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What is a kidney transplant?
What is a kidney transplant?
A kidney transplant is a surgical procedure where a healthy kidney from a donor is placed into a person who has kidneys that no longer function properly.
What is the significance of a kidney transplant for individuals with end-stage kidney disease?
What is the significance of a kidney transplant for individuals with end-stage kidney disease?
Kidney transplantation significantly improves the quality of life and longevity for individuals with end-stage kidney disease (ESKD) or chronic kidney disease (CKD).
Which of the following are common causes of end-stage renal disease?
Which of the following are common causes of end-stage renal disease?
What are the three distinct areas of donor and recipient matching?
What are the three distinct areas of donor and recipient matching?
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The most common blood type is type AB.
The most common blood type is type AB.
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The blood type of the donor must be compatible with the recipient.
The blood type of the donor must be compatible with the recipient.
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What are antigens?
What are antigens?
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What role do six-antigens play in organ transplantation?
What role do six-antigens play in organ transplantation?
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It is common to find a six-antigen match between two unrelated individuals.
It is common to find a six-antigen match between two unrelated individuals.
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What is the approximate chance of finding a six-antigen match between two unrelated individuals?
What is the approximate chance of finding a six-antigen match between two unrelated individuals?
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Kidneys can be transplanted between individuals with no matching antigens without a rejection episode.
Kidneys can be transplanted between individuals with no matching antigens without a rejection episode.
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A good match for a kidney transplant increases the likelihood of rejection.
A good match for a kidney transplant increases the likelihood of rejection.
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What is the cross-match test and why is it significant?
What is the cross-match test and why is it significant?
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A positive cross-match indicates compatibility between the donor and recipient.
A positive cross-match indicates compatibility between the donor and recipient.
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The ideal living donor should have poor overall health.
The ideal living donor should have poor overall health.
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What factors are considered when assessing a living kidney donor?
What factors are considered when assessing a living kidney donor?
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The workup for a living kidney donor includes a comprehensive medical history, physical examination, and various laboratory tests.
The workup for a living kidney donor includes a comprehensive medical history, physical examination, and various laboratory tests.
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Renal function in living kidney donors can be assessed by monitoring creatinine clearances, urinalysis, and blood and urine cultures.
Renal function in living kidney donors can be assessed by monitoring creatinine clearances, urinalysis, and blood and urine cultures.
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What is the purpose of performing a flush aortogram and renal angiography on living donors?
What is the purpose of performing a flush aortogram and renal angiography on living donors?
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A kidney with multiple arteries is preferred for transplantation.
A kidney with multiple arteries is preferred for transplantation.
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A 5-hour glucose tolerance test is recommended for living donors with a family history of diabetes.
A 5-hour glucose tolerance test is recommended for living donors with a family history of diabetes.
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The ideal living donor is always an identical twin.
The ideal living donor is always an identical twin.
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What type of IV solution is given to living donors the evening before nephrectomy?
What type of IV solution is given to living donors the evening before nephrectomy?
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What type of IV solution is given to living donors over the next 10 to 12 hours?
What type of IV solution is given to living donors over the next 10 to 12 hours?
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What medication is administered to living donors about 45 minutes before transport to the operating room?
What medication is administered to living donors about 45 minutes before transport to the operating room?
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What positioning is used for the recipient during a kidney transplant?
What positioning is used for the recipient during a kidney transplant?
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The recipient's lower arm is positioned perpendicular to the torso during a kidney transplant.
The recipient's lower arm is positioned perpendicular to the torso during a kidney transplant.
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What is the primary goal of the positioning during a kidney transplant?
What is the primary goal of the positioning during a kidney transplant?
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The recipient is prepped for surgery from the mid-chest to the mid-thigh.
The recipient is prepped for surgery from the mid-chest to the mid-thigh.
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The instruments and equipment needed for a kidney transplant are identical to those used for a nephrectomy.
The instruments and equipment needed for a kidney transplant are identical to those used for a nephrectomy.
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What type of solution is commonly used to perfuse a harvested kidney?
What type of solution is commonly used to perfuse a harvested kidney?
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The ideal cadaveric donor should be elderly and have a history of chronic illnesses.
The ideal cadaveric donor should be elderly and have a history of chronic illnesses.
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Permission to harvest a donor kidney needs to be obtained from the family and medical examiner after brain death has been confirmed.
