PHOSPHORUS 3.6 T. PROTEIN 6.1
URIC ACID 7.9 S. ALBUMIN 3.8

18. DONOR INVESTIGATION
ANA Neg
24 Hrs. UTP 0.08gm/24hrs
TFT(2081/01/03) FT3/FT4 3.74/1.72
TSH 1.25

19. DONOR INVESTIGATION(2081/01/03)
URINE ANALYSIS ALBUMIN Nil
SUGAR Nil
RBC Nil
WBC 2-4
CAST Nil
URINE
CULTURE(2081/01/03)
No Growth

20. DONOR INVESTIGATION
 ECG: NSR
 USG: Both kidneys are normal in size Rt 10.3cm,Lt 10.7cm,
outline and echotexture. CMD is maintained.
 ECHO: RHD with Mild MR, Mild TR,LVEF: 60%
 CXR –PA: Grossly normal
 SPIROMETRY(2080/10/26):Normal Spirometry.

21. DONOR Systemic Evaluation Clearance
 Chest Evaluation: Done and Cleared
 Cardiac Evaluation: Done and cleared
 ENT Evaluation : Done and cleared
 Dental Evaluation : Done and Cleared
 UROLOGY: Done and Cleared
 PSYCHIATRY Done and Cleared
 PAC To be Reviewed
 CTVS Done and cleared

22. DSA(04/03/2024)
ANTI HLA IgG antibodies MFI Result
CLASS I <500 NEGATIVE
CLASS II <500 NEGATIVE
CDC Cross Match
Auto:- IgM NEGATIVE
DTT cross match:- T &
B cell cross match
NEGATIVE

23. HLA-Typing Report
Reports Awaited.

24. Legal clearance
Done

25. THANK YOU