5th July 2024

Transplantation

Overview

Kidney transplantation is the most prevalent form of renal replacement therapy in the UK. Deceased donor kidney transplants are more common than living kidney donor transplants, with around 2000-3000 a year of the former and 500-1000 a year of the latter. The waiting list for kidney transplants in late 2022 was 3408 people.

Practical Points

Complications

• Immediate post-operative: Vascular thrombosis, bleeding, infected collections
• Early post-transplant (up to 6 months): Infections, rejection
• Late post-transplant: Infections, rejection, malignancy including post-transplant lymphoproliferative disease

Opportunistic Infections

Common infections to be aware of:

• Cytomegalovirus infection
• Pneumocystis jirovecii Pneumonia
• Reactivation of Tuberculosis, Varicella Zoster infection, Hepatitis B
• This list is limited, and doesn’t include community acquired, hospital acquired infections and tropical infections in those with relevant travel history

Immunosuppression

Induction immunosuppression, given at time of the kidney transplantation in the UK, is likely to be one of the following: Basiliximab, Anti -thymocyte Globulin(ATG) or Alemtuzumab.

Commonly used maintenance immunosuppression includes a Calcineurin inhibitor alone or in combination in mycophenolate mofetil and prednisolone.

References

• UK Renal Registry. 24ᵗʰ UK Renal Registry Annual report, 2021 https://ukkidney.org/sites/renal.org/files/publication/file-attachments/24th_UKRR_ANNUAL_REPORT_BOOK%20version%203.pdf
• NHS Blood and Transplant. 24ᵗʰ Annual Report, 2021. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/24212/annual-stats.pdf