A kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. The kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant.

1. Kidney transplantation
Mr.Sachin Dwivedi
College of Nursing, AIIMS
Rishikesh.

2. DEFINITION
• “Renal
transplantation is
the surgical
implantation of a
human kidney from a
compatible donor in
a recipient”.

3. POSITION
• The kidney is surgical Placed
Extraperitoneally in the iliac
fossa.
• The renal artery is
anastomosed to the recipient
hypogastric internal or
external iliac artery
(occasionally the aorta) and
the renal vein is anastomosed
to the recipient’s iliac vein.
• Usually, the kidney begins to
function immediately.

4. INDICATION
End Stage Renal Disease
(ESRD)
• Irreversible GFR of
less than 15ml/min.
• Serum creatinine level
of greater than 8mg/dl.

5. RECIPIENT SELECTION
It is mainly done in end stage of kidney disease and
GFR below 20.
Candidacy is determined by a variety of medical and
psychosocial factors that vary among transplant
centres.
Certain patients, particularly those with
cardiovascular disease and diabetes mellitus, are
considered high risk and must be carefully evaluated
and then monitored closely after the transplantation

6. CONT……
This approach is most advantageous for
patients with diabetes, who have a
much higher mortality rate on dialysis
than non diabetics
Willing family members are evaluated
for physical and mental health and
screened for ABO blood group, tissue
specific antigen, and human leukocyte
antigen histocompatibility.
A PSA procedure may be required
before transplantation based on the
result of recipient evaluation

7. EXCLUSION CRITERA FOR LIVING
DONOR

8. Absolute contraindications
Age less than 18
years and more than
70 years.
Uncontrolled
hypertension
Diabetes mellitus.
High risk of thrombo-
embolism
History of bilateral
kidney stone.
Medically significant
illness (chronic lung
disease, recent
malignant tumours,
heart disease)

9. Relative
contraindicat
ions
Obesity
Psychiatric disorders
Active chronic infection
(TB, HEPATITIS B/C,
PARASITES)

10. Contraindicat
ions to
Transplant
Refractory
or untreated
cardiac
disease
Chronic
respiratory
failure
Extensive
vascular
disease
Chronic
infections.

11. CONT……
Unresolved psychosocial disorders
(alcoholism, drug addiction )
Advance atherosclerosis
Liver disease
Hypertension
Gastrointestinal bleeding.

12. DONOR
SOURCES
Kidneys for
transplantation may be
obtained from
• Compatible blood type
deceased
(cadaver ) donors
• Blood relatives
• living donors (spouses,
distant cousins), and
altruistic living donors
who are known (friends)
and unknown to the
recipient

13. Live
Donor
• Extensive
multidisciplinary
evaluation:
• Donor is in good
health and have no
history of disease
that would place them
at risk for developing
kidney failure or
operative
complications.
• Psychosocial and
financial evaluations
are done as well

14. Advantages of live donor
Better patient and
graft survival rate
because
histocompatibility
matches.
Immediate organ
availability
Immediate function
because of minimal
cold time (kidney
out of body and
getting blood
supply)
The opportunity to
have the recipient
in best possible
medical condition
because the surgery
is elective.

15. Laboratory studies
for donor
• 24 hours urine study for
creatinine clearance and
total protein
• Complete blood count
• Chemistry and
electrolyte profiles
• Hepatitis B and C
• HIV testing to assess
for the presence of any
transmissible disease.

16. CONT……
An ECG and chest
X ray also done.
A renal USG and a
renal angiogram.
CT scan.

17. DECEASED DONORS
Deceased (cadaver) kidney donors are
relatively healthy individuals who have
suffered an irreversible brain injury.
The most common cause of injury is
cerebral trauma from motor vehicle
accidents or gunshot wounds, intracerebral
or subarachnoid haemorrhage, and anoxic
brain damage caused by cardiac arrest.

18. The brain dead donor must have effective
cardiovascular function and be supported
on a ventilator to preserve the organs.
The age range of most suitable kidney
donors is from 2 to 70 years.
The age of donor is less important than
the quality of kidney function.

19. CONT……
The donor must be free of active IV
drug abuse, severe hypertension, long
standing diabetes mellitus,
malignancies, sepsis and communicable
diseases.
Permission from the donor’s relatives
must required after brain death

20. HISTOCOMPATIBILITY
STUDIES
• The purpose of
histocompatibility testing is
to identify the HLAs (human
leukocyte antigen) for both
donors and potential
recipients.
• Extensive histocompatibility
testing is completed for renal
transplantation, because
evidence indicates that six
antigen matches are necessary

21. CROSSMATCH
• A cross match uses serum from the
recipient mixed with donor lymphocytes to
test for any preformed cytotoxic (anti-
HLA) antibodies to the potential donor
organ.
• A positive cross match indicates that the
recipient has cytotoxic antibodies to the
donor and is an absolute contraindication
to transplantation
• A negative cross match indicates that no
preformed antibodies are present and it
is safe to proceed with transplantation.

