- 1,500 renal transplants are performed per year in the United Kingdom
- 50% of patients on dialysis are on transplant waiting list
- 5000 patients waiting for transplant
- Waiting lists are growing by 3% per year due to:
- Increased demand in ageing population
- Reduced road traffic accident deaths from seatbelt legislation
Donor kidneys
- 80% are from beating-heart organ retrievals
- 10% are from non-beating heart donors
- 10% are from live donors
Transplant recipients
- Age less than 75 years
- No history of recent neoplasia
- No major infections (e.g. tuberculosis)
- Good cardiovascular status
Potential donors
- Aged 5-75 years
- No significant renal disease
- No major infections
- Hepatitis B / C and HIV negative
- No history of malignancy
Outcome
- Outcome from renal transplantation is improving
- 95% patients are alive at one year
- 87% patients are alive at five year
Graft survival
|
1 year (%) |
10 years (%) |
| Cadaver donor |
85 |
60 |
| Live donor |
95 |
70 |
Complications of transplantation
- Vascular
- Haemorrhage
- Renal artery thrombosis
- Renal vein thrombosis
- Urological
- Bladder leak
- Ureteric stenosis
- Lymphocele
- Infection
- Cytomegalovirus
- Herpes simplex
- Pneumocystis
- Post transplant neoplasia
- Lymphoma
- Kaposi's sarcoma
Immunosuppression
- Classically achieved with a combination of:
- Cyclosporin A
- Azathioprine
- Prednisolone
- Newer dugs include:
- Tacrolimus
- Mycophenolate mofetil
- Basiliximab
- Daclizumab
- Sirolimus
- Basiliximab and daclizumab are anti-interleukin-2 receptor antibodies
- Newer drugs are associated with fewer side effects
- Incidence of hypertension and hyperuricaemia are reduced
- Rate of adverse lipid profiles is lessened
- Newer drugs may have a reduced incidence of chronic allograft nephropathy
Rejection
- 1-2% of patients develop acute rejection
- Acute rejection is characterised by
- Pyrexia
- Graft tenderness
- Increasing creatinine
- Diagnosis can be confirmed by renal biopsy
- Treated with:
- High dose steroids - methylprednisolone 500 mg/day
- OKT3 = anti-T cell monoclonal antibody
Bibliography
Alsina J, Grinyo J M. New immunosuppressive agents: expectations and controversies. Transplantation
2003; 75: 741-742.
Andrews P A. Renal transplantation. Br Med J 2002; 324: 530-534.
Warrens A N. Pharmacological control of the immune response in renal transplantation. BJU
Int 2002; 90: 784-791. |