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Delayed renal allograft function DGF is defined as the need for dialysis in the first 7 days post transplant. The patient will be oliguric or anuric and the serum creatinine will fail to fall in the early postoperative period. DGF is usually the clinical consequ...

Donation after circulatory death Donation after circulatory death describes the recovery of organs for transplantation after death confirmed by circula tory criteria. These donors were formerly called asystolic or non-heart-beating donors. There have been very ...

Dual kidney transplantation This involves the transplantation of a pair of marginal quality kidneys from the same donor into one recipient in order to provide adequate nephron mass. Both kidneys can be placed in the same iliac fossa. This approach is used fo...

Early postoperative course Accurate fluid and electrolyte balance are maintained with the help of central venous pressure monitoring. Hyperkalaemia is common in the early post-transplant period, especially in patients with DGF . This should be managed initially...

Evaluation of the deceased donor The absolute contraindications to organ donation include active systemic sepsis and transmissible infection. Malignancy within the last 5 years is also an absolute contraindication with the exception of tumours that do not met...

FURTHER READING Bolton EM, Bradley JA. Principles of transplant immunology and immunosuppressive therapy . In: Thomas WEG, Reed MWR, Wyatt MG (eds). Oxford textbook of fundamentals of surgery . Oxford: Oxford University Press, 2016: 767–71. Bradley JA, Nich...

HLA matching Allograft rejection is directed against human leukocyte anti gens (HLAs). These are a group of cell surface glycoprotein molecules. HLA molecules are divided into class I (A, B and C) and class II (DR, DP and DQ). Class I molecules are expressed ...

Hyperacute rejection Hyperacute rejection is extremely rare. It can result from an inadvertent ABO blood group-incompatible transplantation after a clerical error in recording blood groups. It may also occur when there are preformed circulating donor-specific H...

Hypothermic machine perfusion The transplant organ is placed in a sterile chamber and cold preservation fluid is continually recirculated through the vasculature at low temperature and pressure (30 /uni00A0 mmHg) ( Figure 88.4 ). The perfusion fluid is based on ...

IMMUNOLOGY OF TRANSPLANT REJECTION ABO blood groups ABO blood group antigens are glycoproteins with di ff erent carbohydrate components. ABO antigens are expressed not only on the surface of red blood cells but also on endothelial cells. In all organ transplan...

IMMUNOSUPPRESSION Modern immunosuppression is so e ff ective that acute rejec - tion rates of 10–20% can be achieved in all types of solid organ transplantation. The challenge is to deliver su ffi cient immunosuppression to prevent rejection while minimising dr...

Immunosuppressive regimen for renal transplantation Immunosuppression for renal transplantation generally comprises induction therapy with the anti-CD25 monoclonal - antibody basiliximab followed by a maintenance regimen of a calcineurin inhibitor (most usuall...

INTRODUCTION Successful solid organ transplantation represents one of the great medical advances of the twentieth century . The field continues to be an exciting and fast-moving one. Unfor tunately , there continues to be a shortage of suitable donor organs ...

KIDNEY TRANSPLANTATION End-stage renal disease The incidence of end-stage renal disease (ESRD) in the UK is approximately 120 per million population and around 8000 people require renal replacement therapy annually . The lead ing causes of ESRD are diabetes,...

Learning objectives To recognise and understand: The immunological basis of allograft rejection • The principles of immunosuppressive therapy • The side effects of immunosuppressive therapy • The major issues concerning organ donation •

Living donation Living kidney donation is possible because most individuals have two healthy kidneys and it is possible to live a normal life with a single kidney . Parts of non-paired organs can also be removed from live donors; these include liver and lung ...

Living donor kidney transplantation This accounts for approximately 1000 kidney transplants annu ally in the UK, which is approximately one-third of the total renal transplant programme. Living donors may be related, unrelated, altruistic or part of a donor ...

Mammalian target of rapamycin (mTOR) inhibitors The mTOR inhibitors rapamycin and everolimus act by bind ing to and inhibiting a cytoplasmic kinase enzyme complex called mTOR. This prevents intracellular signalling from the IL-2 receptor. The downstream e ff ec...