Permission to harvest a donor kidney needs to be obtained from the family and medical examiner after brain death has been confirmed.
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What are some potential contraindications for organ donation?
What are some potential contraindications for organ donation?
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Preoperative management of cadaveric donors is essential for the success of transplantation.
Preoperative management of cadaveric donors is essential for the success of transplantation.
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Arterial blood gas (ABG) analysis helps guide ventilatory support for a cadaveric donor.
Arterial blood gas (ABG) analysis helps guide ventilatory support for a cadaveric donor.
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Dopamine may be administered if fluids alone are insufficient to maintain adequate blood pressure in a cadaveric donor.
Dopamine may be administered if fluids alone are insufficient to maintain adequate blood pressure in a cadaveric donor.
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Urine output monitoring is not crucial in cadaveric donor management.
Urine output monitoring is not crucial in cadaveric donor management.
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Antibiotics are not typically administered to cadaveric donors.
Antibiotics are not typically administered to cadaveric donors.
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After brain death is confirmed, the cadaveric donor is taken to the OR with their respiratory and cardiac function maintained mechanically.
After brain death is confirmed, the cadaveric donor is taken to the OR with their respiratory and cardiac function maintained mechanically.
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The cadaveric donor is placed in the prone position for harvesting.
The cadaveric donor is placed in the prone position for harvesting.
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Anticoagulants and α-adrenergic receptor blocking agents are administered systemically during the harvesting procedure.
Anticoagulants and α-adrenergic receptor blocking agents are administered systemically during the harvesting procedure.
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Collins or Sachs solution can be used to perfuse kidneys after harvest.
Collins or Sachs solution can be used to perfuse kidneys after harvest.
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Collins or Sachs solution can be used to perfuse a kidney from living donors.
Collins or Sachs solution can be used to perfuse a kidney from living donors.
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The instruments and equipment used for cadaveric kidney transplant are identical to those used for nephrectomy.
The instruments and equipment used for cadaveric kidney transplant are identical to those used for nephrectomy.
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A kidney transplant recipient is a person who receives a kidney from a donor to replace their own failing kidney.
A kidney transplant recipient is a person who receives a kidney from a donor to replace their own failing kidney.
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Patients over the age of 55 are generally unsuitable for kidney transplantation.
Patients over the age of 55 are generally unsuitable for kidney transplantation.
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Uncontrolled diabetes mellitus is a contraindications for kidney transplantation.
Uncontrolled diabetes mellitus is a contraindications for kidney transplantation.
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A patient may undergo bilateral nephrectomy before a kidney transplant to address uncontrollable hypertension.
A patient may undergo bilateral nephrectomy before a kidney transplant to address uncontrollable hypertension.
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A patient requiring a kidney transplant is generally advised to avoid dialysis.
A patient requiring a kidney transplant is generally advised to avoid dialysis.
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A patient undergoing a kidney transplant should avoid all contact sports for life.
A patient undergoing a kidney transplant should avoid all contact sports for life.
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Patients receiving a kidney transplant are advised to avoid exposure to persons with infections.
Patients receiving a kidney transplant are advised to avoid exposure to persons with infections.
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Immunosuppressive medications are a lifelong requirement for kidney transplant recipients.
Immunosuppressive medications are a lifelong requirement for kidney transplant recipients.
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The recipient's diseased kidneys are always removed before transplantation.
The recipient's diseased kidneys are always removed before transplantation.
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The patient's diseased kidneys are always removed before a kidney transplant.
The patient's diseased kidneys are always removed before a kidney transplant.
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Urine output may be delayed in kidney transplant recipients, especially if the donor was a cadaveric donor.
Urine output may be delayed in kidney transplant recipients, especially if the donor was a cadaveric donor.
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Hemodialysis is always necessary for kidney transplant recipients
Hemodialysis is always necessary for kidney transplant recipients
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Which of the following are potential complications following kidney transplantation?
Which of the following are potential complications following kidney transplantation?
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The urinary catheter is typically removed after 1 to 2 days.
The urinary catheter is typically removed after 1 to 2 days.
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The transplanted kidney is always placed in the anterior iliac fossa.
The transplanted kidney is always placed in the anterior iliac fossa.
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Urine is typically a normal clear colour following a kidney transplant.
Urine is typically a normal clear colour following a kidney transplant.
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Administering immunosuppressive medications is typically deferred until the recipient has fully recovered.
