Renal transplantation from non heart beating donors
This presentation is the property of its rightful owner.
Sponsored Links
1 / 25

Renal transplantation from non-heart beating donors PowerPoint PPT Presentation


  • 55 Views
  • Uploaded on
  • Presentation posted in: General

Renal transplantation from non-heart beating donors. M L Nicholson P N Furness* Departments of Transplant Surgery and *Pathology Leicester General Hospital UK. The University of Leicester. The problem - 1. The problem - 2. Sources of asystolic donors in Leicester.

Download Presentation

Renal transplantation from non-heart beating donors

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Renal transplantation from non heart beating donors

Renal transplantation fromnon-heart beating donors

M L Nicholson

P N Furness*

Departments of Transplant Surgery and *Pathology

Leicester General Hospital

UK

The University of Leicester


The problem 1

The problem - 1


The problem 2

The problem - 2


Sources of asystolic donors in leicester

Sources of asystolic donors in Leicester

  • Irreversible cardiorespiratory arrest

  • Accident & Emergency department –failed resuscitation after MI

  • Medical wards –catastrophic intracerebral haemorrhage with ‘coning’


Leicester selection criteria for nhbds

Leicester selection criteria for NHBDs

  • Age<60

  • Warm ischaemic time <40 minutes

  • No history of renal impairment

  • No uncontrolled hypertension

  • No complicated insulin dependent diabetes

  • No systemic sepsis or malignancy


Mechanical cardiopulmonary resuscitation device a k a the thumper

Mechanical cardiopulmonary resuscitation device (a.k.a. ‘The Thumper’)


Correct positioning of aortic catheter

Correct positioning of aortic catheter


Cyclosporin protocol

Cyclosporin protocol


Acute rejection rates

Acute rejection rates


Early graft function rates

Early graft function rates


Graft function

Graft function


Graft survival

Graft survival


Newcastle data km survival curves

With thanks to:

Gok MA

Buckley PE

Mohamed MAS

Balupuri S

Shenton BK

Robertson H

Soomro N

Manas D

Talbot D

Liver / Renal Transplant Unit, The Freeman Hospital, Newcastle Upon Tyne,

UK

NEWCASTLE DATA: KM - Survival curves


Newcastle data creatinine clearance cockroft gault

NEWCASTLE DATA: Creatinine Clearance (Cockroft & Gault)


Biopsy results a typical case 1 week

Biopsy results: a ‘typical’ case, 1 week


Same case 3 months

Same case, 3 months

Hypertrophyof tubules

Little

fibrosis


Biopsy results a good case

Biopsy results: a ‘good’ case

1 week

1 month


Biopsy results a bad case pre perfusion

Biopsy results: a ‘bad’ case. Pre-perfusion:


1 week

1 week:


3 weeks

3 weeks:


2 months

2 months:


Sirius red analysis fibrotic kidney

Sirius Red analysis - fibrotic kidney


Renal transplantation from non heart beating donors

Interstitial collagen volume fraction (Sirius Red, polarized light)Conventional and NHBD kidneys, 6 month protocol biopsies

%

P<0.05


Conclusions non heart beating donor kidneys

Conclusions: Non-heart beating donor kidneys

  • Increased PNF rate (decreases with experience)

  • High DGF rate; dialysis usually needed

  • Slightly higher serum creatinine, may compensate

  • Slightly more interstitial fibrosis at 6 months

  • Indistinguishable graft survival rate at 5 years

  • Biopsy does not help with donor selection (?)

  • Protocol biopsies detect acute rejection at unchanged rate

  • Biopsy helps to distinguish PNF and DGF, but care needed


  • Login