RENAL TRANSPLANTATION - HISTORY, SELECTION OF RECIEPIENT

This is guest article by Dr.N.Anil kumar, Urologist.

History and Major landmarks

1933    - First Human Renal Allograft by Voronoy in Ukraine.

1954    - First long term Success with Human Renal   Allograft achieved in Boston.

1958    - First Histocompatibility antigen was  described.

1959    - Radiation was tried for immunosuppression.

1962    - Glucocorticoids became a part of   immunosuppression.

1962    - First use of tissue matching for selection of Donor-recipient pair.

1966  - Direct cross match between Donor  lymphocytes and  recipient serum introduced.

1970’s- Brain Death laws were passed

1978  - first clinical trials of cyclosporine were reported

1981  - Successful use of monoclonal antibodies for renal allograft rejection

1989  - Recombinant Erythropoietin  became available

1995  - Laparoscopic donor nephrectomy was introduced

Urologist’s role -recipient

Ø      Preliminary screening

Ø       Kidney disease recurrence

Ø       Infections

Ø       Active malignancy

Ø       Probable risk factors for perioperative morbidity

Ø       Non-compliance

Ø       Unsuitable conditions for technical success

1. Preliminary  screening :

• Drug / substance abuse
• Morbid  obesity
• Compliance issues
• Heart disease

2. Kidney disease recurrence

High Risk of Graft Failure

• FSGS
• HUS
• Oxalosis

Potentially treatable

• Renal Amyloidosis
• Cystinosis
• Fabry’s Disease

Graft failure  is rare

• DM
• IgA nephropathy

Do not recur in transplanted kidney

• ADPKD
• Renal  dysplasia
• Alport’s without anti BM antibodies

3. Infections

• Dental sepsis
• Infection of dialysis access sites
• Pulm.infections & Tuberculin test
• Symptomatic cholelithiasis & cholecystitis
• Recurrent diverticulitis
• Diabetic foot ulcers
• UTI
• CMV, HSV, EBV,  Hep.B, Hep.C, HIV

4. Active  malignancy

• Invasive cancers- 2-5 yrs of waiting time after last treatment recommended

• Low grade / Non-invasive cancers-  shorter intervals may be accepted

• GB-Polyps of >1cm in diameter- cholecystectomy is recommended

5.Probable risk factors for perioperative morbidity & mortality

• Cardiac risk factors
• Peptic ulcer disease
• Significant pulmonary  disease
• Smoking

6. Unsuitable conditions for technical success

• Signs& Symptoms of  lower extremity arterial disease
• H/O abdominal or pelvic vascular surgeries
• H/O previous vascular thrombosis, antiphospholipid antibodies,  previous transplant renal vein thrombosis
• Diseases & operations on urinary tract