KIDNEY

TRANSPLANTATION
EBEN EZER SIAHAAN

Dept of surgery
Medical faculty of Christian unuversity of Indonesia
Kidney transplantation is the pioneer discipline in
solid organ transplantation, and the relationship
between transplant surgeon and nephrologist has
served as a model for multidisciplinary team care.
 Introduction

 The 1st human renal allograft was

performed by Voronoy. The recipient is 26
years old woman who had attemped
suicide by ingesting mercury chloride.
The patient was died 48 hours after the
procedure.
 Introduction

The first long term success with

human renal allograft in Boston
1954
 Introduction
 Immunosupresion era :
- Azathioprine
- Radiation
- Corticosteroid + Azathioprine
• 1958 histocompatibility antigen was
describe
• 1962 tissue matching to select donor –
recipient pairs
 Renal failure

 Pre Renal
 Acute
 Renal

 Chronic  Post Renal

 DEFINITION

 Permanent renal failure in adult is an

irreversible glomerular filtration rate of less
then 10 ml/minute or serum creatinine
level greater then 8 mg/l.
SELECTION AND PREPARATION OF
KIDNEY TRANSPLANT RECIPIENTS
 Preliminary screening
 Kidney disease recurrence
 Infection
 Active malignancy
 High probability of peri operative morbidity or
mortality
 Non compliance
 Unsuitable condition for technical succes.
DONOR SELECTION, PREPARATION
AND SURGERY

 Living donor

 Deceased donor
 KIDNEY PRESERVATION
 Cold Ischemic
 Hypothermic pulsatile
perfusion.

 Warm ischemic
 Flushing with an ice
cold solution.
KIDNEY PRESERVATION
Kidney preservation ( deceased donor )
 RENAL ALLOGRAFT REJECTION

 Histocompatibility

 Rejection:
1. Hyperacute rejection
2. Accelerated rejection
3. Acute rejection
4. Chronic rejection
 PROBLEM
 Early graft dysfucntion
 Vascular complications
 Allograft nephrectomy
 Hematuria
 Fluid collection
 Obstruction and stones
 UTI
 VUR
 Cancer
 Summary

 Renal transplant is the best therapy for

most patient ESRD. Morbidity and
mortality have been significantly reduces
by attention to pretransplantation
evaluation, donor surgery,kidney
preservation, recipient selection, recipient
surgery, histocompatibility,
immunosuppresion and the successful
management of complication.