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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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