Renal History
 

Renal Transplant History

 
 
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Overview

  • Renal transplantation is a complex field and requires a detailed understanding of the patient's physical, psychological and social factors. This page contains basic questions to ask in order to better understand the history of a patient who has had a renal transplant.
    • Ask About

    • Pretransplant history - cause and complications of CKD, dialysis, past transplant, medical and social considerations
    • Peritransplant history - timing, indication, donor
    • Complications - past rejection episodes, infections, cardiovascular, metabolic, malignancy
    • Post-transplant management - immunosuppression, infective prophylaxis, osteoporosis prophylaxis, cancer screening

Pretransplant History

  • Before a patient is considered or listed for a transplant they must go through a comprehensive process that includes medical investigation, social assessment and counselling.
    • Ask About

    • Chronic kidney disease - underlying cause, complications
    • Dialysis history - duration of dialysis, type of dialysis, access
    • Past renal transplant
    • Medical comorbidities - particularly cardiovascular and respiratory
    • Psychological factors - depression / anxiety
    • Social situation - family, living arrangement, occupation
    • Adherence - to management plan, dialysis, medications

Peritransplant History

    • Ask About

    • When they received their transplant
    • The indication for the renal transplant
    • Type of donor
    • Types of Renal Transplant Donor

    • Live donor
    • Donor after brain death (DBD)
    • Donor after circulatory death (DCD)

Complications

    • Complications of Renal Transplant

    • Surgical

    • Wound - bleeding, infection, poor healing
    • Urologic - obstruction, leak, haematoma, collection
    • Vascular - renal artery stenosis, renal vein stenosis, thrombosis
    • Acute tubular necrosis
    • Immunologic

    • Rejection - hyperacute, acute T-cell mediated, acute antibody-mediated, chronic
    • Infectious

    • Fungal infections - candida, aspergillus, cryptococcus
    • Viral infections - herpes simplex, varicella, CMV, EBV, influenza, BK virus, JC virus
    • Bacterial infections - mycobacterial, pneumococcal
    • Protozoal infections - pneumocystis, toxoplasmosis
    • Other

    • Cardiovascular disease
    • Diabetes mellitus
    • Osteoporosis
    • Malignancy - skin, bowel, gynaecologic, post-transplant lymphoproliferative disease
    • Disease recurrence

Post-Transplant Management

    • Management Strategy

    • Immunosuppression

    • Induction - steroids, basaliximab, thymoglobulin
    • Maintenance - steroids, tacrolimus / cyclosporine, mycophenolate mofetil, azathioprine, sirolimus / everolimus
    • Prophylaxis & Screening

    • Infection prophylaxis - valaciclovir / valganciclovir, bactrim
    • Osteoporosis prophylaxis - calcitriol
    • Cardiovascular risk management - of hypertension, hypercholesterolaemia, diabetes and vascular disease
    • Cancer screening - skin checks, pap smears, colorectal cancer screening
 
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