Renal Transplantation
A kidney transplant is a surgical procedure to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly. The kidneys are two bean-shaped organs located on each side of the spine just below the rib cage.
01. Indications
All patients with end stage renal failure (GFR<15 ml/min) or those with CKD stage 4 (GFR 15-29 ml/minute) with progressive disease should be assessed for renal transplantation.
02. Complications of Renal Transplant
Delayed Graft Function
Delayed graft function (DGF) is defined by the need for dialysis in the first week after transplantation. Its risk increases with prolonged WITs and CITs (therefore is relatively rare with living donor grafts). Whilst most DGF kidneys eventually function, there is a recognised association with increased rejection rates and decreased graft survival rates.
Vascular Complications
Vascular complications are divided in early and late.
Early complications comprise renal artery thrombosis (rare, 1%) and renal vein thrombosis (6%). They must be recognised promptly using a Doppler ultrasound and will require taking back to theatre urgently if identified. Aspirin and/or heparin are often started post-operatively to reduce this risk
Late complications include renal artery stenosis, which usually presents several months post transplantation with uncontrollable hypertension and worsening graft function. Angiography confirms the diagnosis and the treatment of choice is typically angioplasty.
