Indications and Contraindications for Renal Transplantation

Indications for Renal Transplantation

• End-stage renal disease (ESRD) with dialysis dependence
• Chronic kidney disease (CKD) stage 5 with significant symptoms
• Acute kidney injury (AKI) with high risk of progression to ESRD

Contraindications for Renal Transplantation

• Active malignancy
• Active infection (e.g., HIV, TB)
• Severe cardiovascular disease
• Uncontrolled psychiatric illness
• Non-adherence to medical treatment

Types of Renal Transplantation

• Deceased donor transplantation: kidney from a deceased donor
• Living donor transplantation: kidney from a living donor (e.g., family member, friend)
• Paired donor transplantation: swap of kidneys between two pairs of donors and recipients
• ABO-incompatible transplantation: transplant between individuals with incompatible blood types

Pre-Transplant Evaluation

• Medical evaluation: assess overall health, comorbidities, and potential surgical risks
• Psychological evaluation: assess mental health, coping mechanisms, and potential for non-adherence
• Immunological evaluation: assess immune system function, including HLA typing and cross-matching
• Surgical evaluation: assess anatomical suitability for transplantation

Surgical Procedure

• Open nephrectomy: traditional surgical approach
• Laparoscopic nephrectomy: minimally invasive surgical approach
• Kidney implantation: implantation of the donor kidney in the iliac fossa

Post-Transplant Care

• Immunosuppression: medications to prevent rejection (e.g., calcineurin inhibitors, anti-proliferative agents)
• Monitoring for rejection: regular surveillance for signs of rejection (e.g., biopsy, laboratory tests)
• Infection prevention: prophylaxis against opportunistic infections (e.g., pneumocystis pneumonia)
• Long-term follow-up: regular check-ups to monitor graft function and overall health

Complications and Rejection

• Acute rejection: early rejection of the transplanted kidney
• Chronic rejection: late rejection of the transplanted kidney
• Infection: opportunistic infections (e.g., bacterial, viral, fungal)
• Malignancy: increased risk of cancer due to immunosuppression
• Graft dysfunction: impairment of kidney function due to various causes (e.g., rejection, ischemia)

Indications for Renal Transplantation

• End-stage renal disease with dialysis dependence is a primary indication for renal transplantation
• Chronic kidney disease stage 5 with significant symptoms also necessitates renal transplantation
• Acute kidney injury with high risk of progression to ESRD is another indication

Contraindications for Renal Transplantation

• Active malignancy is a contraindication due to the risk of cancer progression
• Active infections, such as HIV and TB, contraindicate renal transplantation
• Severe cardiovascular disease increases the risk of surgical complications
• Uncontrolled psychiatric illness can lead to non-adherence to medical treatment
• Non-adherence to medical treatment is a contraindication due to the risk of graft failure

Types of Renal Transplantation

• Deceased donor transplantation involves a kidney from a deceased donor
• Living donor transplantation involves a kidney from a living donor, such as a family member or friend
• Paired donor transplantation involves a swap of kidneys between two pairs of donors and recipients
• ABO-incompatible transplantation allows for transplants between individuals with incompatible blood types

Pre-Transplant Evaluation

• Medical evaluation assesses overall health, comorbidities, and potential surgical risks
• Psychological evaluation assesses mental health, coping mechanisms, and potential for non-adherence
• Immunological evaluation assesses immune system function, including HLA typing and cross-matching
• Surgical evaluation assesses anatomical suitability for transplantation

Surgical Procedure

• Open nephrectomy is the traditional surgical approach for kidney removal
• Laparoscopic nephrectomy is a minimally invasive surgical approach for kidney removal
• Kidney implantation involves implantation of the donor kidney in the iliac fossa

Post-Transplant Care

• Immunosuppression medications prevent rejection, including calcineurin inhibitors and anti-proliferative agents
• Regular surveillance for signs of rejection, including biopsy and laboratory tests, is crucial
• Infection prevention involves prophylaxis against opportunistic infections, such as pneumocystis pneumonia
• Long-term follow-up involves regular check-ups to monitor graft function and overall health

Complications and Rejection

• Acute rejection occurs early after transplantation, whereas chronic rejection occurs later
• Infection is a significant complication, including opportunistic infections, such as bacterial, viral, and fungal infections
• Malignancy is a potential complication due to immunosuppression
• Graft dysfunction can result from various causes, including rejection, ischemia, and other factors