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Minimally invasive donor nephrectomy Laparoscopic surgery is now widely established and there are a number of techniques. After a fully laparoscopic trans- peritoneal dissection ( Figure 88.15 ), the kidney is removed through a small retrieval incision. Hand-...

Normothermic machine perfusion Normothermic machine perfusion (NMP) utilises the prin - ciples of cardiopulmonary bypass technology and has been used for heart, lung, liver and kidney preservation. Warmed and oxygenated red blood cell-based perfusate is circu...

Normothermic regional perfusion This technique has been developed for donation after circu latory arrest. A cardiopulmonary bypass system is used to recirculate the donor’s own blood through the thoracic and abdominal organs for 2 hours. The under lying princi...

ORGAN DONATION Donation after brainstem death Brainstem death occurs after severe brain injury as a result of either trauma or a cerebrovascular accident. Potential DBD donors are in an apnoeic coma that requires mechanical ventilation on the intensive care un...

ORGAN PRESERVATION Transplant organs need to be stored and preserved in the period between procurement from the donor and transplan - tation into the recipient. Static cold storage is the traditional - method of organ preservation, but more recently there hav...

Outcomes after renal transplantation Patient and graft survivals vary according to donor type and are presented in Table 88.4 . Overall, kidney transplantation is a highly successful treatment for ESRD. Living donor trans - plants yield better results than dec...

RENAL TRANSPLANT SURGERY Preparation of the donor kidney The donor kidney must be examined and prepared on the back-table in order to check that it is suitable to be transplanted. Multiple renal arteries are present in up to 25% of kidneys and, if present, ma...

Rationale for kidney transplantation Kidney transplantation improves life expectancy and quality of life when compared with dialysis. However, only approxi - mately one-third of patients with ESRD are fit enough to with - stand transplant surgery and long-ter...

Renal transplant operative technique The donor kidney is transplanted heterotopically into one of the iliac fossae via a curvilinear incision. The peritoneum should be kept intact and swept upwards to reveal the iliac vasculature. The transplant renal vein is...

Renal transplantation in children In children with established renal failure, kidney transplanta tion facilitates their growth and development and markedly improves the quality of life of the child and their parents. In young children there is often a size m...

Selection of patients for transplantation Potential transplant recipients undergo a rigorous work-up process to identify major comorbidities that would preclude transplant surgery . Age per se is not a contraindication to renal transplantation and it is now c...

Static cold storage Hypothermia suppresses metabolism to maintain organ viability . The first requirement is to flush the donor organs with an appropriate preservation solution at a temperature of approximately 4°C ( Figure 88.3 ). This is normally done in situ...

Surgical complications of renal transplantation Haemorrhage A haematoma may develop in the transplant bed in the first few postoperative days. This is often due to bleeding from small unsecured vessels in the renal hilum that were not apparent at the time of s...

TRANSPLANT REJECTION Allograft rejection can be divided into distinct types. - -

The immune response to a transplanted organ The main immune cells involved in transplant immunology are APCs and T and B lymphocytes. These cell types interact by a series of specific surface molecules that are designated by CD (cluster of di ff erentiation) n...

Auxiliary liver transplantation Auxiliary LT involves implanting a healthy liver graft placed either heterotopically or orthotopically while leaving all or part of the native liver intact. Auxiliary heterotopic LT , where the graft is implanted below the nativ...

Biliary complications The biliary complications usually present as bile leak, biliary anastomotic stricture (AS), biliary non-anastomotic stricture (NAS), bile duct sludge/stone/casts, biloma and duct loss (ductopenia) in patients with chronic rejection. Bilia...

CAUSES OF ALLOGRAFT DYSFUNCTION Liver graft dysfunction can happen any time after transplanta tion; if not identified early and treated promptly , it can lead to graft loss. The most common presentation is an asymptomatic elevation of liver enzyme levels . Ear...