Renal Transplant History
March 30th, 2020
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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