22. LIVE DONOR
• An incision is made at the level of
the eleventh rib.
• The rib may have to removed to
provide adequate visualization of the
kidney. (Open Nephrectomy)
• After removal of the kidney, it is
flushed with chilled, sterile
electrolyte solution and prepared for
immediate transplant into the
recipient.
• The nephrectomy takes about 3 hours.
The short cold ischemic time is the
primary reason for the success of
living donor transplant.
• Laparoscopic Nephrectomy- Minimal
invasive, 3-4 non muscles cutting
incision.

23. TRANSPLANT RECIPIENT
• The transplanted kidney is
usually placed extra-
peritoneally in the iliac
fossa.
• An incision is made
extending from the iliac
crest to the symphysis pubis.
• The peritoneum is left
intact.
• The iliac and hypogastric
vessels are dissected free.

24. Complication of transplant
Rejection
Infection
Cardiovascular disease
Malignancies
Reoccurrence of renal disease
Corticosteroid related complications

25. Rejection
• Transplantations of allograft (organ
transplanted between genetically different
individuals of same species) elicit an immune
response in which the antigens in tissue of
organs are recognized as foreign, hence a
series of events occur, resulting in rejection
of the organ.

26. Types of rejection
Hyperacute
Rejection
Acute
rejection
Chronic
rejection

27. Hyperacut
e
Rejection
• Hyperacute rejection occurs a
few minutes after the
transplant when the antigens
are completely unmatched. The
tissue must be removed right
away so the recipient does not
die.

28. Acute
Rejection
• Acute rejection happens within
the first 12 months of a
transplant.
• It’s more likely to occur
within the first several
weeks.
• Acute means it happens
quickly. If client don’t have
an acute rejection episode
after 12 months, it may be
less likely to have one as
long as client take the
medication as prescribed.

29. Chronic
Rejection
• Chronic rejection typically
happens slowly and over several
years.
• When body’s immune system slowly
and constantly fights new
kidney, which leads to kidney
damage.
• Chronic rejection happens to
kidney recipients more often
than acute rejection.
• It can happen years after a
kidney transplant. The signs can
often be subtle and unnoticeable
because the rejection is
gradual.
• Cellular rejection which means T
lymphocytes, a specific type of
white blood cell, cause the
rejection.

30. Infection
• Many factors contribute to
the potential risk of
infection, including the
patient’s age, nutritional
status, medical condition
before transplantation,
infection history and
exposure, and the
immunosuppressive regimen.
• During the first month after
transplantation, Hospital
associated infections are
common. Then, between 1 and 6
months after transplantation,
opportunistic infections such
as Pneumocystis carinii
pneumonia, candidiasis and
cytomegalovirus infection
occur.

31. Cardiovascular disease
Transplant recipients
have an increased
incident of
atherosclerotic vascular
disease. Cardiovascular
disease is the leading
cause of death after
renal transplantation.
It is important that the
patient be taught to
control risk factors
such as elevated
cholesterol,
triglycerides, blood
glucose and weight gain

32. MALIGNANCIES
• The primary cause of
this increased
incidence is the
immunosuppressive
therapy.
• Immunosuppressant not
only suppresses the
immune system, but they
also suppress the
ability to fight
infection and the
production of abnormal
cell such as cancer

33. • Corticosteroid related
complications:
Recurrence of disease that
destroyed the native kidneys
occurs in some kidney
transplant recipients
Corticosteroid related
complications:
Aseptic necrosis of the hips,
knees, and other joints can
result from chronic
corticosteroid therapy

34. NURSING MANAGEMENT OF
KIDNEY TRANSPLANT
• PREOPERATIVE NURSING CARE
• POST OPERATVE NURSING CARE

35. NURSING CARE PLAN
1. Fear related to perceived threat of death
secondary to treatment regimen.
2. Deficient knowledge related to surgical
management secondary to post operative self-
care.
3. Risk for Infection related to inadequate
secondary defenses (Immunosuppression)
4. Risk for Fluid Volume Excess related to renal
insufficiency, steroid therapy or decreased
cardiac output.

36. Thank You