Preparing the recipient for a renal transplant operation

1. Full History and Examination

Particular points of note:

	History	-	cause of renal failure
		-	dialysis - type, when commenced
		-	time of last dialysis - normal target or dry weight
		-	access and any related problems
		-	Volume of urine output and history of past/present, urinary tract problems
		-	infections - any recent
		-	CAPD peritonitis/exit site/acess related
		-	other operations
		-	ischaemic heart disease
		-	peripheral vascular disease

Recipient blood group, tissue typing and virology (CMV, EBV, HIV, Hep B & C) must be recorded in the notes.

Donor details should also be included in recipient clerking - age, cause of death, blood group, tissue typing, virology and ischaemic time. The transplant co-ordinator will provide this information. Avoid noting any further details that could compromise donor confidentiality if read by the patient.

Examination

-

a full physical examination of the patient should be performed and should include observation of fluid status peripheral pulses abdominal scars/hernias

2. Investigations

	Blood Tests (Phone laboratory to alert staff that sample is arriving) 60-70 mls blood required and should be taken as soon as patient is admitted. *FBC *U&E's + creatinine Baseline calcium/LFT's (results available post-op) *Clotting screen/INR (if on Warfarin) *Tissue Typing (white clotted bottle for lymphocytotoxic Antibody, plus 5 ml EDTA sample) See Apendix IV Virology - CMV, HIV, Hep B + C (only if >1/12 since last test) *Glucose BM test on ward *Asterisked results must be requested as urgent. If patient requires dialysis pre-op, repeat biochem 30 mins after dialysis.
	Chest X-ray
	MSSU - for gram stain and subsequent culture
	PD fluid - for WCC and gram stain / culture if appropriate

3. Communication

Patient (See also consent section below) Ensure potential recipients are aware that they will not definately be getting the kidney until the result of the cross-match is known. Inform patient re: ureteric stent insertion with cystoscopic removal required at 3 months, (usually as a day case). CAPD catheter also removed at the same time as ureteric stent. Do not give donor info to the recipient beyond what is necessary to explain any particular risks/techniques of the transplant. Patients who are not suitable for transplant need discharge sheet with appropriate reasons.

Staff Inform theatre and anaesthetist of any special problems.

4. Consent

Consent for HIV test - verbal consent should be obtained by the physician who clerks in the recipient

Consent for the transplant operation should be obtained by the transplant surgeon

(mention central line, surgical drain, urinary catheter and ureteric stent).

5. Other Considerations

Diabetes

Subcutaneous insulin should be omitted.

Insulin / Dextrose infusion mut be established pre-operatively: standard sliding scale -

	BM < 6 mmol/l	-	add 6 units Actrapid in 500mls Gluclose 10%
	BM 6 - 9 mmol/l	-	add 10 units Actrapid in 500mls Glucose 10%
	BM >9 mmol/l	-	add 14 units Actrapid in 500mls Glucose 10%

Run Infusion @ 100 ml/hr and check glucose (BM stick) hourly

Anti-viral and CMV prophylaxis

Further info in dedicated section

Rhesus Sensitisation

Rh-ve young female recipients with Rh +ve donor require anti D immunoglobulin at induction (can be given up to 72 hours later if overlooked initially).

Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, updated November 2006 and last updated Tuesday, August 11, 2009.

NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.