• KIDNEY TRANSPLANTATION
• LIVER TRANSPLANTATION
• PANCREAS TRANSPLANTATION
• BONE MARROW TRANSPLANTATION
• SMALL BOWEL TRANSPLANTATION

KIDNEY TRANSPLANTATION

For patients with end-stage renal disease (ESRD), there are two treatment options: dialysis and transplantation. Although some patients respond well to dialysis, many do not. Children maintained with chronic dialysis do not grow. Adults frequently must give up their jobs and lose their roles as providers and heads of their families. Physical and financial dependency often leads to emotional dependency and depression. The majority of individuals with ESRD also suffer from a myriad of medical complications, including chronic anemia, muscle wasting, extensive bone deterioration, and peripheral nerve damage. Typically, dialysis treatment is 2-3 times a week; 2.5 – 5 hours per session worldwide. For those patients who adapt poorly to dialysis, the only hope for a normal life is a new kidney - a real kidney.

More than 250,000 renal transplants have been performed since 1963. Most common disease indications include: glomerular diseases, Diabetes Nephropathy, Hypertensive Nephrosclerosis, etc.

In the Philippines, over 2,500 kidneys had been transplanted in 15 hospitals, so far. However, in Metro Manila alone, there are more than 200 patients waiting for a phone call that tells them that a suitable kidney has been found for them. Nationally there are over 7,000 ESRD patients on renal transplant waiting lists and the lists continue to grow.

TYPES OF KIDNEY TRANSPLANTS

There are three types of renal transplants that are performed at the National Kidney and Transplant Institute:

• Living Related Kidney Transplantation
• Living Non-Related Kidney Transplantation
• Cadaveric Kidney Transplantation

RECIPIENT – PRE-KIDNEY TRANSPLANT EVALUATION

As much as possible, the pre-transplant evaluation and work-up of both the recipient and the donor should be done on an outpatient basis. This will free hospital beds for more urgent cases.

It is the responsibility of the rotating pre-transplant nephrology fellow to complete the pre-transplant evaluation forms for both the recipient and the donor in coordination with the transplant (recipient surgeon) and urology (donor surgeon) fellow.

The rotating pre-transplant nephrology fellow presents the prospective patients for kidney transplantation to the CDTA.

Pre- transplant evaluation consists of:

• Donor work-up checklist
• Recipient Work-up checklist
• Social Service Report

RECIPIENT PRE-TRANSPLANT WORK-UP

Verify Diagnosis of ESRD:

• History with emphasis on –

• Primary renal disease – renal biopsy if available
• Coexisting disease – DM, coronary artery disease, CHF, collagen disease, liver disease, pulmonary disease
• Previous infections – PTB, hepatitis, childhood diseases especially chicken pox
• BP control and fluid status
• Overall functional capacity
• Medications taken
• Drug and food allergies
• Type of dialysis, access, duration of dialysis
• History of blood transfusion
• OB-Gyne history
• GI history
• Exposure to noxious agents
• For children, rule out congenital urologic problems. If (+), refer for urologic clearance

• Complete PE to include rectal examinations
• Laboratory work-ups – CBC, blood type, BUN, creatinine, FBS, urinalysis, urine CS, 24

• UC for TP and ECC (if available), US of KUB, stool and occult blood examination

You will also receive appointments to meet our:

• Social Worker
• Dietitian
• Cardiologist
• Pulmonologist
• Psychiatrist
• Transplant Surgeon
• Transplant Coordinator

IMPORTANT!!!

Recipient Education:

• Risk/benefit of KT
• Work-up requirements
• For cadaver recipient: the need for monthly blood extraction to obtain serum for cross matching & 2 weeks after a blood transfusion, and notification of any major illness or surgery. Inform patients on waiting list that ATN do occur on cadaver kidney and dialysis support may be needed after KT while waiting for the graft to fully recover from ATN.
• The need for compliance on medications & regular OPD check up after KT
• Avoidance of blood transfusion, thus the preference for erythropoietin. But if BT is needed, the use of leukocyte filtered/washed PRBC is recommended.
• Avoidance of pregnancy until at least 2 years after KT.
• Discontinue smoking because of the increase risk of operative complication & serious pulmonary infection & cancer after KT.
• High possibility for the need of insulin post-KT among diabetics
• Hepatitis vaccination of patients who are HBs Ag and anti-HBs (-).

Inclusion Criteria:

• 18 – 60 y/o
• No history of hypertension, DM, GN, Renal stones, collagen disease

Exclusion Criteria:

• Age < 18 & > 60 y/o. Donors < 18 y/o should be presented to CDTA & Ethics Committee for approval.
• Hypertension with BP > 140/90 or need for anti-hypertensive medications
• Diabetes Mellitus
• History of Nephrolithiasis
• Hematuria (macroscopic/microscopic)
• Proteinuria > 250 mg/day
• GFR < 80 cc/min.
• Urologic abnormalities such as solitary kidney, horseshoe kidney.
• Morbid obesity (>30% IBW)
• Significant medical conditions such as coronary artery disease, neoplastic disease other than localized skin cancer, hepatitis B & C infection, HIV

SELECTION OF CADAVERIC DONORS

• Age above 18 months and below 60 years old
• Normal renal function as defined by serum creatinine and creatinine clearance if feasible and by history
• Contraindications:

Absolute:

a. Obvious sepsis
b. Malignancy (except brain tumor)
c. Primary renal disease
d. Known fungal or slow virus disease