RENAL TRANSPLANTATION IN CHILDHOOD

Posted by e-Medical PPT Wednesday, August 4, 2010
Kidney transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as cadaveric-donor or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants.
The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause.Common diseases leading to ESRD include malignant hypertension, infections, diabetes mellitus, and focal segmental glomerulosclerosis; genetic causes include polycystic kidney disease, a number of inborn errors of metabolism, and autoimmune conditions such as SLE and Goodpasture's syndrome. Diabetes is the most common cause of kidney transplantation.The majority of renal transplant recipients are on some form of dialysis—hemodialysis or peritoneal dialysis at the time of transplantation.
Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease. Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications.
If plasmapheresis or IVIG is not performed, the donor and recipient have to be ABO blood group compatible. Also, they should ideally share as many HLA and "minor antigens" as possible. This reduces the risk of transplant rejection.In most cases the barely functioning existing kidneys are not removed, as this has been shown to increase the rates of surgical morbidities. Therefore the kidney is usually placed in a location different from the original kidney, often in the iliac fossa, so it is often necessary to use a different blood supply.

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