24th June 2023

At time of transplantation

Surgical

• The donor kidney is transplanted into the iliac fossa of the recipient, vasculature is anastomosed to the external iliac vessels and the ureter is implanted into the bladder (usually with a stent that is removed after 4-6 weeks). The kidney is sited outside of the peritoneum. The native kidneys are usually left in situ.

Medical

• Immunosuppression:
  • Induction (i.e. at the time of surgery) – practice varies between transplant units, commonly involving an interleukin-2 receptor antagonist, e.g. basiliximab, or T-cell depleting antibodies, e.g. alemtuzumab or ATG (anti-human thymocyte immunoglobulin)
  • Maintenance – generally a combination of a calcineurin inhibitor, e.g. tacrolimus, an antiproliferative agent, e.g. mycophenolate mofetil or azathioprine and occasionally steroids.
• Prophylaxis:
  • PCP (Pneumocystis jirovecii) prophylaxis – e.g. co-trimoxazole
  • CMV prophylaxis – e.g. valganciclovir, decisions depend on the donor and recipient’s viral status