Administering immunosuppressive medications is typically deferred until the recipient has fully recovered.
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Encouraging coughing and deep breathing exercises is contraindicated after kidney transplantation.
Encouraging coughing and deep breathing exercises is contraindicated after kidney transplantation.
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Study Notes
Kidney Transplant
- A kidney transplant involves surgically placing a healthy donor kidney into a person whose kidneys no longer function properly.
- This procedure significantly improves the quality of life and longevity for those with end-stage kidney disease (ESKD) or chronic kidney disease (CKD).
Indications for Transplant
- Advanced renal failure (GFR <20 ml/min) indicates end-stage renal disease.
- End-stage renal disease is irreversible and requires dialysis to sustain life.
- Common causes of end-stage renal disease:
- Diabetes
- Chronic, uncontrolled high blood pressure
- Chronic glomerulonephritis (inflammation and scarring of kidney filters)
Donor and Recipient Matching
- Matching involves three distinct areas:
- Blood type matching (vital for compatibility)
- Tissue type matching (HLA typing)
- Cross-matching (testing for recipient antibodies against donor cells)
- Applies to both living and deceased donor transplants.
Blood Typing
- Most common blood type is O, followed by A, then B, and the rarest is AB.
- Donor blood type must be compatible with recipient type (e.g., O can donate to all blood types, AB can only receive from AB).
HLA Typing
- HLA antigens are important proteins on the cells.
- Six HLA antigens are critical in organ transplantation, inherited from each parent.
- Matching six antigens between unrelated people is rare (about one in 100,000).
- A good match reduces the likelihood of rejection by the recipient's immune system.
Cross-Match Testing
- An important step to determine compatibility.
- Blood from the donor and recipient are mixed; if recipient cells attack donor cells, the crossmatch is positive (incompatible).
- A negative crossmatch indicates compatibility.
Transplant from a Living Donor
- Donor must be healthy.
- ABO blood typing and histocompatibility (HLA) tissue typing are necessary.
- A negative white blood cell (lymphocyte) crossmatch is essential.
- Pre-transplant workup includes history, physical exam, chest X-ray, ECG, CBC, BUN/creatinine values, blood chemistry profiles, coagulation studies, and serologic testing.
- Renal function assessment by creatinine clearances, urinalysis, blood/urine cultures (often if hospitalized >72 hours), and intravenous pyelography (IVP).
- A flush aortogram and renal angiography can evaluate vascular anatomy and rule out renal lesions.
- Kidneys with single arteries are preferred, but double or triple arteries are acceptable if necessary.
- A 5-hour glucose tolerance test needed if family history of diabetes.
- Identical twins are ideal, but any immediate family member can be a donor.
- IV solution (1000 ml 5% dextrose in lactated Ringers) is given the evening before surgery. Followed by 500 ml of 5% dextrose in water over 10-12 hours.
- 12.5 g of mannitol administered 45 minutes before transport to the OR.
Transplant from a Cadaveric Donor
- Ideal donor is young, without infection or cancer, normotensive, and under hospital observation before death.
- Permission from family and medical examiner is required after brain death.
- State laws concerning organ donation should be understood.
- Complete evaluation for contraindications (e.g., chronic disease, infection, IV drug use, malignancy, heart/lung disease, organ trauma, HIV).
- Preoperative management crucial: maintain organ perfusion, oxygenation, hydration; ABG evaluation determines the need for ventilatory support, and possible dopamine administration if fluids are insufficient to maintain adequate blood pressure.
- Urine output monitored; administering antibiotics.
Procedural Considerations (General)
- Patient positioned on a positioning device in the left lateral decubitus position after endotracheal intubation.
- Lower arm extended outward on padded arm board, upper arm on an elevated board.
- Sternum and anterior superior iliac spine near the OR bed edge, pillow between legs; ankle and feet padded.
- Bed positioned 30-45 degrees (semi-Fowler's).
- Skin prepped and draped from mid-chest to mid-thigh.
Procedural Considerations (Surgical)
- The procedure is similar to a nephrectomy in terms of instruments and equipment (needle catheter, hemostats, vascular forceps, tissue/suture scissors, Kelly hemostats, etc.).
- Electrolyte solution (Ringer's lactate with procaine and heparin) or CUW solution for perfusion is used.
