{"id":8309,"date":"2021-11-22T18:18:26","date_gmt":"2021-11-22T16:18:26","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/nephrology\/kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression\/"},"modified":"2022-01-09T12:54:59","modified_gmt":"2022-01-09T10:54:59","slug":"kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression\/","title":{"rendered":"Kidney transplantation, forms, recipient and living donor suitability, immunosuppression"},"content":{"rendered":"\n<ul class=\"wp-block-list\"><li>Renal transplantation is commonly performed in the case of end-stage kidney failure.<\/li><li>It is the most commonly transplanted organ.<\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Recipient and donor evaluation and suitability<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Forms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\" id=\"block-4c629082-5e59-45a1-8c01-4e32e8b5b1bf\"><li>Donors can be classified into three types:<ul><li><strong>Alive<\/strong><\/li><li><strong>Donation-after-brain-death<\/strong> (DBD, most cases)<\/li><li><strong>Donation-after-cardiac-death<\/strong> (DCD)<\/li><\/ul><\/li><li>In post-cardiac-death kidneys, we can expect ischemic damage (mostly acute tubular necrosis)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Recipient evaluation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Absolute contraindications include malignancy, active infection, substance abuse, and short life-expectancy (&lt;2 years).<\/li><li>The following are evaluated:<ul><li>Coronary artery diseases (angiography and revascularization if necessary)<\/li><li>Cerebrovascular diseases<\/li><li>Peripheral artery diseases<\/li><li>Malignancy (wait 2 years after recovery)<\/li><li>Infections (EBV, CMV, HBV, HCV, HIV)<\/li><li>Habits and general status (obesity, smoking, alcohol)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Donor evaluation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Contraindications include donors with uncontrolled cardiovascular diseases, severe renal diseases, and recurrent renal stones, malignancies (except for primary brain and non-melanoma skin cancers), and infections (although donors with hepatitis virus can donate to patients who are seropositive).<\/li><li>In living patients, the following are evaluated:<ul><li>Thorough history<\/li><li>Blood tests<\/li><li>Screening and radiographic assessment of the cardiovascular system and kidneys<\/li><li>GFR measurement (lowest limit is 80ml\/min\/1.73m^2)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Suitability<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">The following must be taken into account when considering the compatibility between a donor and a recipient:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Blood group compatibility<\/li><li>HLA compatibility and determination of anti-HLA antibodies in the recipient<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Post-transplant immunosuppression and early complications<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Immunosuppression<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Immunosuppressive treatment is important in order to prevent graft rejection. The following agents are used:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Corticosteroids<\/strong><ul><li>Prednisone, methylprednisolone<\/li><li>Used for induction and maintenance, as well as the treatment of acute rejection.<\/li><\/ul><\/li><li><strong>Calcineurin inhibitors<\/strong><ul><li>Cyclosporin, tacrolimus<\/li><\/ul><\/li><li><strong>Mycophenolate<\/strong> <strong>mofetil<\/strong><\/li><li><strong>Azathioprine<\/strong><\/li><li><strong>mTOR inhibitors<\/strong><\/li><li><strong>Monoclonal antibodies<\/strong><ul><li>Rituximab<\/li><li>Alemtuzumab<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Early complications<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Infections<\/li><li>Gastrointestinal complications (drug-related, infections)<\/li><li>Hyperacute graft rejection (48 hours)<ul><li>Preformed antibodies in the recipient<\/li><\/ul><\/li><li>Acute graft rejection (&lt;3 months)<ul><li>Acute T-cell mediated rejection<\/li><li>Acute antibody-mediated rejection<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Long-term complications<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Chronic rejection (&gt;3 months)<\/li><li>Post-transplantation malignancies<ul><li>2-4x more common in transplantation recipients.<\/li><li>Skin and lymphoid cancers.<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Recipient and donor evaluation and suitability<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Forms<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Recipient evaluation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Donor evaluation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Suitability<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Post-transplant immunosuppression and early complications<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Immunosuppression<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Early complications<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Long-term complications<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Renal transplantation is commonly performed in the case of end-stage kidney failure. It is the most commonly transplanted organ. Recipient and donor evaluation and suitability Forms Donors can be classified into three types: Alive Donation-after-brain-death (DBD, most cases) Donation-after-cardiac-death (DCD) In post-cardiac-death kidneys, we can expect ischemic damage (mostly acute tubular necrosis) Recipient evaluation Absolute [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":17,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8309","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Kidney transplantation, forms, recipient and living donor suitability, immunosuppression &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/kidney-transplantation-forms-recipient-and-living-donor-suitability-immunosuppression\\\/\",\"name\":\"Kidney transplantation, forms, recipient and living donor suitability, immunosuppression &#8211; 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