Kidney transplantation involves removing a healthy kidney from a living or deceased donor and placing it into a recipient with kidney failure. Patients are eligible for a transplant if their kidney function has declined to less than 25% or 15%. Prior to surgery, recipients undergo tests and consultations to assess their health and options. If a living donor is available, both the donor and recipient undergo testing, and the transplant is performed within a few hours of removal. For cadaveric donors, recipients must come to the hospital immediately if a matching kidney becomes available and may undergo additional tests before a transplant. After surgery, recipients are monitored for kidney function and any complications during a hospital stay before continuing long-term follow-up as outpatients.

1. Kidney Transplantation:
Patient Pathway
By Mehreen Mehmood

2. Introduction:
• Kidney Transplant: taking a kidney from
another person (Donor), and placing it
into the patient (Recipient)
• Donor can be either a
• Living Donor
• or a Cadaveric Donor
• NHSBT: April 2011-March 2012, 674
Cadaveric, and 1,009 Live Donor
Transplants

3. Who is eligible for Renal Transplantation?
Chronic Kidney Disease (CKD)
Stage 4 or 5 (where
eGFR<25%)
GP Referral to Nephrologist for
assessment
End-Stage Renal Disease
eGFR<15%
Conservative Care
Dialysis Kidney Transplant
 In developed
countries, Kidney
damage associated
with:
 Diabetes
 Old age
 Hypertension
 Obesity
 Cardiovascular
disease (CVD)
Staging CKD:
1: >75%
2: 50-75%
3: 25-50%
4: 12.5-25%
5: <12.5%

4. Assessment and Options
• Live Donor Seminar: Patient Information
• Tests: ECHO, Myocardial Perfusion scan, Blood
group
• Surgical Clinic:
1) Thorough history (past medical problems,
medications, social history)
2) Examination: abdominal palpation, pulses in
legs
3) Discussion: Patient expectations, surgery,
hospital stay, common complications, reasons for
long term kidney failure, risk to life, other options
• Donor Coordinator: paperwork, contact details

5. Dialysis:
Haemodialysis:
-Ward 301 at QEHB
-Satellite Units or Home
Peritoneal Dialysis:
-Old QE
-Home
AV Fistula created

6. Pre-Surgery:
Live Donor:
•Tests on both recipient and
donor completed while on
Ward 305: ECHO etc.
•Surgery
•NB: Kidney should be
transplanted within 3-4
hours
Cadaveric:
Phone call can come at any
time!
Recipient must come to hospital
(Ward 305) straight away
If no up to date imaging, get
tests done: ECG, X Ray, ECHO
Surgery
NB: Kidney can be stored for up
to 24 hours

7. Surgery:
• 2-3 hours surgery each:
• To remove a kidney: Assisted Laparoscopic
• To insert a kidney: Laparotomy

8. Immediate Post-Op Care:
• Patient taken back to Ward 305 (or to
Critical care if not enough beds)
• Regular Blood Tests: Creatinine should
be decreasing, any sign of infection or
rejection
• Is recipient urinating well?
• Essentially: Is new kidney functioning?
• Patient can be kept for 1-2 weeks

9. Post-op Outpatients Care:
Surgical Clinic:
Meet the Surgeon
For 3 months after transplant
Acute Complications
Medication review:
immunosuppression drugs
(Tacrolimus)
Regular blood tests to
monitor kidney function:
Creatinine
Medical Clinic:
Meet the Nephrologist
Followed up for the rest of
their life. Every 3 months, on
average
Chronic Complications
Medication review
Regular blood tests to
monitor kidney function:
Creatinine
Wellbeing (Holistic care)

10. Summary:
GP Nephrologist
Basic
Tests
Discussion
Surgical Assessment
Clinic
In depth
discussion
More tests:
ECG, X-ray,
ECHO,
Myocardial
perfusion
scan
Dialysis Transplantation
Cadaveric
Live Donor
Join List
(Donor
Coordinator)
Matching
Ward 305:
Tests,
Monitoring
Peritoneal:
at home or
CAPD
Haemodialysis:
Satellite unit or
ward 301
Surgery
Ward
305 or
Critical
Care
Discharge
Outpatients
Surgical Clinic
Outpatients
Medical Clinic

11. References
• Organ Donation. How To Become A Donor. www.organdonation.nhs.uk/ukt/how_to_become_a_donor/ (accessed 25
November 2012).
• Organ Donation. Queen Elizabeth Hospital (Centre Specific Report).
www.organdonation.nhs.uk:8001/ukt/statistics/centre-specific_reports/pdf/Birmingham.pdf (accessed 25 November
2012).
• NHS University Hospitals Birmingham . Patient Information Leaflets and Factsheets. www.uhb.nhs.uk/patient-information-
leaflets.htm (accessed 25 November 2012).
• Patient UK. Chronic Kidney Disease (Chronic Renal Failure). www.patient.co.uk/doctor/chronic-kidney-disease-chronic-
renal-failure (accessed 25 November 2012).
• Patient UK. Renal Replacement Therapy and Transplantation. www.patient.co.uk/doctor/renal-replacement-therapy-and-
transplantation (accessed 25 November 2012).
• NHS National Institute for Health and Clinical Excellence (NICE). Quick Reference Guide: Chronic kidney disease: Early
identification and management of chronic kidney disease in adults in primary and secondary care. Issued September
2008. www.nice.org.uk/nicemedia/live/12069/42119/42119.pdf (accessed 25 November 2012).
• NHS National Institute for Health and Clinical Excellence (NICE). Chronic kidney disease: Early identification and
management of chronic kidney disease in adults in primary and secondary care. Issued September 2008.
www.nice.org.uk/nicemedia/live/12069/42117/42117.pdf (accessed 25 November 2012).

12. Questions?