- Cadaveric kidney perfusion with Collins or Sachs solution may be, but should not be used with a living donor kidney due to potential potassium elevation in the recipient.
- Other equipment includes cold IV saline, IV extension tubes, and a kidney basin.
- Instruments include tissue scissors, suture scissors, vascular forceps, deBakey forceps, Dean hemostatic forceps, mosquito hemostats, deBakey clamps, angled clip appliers, and bulldog clamps.
Transplant Recipient
- Person receiving a kidney transplant to replace failing kidneys.
- Most acceptable are those under 55; older patients are more susceptible to postoperative complications.
- Optimal nutritional support and adequate dialysis are required.
- Treat all potential infection sources (teeth, bladder, nasal sinuses, and skin).
- Patients may require short hemodialysis for fluid overload or electrolyte imbalance, and a repeat cytotoxic crossmatch with fresh serum specimens after hemodialysis.
Contraindications for Transplant
- Systemic disease, metabolic disorder or conditions that preclude major surgery, (e.g., untreatable cardiovascular disease, cancer, immune compromise, COPD, uncontrolled diabetes mellitus).
- Bilateral nephrectomy may be needed in cases of uncontrollable hypertension or kidney infections.
Contraindications for Transplant Surgery
- Metastatic cancer
- Untreated infections
- Serious cardiac or vascular conditions
- Hepatic insufficiency
- Conditions unlikely to improve post-transplant
- Repeated episodes of non-compliance
- Inability to perform post-transplant rehabilitation
Complications during or after Transplant
- Blood clots, bleeding.
- Leaking or blockage of the ureter.
- Donated kidney failure.
- Donated kidney rejection.
- Donated kidney infections
- Death, heart attack or stroke
Renal Transplant Rejection (Types)
- Hyperacute: Occurs within 48 hours of transplant; removal of the kidney is the intervention.
- Acute: Occurs within the first week of surgery or later, potentially reversible with increased immunosuppressive therapy.
- Chronic: Occurs over months or years after transplant; immunosuppressive medications and dialysis are common interventions.
Clinical Signs of Renal Transplant Rejection (Graft)
- Temperature higher than 100°F (37.8 °C).
- Pain or tenderness over the transplanted kidney
- Weight gain (2-3 pounds in 24 hours)
- Edema
- Hypertension
- Malaise
- Elevated BUN and serum creatinine.
- Decreased creatinine clearance
- Elevated white blood cell count.
- Rejection can be diagnosed with ultrasound or biopsy.
Anti-Rejection Medication Side-Effects
- Acne
- Bone thinning (osteoporosis) and bone damage (osteonecrosis)
- Diabetes
- Excessive hair (growth or loss)
- High blood pressure
- High cholesterol
- Infection (potentially increased risk)
- Puffiness, edema
- Weight gain
Preoperative Interventions
- Verify histocompatibility tests by organ bank personnel.
- Administer immunosuppressive medications as prescribed.
- Maintain strict aseptic technique.
- Verify that the recipient had hemodialysis within 24 hours before transplant.
- Confirm the recipient is free of infections, encourage discussion of feelings for both the donor and recipient; and provide psychological support to them as needed.
Postoperative Interventions
- Transplanted kidney placed in the anterior iliac fossa, usually with diseased kidneys remaining unless it is polycystic kidney disease.
- Urine output usually begins immediately if donor was a living donor, but may be delayed for a few days or more.
- Hemodialysis for adequate kidney function establishment.
- Monitor vital signs, urine output (hourly), and IV fluids closely.
- Administer prescribed diuretics and osmotic agents as necessary
- Monitor daily weight and lab values (including hematocrit, BUN, serum creatinine).
- Monitor urine for blood and specific gravity.
- Client positioned in a semi-Fowler's position.
- Monitor urinary catheter patency and watch for gross urine hematuria and clots; irrigate 3-way bladder irrigation as needed.
Client Instructions
- Avoid prolonged periods of sitting
- Monitor intake and output
- Recognize signs/symptoms of infection and rejection
- Adhere to all prescribed medications, including immunosuppressants
- Avoid contact sports & exposure to people with infections
- Understand and recognize symptoms needing medical contact
- Ensure follow-up care.
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Description
This quiz covers essential aspects of kidney transplants, including indications for the procedure, donor and recipient matching, and the significance of advanced renal failure. Understanding these topics is crucial for anyone interested in renal health and transplantation processes.
